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NATIONAL LIBRARY OF  MEDICINE
Washington
Founded 1836
U. S. Department of Health, Education, and Welfare
             Public Health SerTke 
 
 
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           Communication*




  /             OF THE





MEDICAL  SOCIETY




                 OF




       CONNECTICUT, ^TntP







      ^-^j     //UMBER I.
Sidney'* Press, New-Haven, 1810. 
     AT a Convention of the Medical Society of the  State of Con-
necticut, October 1809, a Committee was appointed, to select pieces
for publication, from such communications, as then were in possessi-
on of the Secretary, or should be made to them, and to publish them
before the meeting of the next Convention—In  pursuance of their
appointment,  a selection has been made, of such pieces, as in the o-
pinion of the Committee, were best calculated to answer the design
of the Convention.
   The Committee regret, that from some  of  the  Counties they
have received no Communications, nor from several individuals, i'rqjj^,
whom they flattered themselves, that valuable medical  info; irrTftfon*
would have been received.
                         JOHN BARKER,
                         JOSEPH FOOT,
                         ELI IVES,
                         THOs. GOODSELL,
   New-Haven, September 1810.
Committee. 
NUMBER I.
             Communications
OF THE MEDICAL SOCIETY OF CONNECTICUT.
     AN enquiry into the propriety of ufing highly Jlimu-
 lating remedies in the PETECHIAL, or SPOTTED FE-
 VER, TYPHUS  and other  cafes of debility.  Alfo  a
fketch of the SYMPTOMS of the  Spotted Fever, and a
 method of cure propofed.                    j



                East-Hartford, April 10, 1810.

   IN this enquiry I fhall endeavor  to point out the
 primary  effects of the caufe of difeafe, whatever the
 caufe may be, on the  human fyftem,  in violent  cafes
 offpotted and other fevers.
   And in this place I fhall  premife, that I underftand
 by what Dr. Cullen calls the fedative effect of difeafe,
 or of the caufe of difeafe, to be the fame on the fyflem,,
 as Dr. Brown's over excitement, Dr. Rufh's  defecl of
 aclion, from excefs  of force,  and Dr. Wilfon's atony
 from the fame caufe.   Thefe pofitions I fhall endeavor
 to illuftrate by quotations from the above named Au-
 thors ; and fhall afterwards attempt to apply the  prin-
 ciples held by Drs. Rufh and Wilfon, to the cure  of
 cafes of debility.                         :
   Dr. Cullen in fpeaking of the proximate  caufe of
 fever, fays " To difcover the caufe of the cold ftage of
 fevers, we may obferve, that it is always preceded by
 ftrong marks of a  general  debility prevailing in the 
  _; -iii."  In fpeaking of the remote caufe of fever Dr.
 Cullen fays," I fhall hereafter endeavor to fhew, that
 the moft noted of the remote caufes of fever, as conta-
 gion, miasmata, cold and fear, are of zfedative nature,
 and therefore render  it probable that a debility is in-
 duced."
  Dr. Brown on the other hand, does not allow that
 any agent produces a fedative effect on the human fyf-
 tem,  for he feerns to confider every agent capable of
producing any change on the living body as an exci-
ting power. Thefe powers he terms flimuli, and their
effects on the living folid, or excitability, he terms ex-
citement.  The application of every agent,  therefore,
to the living body, produces excitement, and in pro-
 portion as it has this effect, it exhaufls excitability.
  Dr. Brown fays, " This mutual  relation obtains be-
tween the excitability and excitement,  that the more
weakly the powers have acted, or the lefs the ftimulus
 has been applied,  the more abundant the excitability
becomes.   The more powerful the ftimulus,  the exci-
tability becomes the more exhaufted.''  In the latter of
thefe  the body  is  faid to be in a ftate of indirect, and
in the former of direct debility.  Dr. Wilfon obferves
here," Dr. Brown regarded thefe principles as fully
demonftrated,  and  with a want of caution altogether
inexcufable, founded on them his modes  of practice."
Which every one knows is to give ftimulants in almoft
 all difeafes, whether brought on by too much excite-
 ment, in which the excitability, as he fuppofes, is ex-
 haufted; or by too little excitement, where the excita-
 b;dty is accumulated.
   I fhall now attempt to give Dr. Rufh's opinion of
 tnis primary effect of difeafe,  or its caufe, when fud-
 denly induced, on the fyftem.   Dr. Rufh fays in his
 outlines of a Theory of Fever, "There is but one ex-
 dting caufe of fever, and that is ftimulus.  Heat, alter-
 nating with cold,  marfh and human miafmata, conta-
 gions and poifons of all kinds, intemperance,  paflions 
5
of the mind,  &c.  all aft by a ftimulating power only,
in producing fever."
  The following is Dr. Rufh's ftatement of the differ-
ence between  his opinion and Dr. Brown's on this fub-
ject.  " The Dr. he fays, fuppofes a fever to confift in
debility, I do not admit debility to be  a difeafe, but
place it wholly in morbid excitement, invited and fix-
ed by previous debility.  He makes a fever  to confift
in a change only of natural action of the blood veffels.
I maintain that it confifts  in a preternatural  and con-
vulfive aaion of the blood veffels.  Laftly, Dr. B. fup-
pofes excitement and excitability to be equally diffufed
over the whole body, but in unhealthy proportions to
each  other.   My  theory  places fever in excitement
and excitability  unequally diffufed, manifefting them-
felves, at the fame time, in  morbid actions, depreffion,
and debility from abftraftion, in different parts of the
body. No new excitement from without is infufed
into the fyftem by the irritants which excite a fever.
They only deftroy  its equal and  natural diftribution ;
for while the  arteries are  in a  plus, the mufcles, fto-
mach, and bowels, are  in a minus ft ate of excitement,
and the bufinefs of medicine is to equalize  it in the
cure  of fever.  Dr. Rufh remarks, that morbid action
in the blood veffels, whether  it confifts in preternatu-
ral force and frequency, or preternatural force without
frequency,  or frequency without force,  conftitutes fe-
ver.  Excefs in  the force and frequency in the pulfa-
tions of the arteries have been confidered as the cha-
racteriftic marks of what is called inflammatory fever.
There are, however, fymptoms which indicate a much
greater excefs of irritating impreffions upon the  blood
veffels.   Thefe are preternatural flownefs,  intermiffi-
ons, and depreffion in the pulfe,  fuch  as occur in cer-
tain malignant fevers.   This grade of fever tranfcends
in force that which produces inflammation, and proves
fatal in a few hours after it  attacks.   Such is the
force  of morbid excitement,  that it fometimes paffes 
6
fuddenly over all its intermediate ejfecls, and difcovers it-
felf only in death.  The following is Dr. R's account of
the malignant ftate of fever.  It conftitutes the high-
eft grade of morbid diathelis.   It is known by attack-
ing frequently without a chilly fit, by coma, a depreff-
ed, flow, or intermitting pulfe, and fometimes by the
abfence of pain,  and with  a  natural temperature or
coldnefs of the fkin.   It occurs in the plague, in the
yellow fever, in the gout,  in  the  fmall-pox and mea-
fles, in the hydrophobia,  and  after taking opium  and
other Jlimnlating  mbftances."  [And why, I would afk,
may it not occur in the fpotted fever, as many of the
above  and following  fymptoms  mentioned  by  Dr.
Rufh, fecm ftrongly to refemble thofe which appear in
the worft forms of tha£ difeafe.]]   " They are the ef-
fect," continues Dr. R. " of fuch a degree of impreffion
as to proftrate the arterial fyftem and produce a defecl
of aclion from an excefs of force.  Such is the excefs of
force in fome inftances, in  this ftate  of fever,  that it
induces general  convulfions,  tetanus, and palfy,  and
fometimes extinguishes life in a few hours by means
of apoplexy or fyncope. The lefs  violent  degrees of
ftimulus in  this ftate  of fever produce palfy in the
blood veffels.   It probably begins in the veins and ex-
tends gradually to the arteries.  It feems further to
begin in the extremities of the arteries, and to extend
by degrees to their origin  in  the  heart.   This is evi-
dent in the total  abfence  of pulfe which  fometimes
takes place twenty-four and even forty-eight hours be-
fore death.  But there are cafes in which' the palfy ef-
fects both the veins  and  arteries at the  fame  time.
The depreffed and intermitting pulfe which occurs in
the beginning of thefe fevers  perhaps depends upon a
tendency to palfy in  the arteries,  independently of an
affection of the heart or brain.  This proftrate ftate of
fever more frequently, if  not foon  removed,  termi-
nates in petechia, buboes, carbuncles, abfceffes and morti-
fication, according as ferum, lyir;ph, or red blood is ef- 
7
fufed in the vicera, or  external parts  of the body,
Thefe morbid appearances have  been afcribed to pu-
trifaction, and the fever has received, from its fuppofed
prefence, the name of putrid.   The exiftence of putre-
faction in the blood in a fever is rendered improbable
by fimilar appearances with thofe which have been  af-
cribed to putrefaction, having been produced by light-
ning, by violent commotions of the mind, by extreme
pain, and by  every  thing elfe which produces fudden
and universal diforganization in the fluids and  folids of
the body."  Dr. R. goes on to prove, that the above
named fymptoms are caufed by the effecls of difeafe  on
the blood veffels, and not by any thing  putrid in the
blood, by feveral particulars which he mentions, fuch
as an acute pain in the  eye,  the  effects of a  certain
fifh taken into the ftomach, which produced a diitrefl-
ing vomiting, a coldnefs of the extremities, and an ab-
fence of pulfe.  He alfo mentions the effects of opium
in large dofes producing the fame train  of fymptoms.
Error, continues Dr. R. is often perpetuated by words.
A belief in the putrefaction of the blood has done great
mischief in medicine.  For which  reafon I fhall reject
it hereafter, and fubftitute in its room,  The gangre-
nous ftate of fever ; for what appears to fome Phyfi-
cians to be figns of putrefaction,  are nothing but the
iffue of a violent inflammation left  in the hands of na-
ture, or accelerated by ftimulating remedies."
  I fhall next take a view of Dr. Wilfon's  opinion of
the effects of difeafe on the fyftem.  He feems to adopt
the opinion of Drs.  Brown and Rufh, as to the appli-
cation of agents to the fyftem having a ftimulating  ef-
fect, at leaft, when moderately applied ;  but when ap-
plied in excefs, inftead of producing excitement, atony
is the confequence.  He fays," If the change, produced
by the agent, be moderate,  it proves a ftimulus ; and
within a certain range,  the  greater the change the
greater is the excitement.  Beyond  this as we have
feen in  the inftances of opium and diftilled fpirits, it 
8
 occafions debility, and when exceffive, death.   When
 the change  produced is confiftent with  the health of
 the parts on which the  agent acts, excitement is  the
 confequence ;  but when the change is fufficient to de-
 range tlje mechanifm of the living folid,  if I may ufe
 the expreffion, its  immediate effects are debility  or
 death.  Dr. W. in fumming up the facts  which he
 thinks Dr. B. overlooked in forming the great outlines
 of his hypothefis, fays, every agent is capable of produ-
 cing either excitement or atony, according to the de-
 gree in which it is applied.  In general difeafes, i. e. in
 fever, which is the only general difeafe properly fo cal-
 led, the ftate of excitability is fo changed, that the fame
 agents do not produce a greater or lefs degree of the
 fame effects they produce in health,  as Dr. B. fuppo-
 fes ; but either atony, or  that  kind  of excitement
 which is followed by atony."
                     Cause.
  As to the caufe which produces fpotted fever, I know
 of nothing we  can add  to the common caufes produ-
cing fevers prevalent in this country,  unlefs it may be
 the unufual ftate of the weather for feveral years paft,
 which we know has been uncommonly wet  and cold,
 and in that way may not only have injured the human
 fyftem, and difpofed it more to the particular difeafe
 under consideration by its immediate effects on the fyf-
 tem, but it may alfo have injured grain, fruits and o-
 ther vegetables fo much as to caufe them to have a nox-
 ious effect on the body.
  We read of difeafes which appear in Europe at cer-
 tain times  being afcribed to  the badnefs of grain,
 fruits, &c. and we know that wet and cold feafons do
 not produce grain, &c. in as great perfection as warm-
 er and drier feafons.  The caufe, perhaps, lies hid, but
 the effects fufficiently appear ; which mould ftimulate
 us to ufe all our exertions to difcover the beft method
 of cure. 
9
                    Symptoms;
  I have faid above that many of the fymptoms point-
ed out by Dr. Rufh under his malignant ftate of fever,
occur in the worft forms of fpotted  fever;  I have
been informed of many  cafes of this difeafe, in which
the patient was  fuddenly attacked, without a chilly
fit, with coma, a depreffed, flow, or intermitting pulfe*
and fome with abfence of, or infenfibility to pain, with
univerfal coldnefs of the fkin, entire lofs  of the fenfes,
numbnefs, partial or total blindnefs ; in fhort, a univer-
fal  torrJor feemed to pervade the fyftem.  Some of
thefe laft fymptoms I have feen, as will be mentioned
below.
   The fymptoms peculiar to this difeafe are very vari-
ous ; and from the beft  information I have been able
to obtain, they vary  confiderably in the  different pla-
ces in which the  difeafe has made> its appearance.   I
fhall ftate a few of the fymptoms, as they are mention-
ed by Dr. Woodward ; thofe which I have feen myfelf
will be defcribed in a ftatement of cafes.  Dr. W. fays,
" It attacks  with laffitude, chills,  great proftration of
ftrength, eyes red and watery,  often  delirium, with
exquifite pain in the  head, great anxiety at ftomach,
with tolling of the body, naufea ;  often a troublefome
Vomiting.   A pain and  lamenefs in fome  of the limbs
Often ufhered in the diforder. In fome, after the chills,
there was great  heat, of the flinging, thrilling kind.
The pulfe,  like other fymptoms,  was  various, fome-
times confiderably full, but generally very weak, quick
and irregular.  The  difeafe, fometimes in this feafon,
affumed the inflammatory type, but generally the ty-
phus.  The violent  fymptoms  were, great laffitude
with univerfal pains in the mufcles, heats, if any, were
of fhort duration, univerfal proftration of ftrength, de-
lirium with fevere pain in the head, vomiting, with in-
difcribable anxiety at the ftomach,  eyes red, watery
and rolled up, and the head drawn back with fpafm,
pulfe weak, quick and irregular, petechias and vibefces
                          B 
10
all over the body,  and a cadaverous countenance and
fmell.  When the vital flame began to be kindled in
the fyftem, fome grievous external affection moft cer-
tainly appeared ; fuch as inflammation of the joints,
like the acute rheumatifm, or an erysipelatous  affec-
tion of the fkin, or racking pains, convulfions, he."
  While writing the above, Dr. North's defcription of
this difeafe, publifhed ir Med. Mufeum, vol. 6, p. 280,
fell into my hands.
  Dr. N. fays the fymptoms are,  " pain in the head,
more commonly the back fide ;  flight chills ; furred
tongue, great proftration of ftrength early in the dif-
eafe ; lofs of appetite,  although  lefs  he thinks than in
other fevers,  efpecially in  the lighter cafes, vomiting
and purging fometimes ; diftrefs about the precordia ;
pains of  the  limbs,  frequently; fometimes a flight
cough; pulfe  generally weak  and quick,  fometimes
full, but never hard, as he judged.  Some had, appa-
rently, little  or  no febrile heat.   Others had great
heat, and apparently a high fever.
  Dr. N. fays, upon enquiry, almoft all would tell you
that they had, in the commencement of the complaint,
a flight fore throut, although few  would mention it of
their own accord.
  In the bad cafes, the moft diftreffing fymptoms wcr -
pain of the head, and univerfal pain  and agony, which
would  caufe  children to  draw back their heads, and
tofs and throw about  their limbs ; thefe had a con-
ftant fighing  and quicknefs of breathing.   Some had
delirium.   It was fometimes low ;  in others it was a
violent mania.  Some were comatofe.
  With regard to the fpots or pelechiae, from which
the difeafe appears  to .take its  name, they are bv no
means  a conftant or frequent fymptom.  When they
do appear, they are of various forts.  Some have fpots
in the  true fkin refembling flea  bites.  One  patient
was covered all over with fuch fpots, for a number of
days.   But more commonly you will find only a few 
11
fcattered on different parts of the body.  They are of
different grades of colour, from a red to a dark colour.
Some refemble a bruife ;  others appear as  though the
patient  had been ftruck with a whip.   Some  have
been attended with hemorrages from the nofe ; others
with fymptoms refembling hyfteria.
  Although the typhus fever has been evidently very
contagious, yet the fpotted fever has appeared not to
be communicated by contagion.   Death happens ma-
ny times, in the fpotted  fever, fuddenly and unex-
pectedly, and when there is apparently little danger,
at lead  to common  obfervers.   Children and young
perfons are  the moft liable to this difeafe, although I
have heard of one woman who was fixty years old who
died with it.  Thofe of a faneuine' conftitution  and
feeble habit, are more liable to  it than others.
  Dr. N. fays he has been of opinion,  that fuch caufes
as had a tendency to produce a debilitated and fcorbu-
tic habit of body muft be confidered as the predifpo-
fing.   Of thefe may be reckoned a moift atmofphere,
and lefs nutritious food than ufual  Two feafons pre-
ceding this epidemic, have been uncommonly wet ; fo
much fo that we have had very little corn, lefs garden
vegetables, and bad grain.  The moft frequent imme-
diate exciting caufe  has been obftructed  perfpiration
by cold."
  Many of the above named fymptoms have not been
noticed, fince the firft year or two  of the prevalence
of the difeafe.
                Method of Cure.
  A confiderable  difference exifts, or has exifted, in
the opinion of  practitioners  reflecting  the proper
mode  of  treatment  in  this complaint.  Many who
ftand high  in the profeffion fuppofe fome kind of eva-
cuation from the ftomach, or bowels, or both,  to be
neceilary  in the  commencement of the difeafe, (at
leaft in a great proportion of the cafes) and to be con-
tinued as occafion requires through the whole courfe 
                       12

of it.   And from analogy,  we  fhould  fuppofe  they
judge right; for even in the plague, when the infected
have dropped down fuddenly, as if fhot by a mufket
ball, they have been perfectly reftored by one emetic,
in fome inftances ; in other cafes, three or  four  erne.
tics have been given in twelve hours, with the bell ef-
fects, according to writers on that difeafe.   Indeed I
do not recollect reading of any febrile difeafe, fpotted
fever excepted, in which evacuations were not,  gene-
rally, recommended in the commencement.
  On the other hand, there are Phyficians who will
not allow  of any evacuations, neither  in  the  com-
mencement or courfe, not even  the moft gentle  ene-
ma, for days, and in fome inftances,  for weeks, and
then have imagined  the patient funk in confequence
of a gentle enema, adminiftered after fo long a time.
  Thofe who are oppofed to evacuations, as far as my
information  extends, infill, that we muft  begin the
cure with highly ftimulating remedies,  and continue
them through the whole courfe of the difeafe.
  It appears to me that we  ought to be very cautious
in adopting a method of practice, fo  contrary  to all
former experience with which we  are acquainted.
That  the Brunonian practice, efpecially in typhus fe-
ver, is faft falling into difrepute, we are abundantly
taught by many of the late writers in Europe ; witnefs
a Wilfon,  a Hamilton,  and the Edinburg  Med. and
Surgical Journal; and  on  the fame fide we are not
wanting for writers in our own country,
  To illuftrate what  I  have hinted above  reflecting
the treatment of typhus fever and Brown's practice, I
fhall quote fomething from Dr, Wilfon s Effay on fe-
ver, and fomething from the Journal, above mention-
ed, before I quit the fubject.
  I do not, however, mean to infinuate that there are
no cafes in  which evacuations, elpecially in the. com-
mencement of fpotted fever,  are  unfafe;  but  furely
they are not unfafe in  all cafes ! neither do I pretend 
13
 there are no cafes in which ftimulants are not benefi-
 cial and even neceffary.  But what I contend for is,
 that they are not univerfally neceffary or beneficial ;
 and that evacuations ought generally, to be made,  ei-
 ther immediately, or as foon as may be done with fafe-
 ty.  What I wifh to bear teftimony againft, is preferr-
 ing for  the name of a difeafe.   When ftimulants are
 neceffary in the cold ftage,  let them be ufed,  and let
 them be gradually withdrawn, as excitement takes
 place, and not continue the  ufe  of ftimulants  merely
 becaufe the difeafe has the name of fpotted fever.
   It feems to be  too much  the practice  with fome of
 the Medical profeffion to prefcribe the fame kind of re-
 medies through every ftage of a difeafe.  If they would
 attend  more  to the  fluctuating ftate of the  fyftem,
 and prefcribe accordingly, many might be faved from
 an untimely death.
   I would now take notice  of the practice  which Dr.
 Rufh has adopted, when fuchfymptoms as he menti-
 ons under the malignant ftate of fever take place.  For
 a number of years, viz. from 1793 to 1797, while the
 highly  inflammatory diathefis prevailed, he found it
 neceffary to bleed and purge, in order to relieve the
 fyftem.   So in fome places a fmall bleeding, provided
 it was done at the commencement of the difeafe,  was
 fafe and beneficial in fpotted fever, and in fome inftan-
 ces it was neceffary to repeat the  bleeding.   Emetics
 and Cathartics were alfo neceffary, followed by gentle
 ftimulants.   In  1798,  Dr. R. fays  there were cafes in
 which the lancet was forbidden altogether.  In thefe
 the fymptoms appeared to be proftrated by  the force  msT  -i
 of the miafmata below the point of reaction.  This
. ftate of the difeafe manifefted itfelf in  a weak, quick,
 and frequent pulfe, languid  eye, fighing, great inquie-
 tude, or great infenfibility.*  In this ftate of the difeafe
 he gave emetics  with  the beft  effects.  And it is as
 certain, that many have been benefitted, in fpotted fe-

   * The very symptopis which occurs in some cases of spotted fever. 
14
ver, by an emetic.   Some have been nearly cured by
it, when given in the forming ftate of the difeafe.   In
the year 1799, Dr. R. fays," In thofe cafes where the
fyftem was proftrated below the point of reaction, he
began the cure by fweating.   Blankets, with hot bricks
wetted with vinegar, and the hot bath, when practica-
ble, were ufed for this purpofe."  We  alfo  find  the
fweating practice has gained much credit  in  the fpot-
ted fever,  izifomuch as to be the firft thing reforted to
by many.
  I fhall next  quote fome of Dr. Wilfon's fentiments
refpecting the ufe  of ftimulants in typhus, which will
apply in fome meafure atleaft, to fpotted fever, and all
other difeafes of debility, as far as his principles are
correct.  He fays," The feeble ftate of the circulation,
and the temporary good effects  of powerful flimuli,
has led moft Phyficians, and particularly thofe of later
times,  to employ them  with great freedom.   Many,
however, confefs that they have been difappointed in
their effects  ; of this number, he feels no hefitation in
declaring himfelf to be one.  He has found the fecond
ftage of fever moft tractable when  all powerful flimu-
li were avoided.   It is true, indeed, that large  quan-
tities of opium, or wine, will often give a degree of
vigor,  increafing the ftrength and  leffening  the  fre-
quency of the  pulfe.  But thefe effects  are tranfitory.
It is foon neceffary to repeat the remedy, and at length
to increafe its power, in order to produce the fame ef-
fects ; and this tranfitory vigor feems frequently  ob-
tained  at the  expence of exhaufting the  ftrength,
which, had  it  been more carefully  hufbanded,  might
have carried the patient through his difeafe.
  Dr.  W. fays, were he to ftate the refult  of his own
experience,  in the fecond ftage of fever, it would be,
that opium is only ufeful when fmall dofes allay irri-
tation, and procure compofure,  if not fleep ;  and that
wine is rarely beneficial if given in  larger quantities
than might be taken in health without fubfequent de- 
15
bility, and can feldom, perhaps,  be given without in-
jury to this extent.  Whether there are ftates of fe-
ver in which large  dofes of the flimuli may be of ad-
vantage, is difficult to fay.  In extreme debility, when
the patient is almoft in articulo mortis,  a ftrong ftimu-
lus may  fometimes, perhaps,  by roufing the languid
fyftem, be the means of preferving life.  He has fre-
quently  feen  the  experiment  made  with temporary,
never with permanent good effects.
   In Note 63, to  his effay on fever, Dr. W. fays,—
When we fee a patient labouring under fymptoms of
extreme debility, and thefe fymptoms  almoft uniform-
ly relieved by a  confiderable quantity of wine, it is
difficult, at tfirft view,  to perfuade ourfelves that the
wine is pernicious ; but an attentive obferver will look
beyond its immediate effects, and will then readily fee
fufficient reafon to  doubt the fafety  of this practice.
   He will find, that the temporary excitement he thus
procured, is fucceeded by a greater degree of debility
than that which the ftimulus  had removed, arid if he
perfeveres in this plan,  that  in a large  proportion of
cafes the pulfe, upon the whole, will gradually become
more frequent and feeble, till it ceafes altogether.
   Dr. W. fays, he has feen thefe effects fo often, that
he cannot help thinking that almoft any fever may be
rendered fatal by a certain quantity  of wine.   And
when we recollect that the exceffive ftimulus of wine
is a frequent caufe of fever, can we be furprifed that
the conftant repetion of this  ftimulus fhould increafe
its fymptoms. Befides the apparent good  effects of
wine for a fhort  time after its exhibition, Phyficians
have been led to an exceffive ufe of it in typhus by a-
nother obfervation, the comparatively fmall effects it
produces.  That a pint of wine in  typhus  will not
produce a greater effect than a glafs in health, is addu-
ced as an argument for a pint in the one cafe being as
innocent as the glafs in the other. But it is to  be recol-
lected that wine in typus, only produces lefs excitement 
16
than in health, in proportion as the remaining excita-
bility is lefs, and confequently, that a degree of excite-
ment which would occafion little or no inconvenience1
in health,  may produce a fatal exhauftion in typhus*
Here  there is no excitability  to fpare,  and the  firft
principle of treatment feems to be, as much as poffible,
to prevent its further exhauftion,   A very moderate
and uniform exhibition of flimuli feems often neceffa-
ry, that the action of the central parts of the fanguife-
rous fyftem may not fall too low to fuppOrt that of the
circumference •, but all excitement beyond  this feems to
have no other effect, except that of exhaufling the little
vigor  which yet remains."
  In further  confirmation of my opinioi^, reflecting
the ill effects  of too free  a ufe of  highly ftimulating
remedies in typhus and fpotted fever, and my belief
in the juftnefs of Dr. Wilfon's remarks above quoted,
I beg leave to add fome obfervations on the Brunoni-
an Doctrine, from the Edinburgh Journal above men-
ed.   In vol. V. page 85,  &c.  we find the  following
fentiments.—" Phyficians feem now to  be gradually
recovering  from thofe  delufions with which a  falfe
theory, more than miftaken or unguarded obfervation
had befet them.
  " The practice founded on the Brunonian doctrine
of debility, excitement, and  ftimulus, has flain, we
believe, in  fincerity of  heart, its thoufands, and ten
thoufands.  This  doctrine not only fet ail former ob-
fervation and  experience at  defiance, but fo ftrong a
hold had it taken on the imagination  of its votaries^
that medicine appeared to them unfufceptible of  fur-
ther improvement.  The moft obvious and moil fatal
 error of the doctrine now alluded to, was*, that every
evacuation was neceffarily and directly  debilitating^
and that  firength and excitement could only be ef^
feded by flimuli.   In fevers, therefore,  all 'evacua-
tions  were  dreaded, while wine, brandy, and opium *
were  confidered as fovereign remedies, and too often 
17
 employed wiih little difcrimination,  and flill  lefs re-
 gard to the ftate of local fymptoms and organic affec-
 tions."
   The quotations that have been made above, efpeci-
 ally from the writings of  Dr. Rufh,  feem clearly  to
 fhew, that  the  caufe which acts  thus fuddenly and
 powerfully  on  the fyftem, produces  the very fame
 fymptoms,  or appearances, whether  plague,  yellow
 fevers goutj fmdl-pox, meafles, or fpotted fever is to
 follow.  And it alfo appears clearly, frcmi the princi-
 ples  of phyfic,  that whatever remedy will remove
 thofe fymptoms which appear in either of the  above
 named difeafes,  will, cet. par. have the fame effect  in
 any one, or in  all of them.   To be more particular, if
 we fee a patient affected with coma, a depreffed, flow,
 or intermitting pulfe, abfence of,  or infenfibility  to
 pain, with  a natural temperature  or  coldnefs of the
 fkin, great proftration of ftrength,  &c. our indications
 of cure ought to be taken from the prefent fymptoms,
 without regard to what particular difeafe  is  about  to
 follow. I hold this as a fundamental maxim in phyfic.
   It would  be  difficult, perhaps impoffible, to point
 out a plan of treatment that would embrace all cafes of
 fpotted fever.  I beg leave, however,  to mention the
 plan which appears to me the moft proper in many cafes,
 at leaft, of this difeafe.
   If the patient is found in a cold, torpid, infenfible
 ftate, with great proftration of ftrength, fmall, weak
 and quick pulfe, coldnefs of the extremities, and  of
 the  furface,  generally, undoubtedly  no  evacuation
 fhould be immediately made from the blood veffels,
 ftomach, or bowels j  but he fhould be put  into the
 warm bath,  and the heat of  the bath fhould be increaf:
 ed after being in for  a few minutes ; or external heat
 fhould be applied to the body in  fome  other way ; by
 fleam, as recommended by Dr. Woodward,  or by
wrapping the patient in hot blankets, and  applying
hot bricks, or blocks of wood,  or brands from the
                        C 
18
fire quenched in water and wrapped in flannel, to the
body and limbs.   Sinapifms and bottles of hot water
fhould be applied to the feet,  giving  internally at the
fame time,  warm or hot aromatic teas,  fuch as fhake-
root, pennyroyal,  &c.   Tincture  of opium,  if the
pain is great, effence of peppermint, heated wine, if
neceffary, fhould be given till  warmth is reftored, and
fweating, if it can be induced, takes place.   As foon
as there appears to be fufficient warmth, let the ftimu-
lating remedies be leffened,  and gradually withdrawn,
as the particular cafe feems to indicate.   When there
appears to  be fufficient ftrength, let  a  gentle emetic,
injection, or cathartic,  according to circumftances, be
adminiftered. Perhaps fome wine and laudanum may,
occafionally, be neceffary after the natural warmth is
reftored.  Laudanum should always be given after eva-
cuations.
  It feems  to me, however, that it cannot be proper
to make ufe of ftimulants of  the ftronger kind, fuch
as wine, ardent fpirits, and laudanum,  in great quan-
tities, when there is increafed action of  the heart and
arteries, and at the fame time too much heat on the
fkin.   From what I have  obferved in  this difeafe, it
is very neceffary to keep the  feet warm.  I have feen
feveral become faint and very much diftieiied, if  the
feet became too cool, and the moft ready way to re-
move fuch  fymptoms, was to reftore warmth to them.
  Local applications to remove fevere pain often have
a very fudden and agreeable effect.   Where the pain
is urgent, finapifms, from their quick  action, fliould
be prefered to  bliftering-plafters:  blifters,  however,
are of great benefit, and ought to be  ufed very freely.
In feveral cafes, diftreffing vomiting, and great anxiety
at the pit of the ftomach are  apt to occur, and require
immediate and affiduous attention.  In fome of thefe
cafes, efpecially where conftant naufea takesplace,I luive
feen good effects  from  a julep compofed of a common
tea-fpoon full of carbonate of potafh, with as much, or 
19
more of the effence of peppermint,  in a  tumbler of
water, fweetened with loaf fugar fo as to make it pal-
ateable, taken frequently, from half  a table fpoonful
to two or three fpoonfuls.  If the vomiting and dif-
trefs at the ftomach continue,  and the cafe is urgent,
apply a large finapifm to the region  of the ftomach.
I law one inftance where  life was  apparently faved by
fuch an application.  Dr. Rufh mentions great benefit
refulting from  fpirits of  turpentine given  ^n a  dofe of
ten  drops every two hours,  in a little molaffes,  or
fyrup, in  the diftrefling vomiting occurring  in  the
fecond ftage of yellow fever, in the year 1805.  He
fays it was  adminiftered with fuccefs  in one cafe after
an abfence  of pulfe, and coldnefs  of the  extremities
had  come on, and that it gave great relief when ex-
hibited in glyfters,  as well as  by  the  mouth, in dif-
trefling affections  of the ftomach and bowels.   Dr.
Fowler's folution of arfenite of potafh has been ufed
by many, as  I  have been informed, with  much ad-
vantage, in cafes of great lownefs.  Does this folution
prove beneficial folely from its ftimulating power, or
from a fpecific effect, which it exerts on" fpotted fever
and fome other complaints, in the  fame way that mer-
 cury acts on the fiphylitic virus ?
   In cafes of lefs feverity, I fhould, with Dr. North,
propofe the following as  the indications of cure.  lft.
To evacuate the firft fBfiages.   2d. To reftore  the ob-
structed perfpiration. ^d.  To invigorate  the folids.
Dr.  North propofes two more indications,  viz. to cor-
rect the fcorbutic tendency of  the  humours, and to
obviate accidental death.
   Dr. North's method of practice coincides more with
 my  own ideas of the proper mode of treating  this dif-
 eafe, than any thing I have feen written  on thefub-

   If the phyfician is called in the commencement of
 the  complaint, and there are no fymptoms of imme-
diate danger, let  an emetic of ipecac, or tartarized
i 
20
antimony, according to circumftances, be immediate-
ly adminiftered.  I am aware that it is laid by fome,
that nothing of a morbid appearance is difcharged by
fpontaneous  vomiting, or that  which is procured by
emetics, but if I am not much miftaken, it is for the
moft part owing to the emitic not being ftrong enough
to cleanfe the ftomach.   How often do we fee emetics
fail to throw up any thing billious, or otherwife foul,
and the very next day, or in a few hours, on the ex-
hibition df another emetic,  there will be a vaft quan-
tity of very foul matters difcharged from the ftomach ?
If we  give only a few grains of fulphate of zinc, or a
fmall dofe of ipecac,  we muft often expect to be difap-
pointed.
   Although the  fame objections are made to cathar-
tics, which are made to emetics, viz.  that nothing
morbid is difcharged from the bowels, yet if the emet-
ic does not operate downwards, and  the bowels appear
to require evacuating, I would give an injection, or
fome gentle  phyfic,  as fenna  and  manna,  rheubarb
or  calomel,  according to circumftances.
   I have a great opinion of calomel,  both as a purge,
and in fmall dofes.  Sinapifms,  &c. muft be applied to
remove local pains, and reftore the natural excitement.
Opium, in fome forrri^, fhould be exhibited after eva-
cuations,  and continued  as  occafion requires ;  and
either  cooling or gently ftiipllating drinks,  as cir-
cumftances point out.  I have known one patient ve-
ry fenfibfy benefited by washing the whole body and
limbs  with vinegar  and water, on account of the
great heat of the furface.  I have been informed by
Dr. Evireft, that he made ufe of the cold affufion  to
one patient with great advantage.
   The bowels muft  by all means be kept free,  with
injections, or with gentle, or more  active  phyfic, ac-
cording to the degree of excitement in the fyftem.
In fhort, it appears to  me  that the principal part of
the phyfician's bufinefs,  is to  equalize excitement, re-
t 
21
flore perfpiration, in fome inftances induce fweating,
regulate the bowels,  and adminifter  proper  nourish-
ment.
   A pill compofed of opium,  camphor, and  calomel,
given two or three times a day, efpecially where there
is much uneafinefs, and the extremities are apt to be-
come cold, is of great advantage.   There may be cafes
of this grade of  the  difeafe which will require fome
wine before convalefcence takes place, but I have rare-
ly feen  any.  From the time that reaction takes place.,
the difeafe is, generally,  eafily managed.
   It will be kept in mind that I am oppofing the highly
ftimulating plan of treating this difeafe only ; although
it is said by fome,  to be the " only fafe and efficacious
mode of cure."   I am very fenfible that I differ confi-
derably from fome of my brethren, in my fentiments
reflecting the beft method of cure in the fpotted, as
as well  as the typhus fever.  I fhall ftate the following
as fome of my reafons.
   Firft, the method of cure, which can, with propri-
ety, be faid to be the beft,  fhould be fuch as will cure
the greateft number  of patients treated according to
the propofed method ; and as fpeedily  as the nature
of the difeafe will admit.   I would afk, has this highly
ftimulating  mode of practice  been thus fuccefsful ? I
think the anfwer muft be in the negative.
   Secondly, all other methods of  treating the difeafe
fhould  appear  very evidently to be lefs efficacious.
The laft pofition, I think is not true ; for I have reafon
to believe that many very bad cafes have  been cured
by a practice different from the highly ftimulating one,
or by fuch a kind of practice as is recommended above.
   I fhall weary your patience but a few moments lon-
ger, while I give a fhort account of a few cafes of fpot-
ted fever which have come under my care.
   The firft I faw, was April 18, 1807, which was pro-
nounced to be a cafe  of fpotted fever^ by a practition-
er who  had  been very converfant with that difeafe, 
oo
and ftimulants were recommended.  1 faw the patient
in lefs than an hour after, a girl aged ten years.   She
complained of a fevere head ache, pain and diftrefs at
the pit of the ftomach, confiderable numbnefs of the
limbs, extremities rather cool, &c.  The action of the
arterial fyftem was rather too great.   I drew eight or
nine ounces of blood from  the arm,  which  relieved
the pain of the head in half an  hour, and fhe fell a-
fleep foon after.  I directed finapifm to the feet,  gave
a dofe of calomel, defired that fhe might be kept  com-
fortably warm.  The next morning  found  that fhe
had refted well, calomel had operated, and in three
days fhe left the room.
   On the 15th April, 1808, I wras called to fee  a lad
aged fixteen years, he was taken a few hours before I
faw him, fuddenly with a chilly fit, followed by vio-
lent pain in the head and ftomach, fharp flying  pains
in the limbs, feet and hands cold, furface of the  body
unequal as to  heat, fome parts of it  being too  cool,
while other parts were too  hot at the fame time.   His
pulfe indicated the lofs of fome blood, which  was tak-
en, an emetic was  adminiftered,  blifters  to the  neck
and ancles,  finapifms to the feet.  Laudanum was giv-
en after the emetic.  Some part of the time for  three
days,  the furface of  the body was very hot, fo that
he was benefitted by having his body  and limbs wash-
ed with vinegar and water.  At other times he was
too cool  and  received  benefit  from  wrarm aromatic
teas, laudanum in fmall dofes, bottles  of  hot water to
his feet, &c.  His bowels were attended to through-
out the difeafe.  He was very  fick for three days, af-
ter which he  bore gentle tonics, a little v/ine, &c. and
was well in about ten days.
   On the 24th of the laft mentioned month, I was cal-
led to fee a woman aged about twenty-two years, who
was taken fuddenly in the  meeting-houfe, in the time
of the forenoontfermon, fhe was put into a carriage
and carried home ; fhe was fo  fleepy on the way that 
23
her hufband had much difficulty in preventing hef
from falling out of the carriage.
  I faw her at half pall four in the afternoon, fhe was
comatofe, had great proftration of ftrength, and fo
torpid in mind and  body, that fhe  took no notice of
any thing, and could give no account of herfelf, only
that her head pained her, and that  fhe  had great dif-
trefs at her ftomach.  Her hands and feet  were, cold,
almoft as ice.  The  inequality of heat and cold on the
furface of the body,  much  as in the laft mentioned
cafe.   The piilfe was rather frequent, very weak, un-
equal, and hefitating.     JQ
  My firft endeavor  was equalize  excitement.  For
this purpofe, laudanum and effence of peppermit were
given in warm aromatic  teas, the  feet put in warm
water, finapifms and blifters applied, bottles of hot wa-
ter, &c.   The great proftration, weak pulfe, kc. feem-
ed to forbid evacuations altogether.  At eight o'clock
in the evening I faw her again, found the  excitement
rather more equal.  The apparent debility was ftill fo
great, that I dared not make  any evacuation. She had
moister on fome parts of the fkin.   Same plan contin-
ued.   Monday morning, the fymptoms pretty much
the fame as yesterday,  except the coldnefs, wdiich was
nearly gone, heat,  generally, rather too great,  coma
continues, pulfe rather fuller and not fo frequent.—
Left calomel to be given in dofes of a few grains, every
three or four hours till it operated ; other medicines to
be given much as yefterday.  Tuefday  morning, the
calomel operated in  the night  and afforded  evident re-
lief, pulfe freer, breathing eafier,  coma, however, con-
tinues.   About the  clofe of the third day fhe recover-
ed her fenfes, and was able to inform me that fhe was
ftruck with a fudden and violent pain, which fhot like
lightning acrofs the hams and calves of the legs,  and
immediately affected her  head and ftomach, and that
file remembered but little, if  any thing, more for the
three days.  She convalefced  very flowly ; the  latter 
24
end of the week, her ftomach appearing to be foul, fhe
took an emetic, and afterwards light  bitters ;  fome
wine was tried, but as it did  not fet well, it was dif-
continued.   About the middle of  the  next week, fhe
was feizedwith a violent pain in her send,  which re-
quired feveral bleedings,  cathartics and ' * iters to the
head and limbs.  She was  confined  for a number of
days, from the violence  of the pain  in the head, and
the blifters were repeated feveral times to the head,
fometimes to a particular part  of it, and fometimes to
the whole head.  She  finally recovered and is now in
good health.
  I would remark, that the  laft  patient feemed to
have a violent inflammation of the brain, or its menin-
ges, and appeared to be  threatened with hydrocepha-
lus internus, and that it commenced in  about ten days
from the firft attack.   Is  it not probable that fhe was
not fufficiently evacuated during the  firft ten days, and
that the great degree of proftration and debility, in her
cafe was owing, in  part,  at leaft, to a depreffed ftate of
the fyftem ;  and not  wholly to that kind of debility
which takes place more gradually, in common  typhus
complaints ? Could fo great a degree of inflammation
take place in fo fhort a time, if the debility was purely
of typhus kind ? Does not  this cafe add to the necef-
fity of the caution above  mentioned,  as  to the mode of
practice, proper to be adopted in fpotted fever ?
  On the 20th of May following, I was called in great
hafle to fee the child of the laft mentioned patient.  It
had been fick about four hours, the  pulfe  was fo rapid
as not to be counted, heat and cold partial, as in the
two laft  mentioned cafes, eyes flaring, pupils fome-
times very much dilated, fometimes much contracted,
frequent toffing of the body and  limbs, convulfive
motions of  the face,  fudden  flarting; and in fhort
the child appeared to be  dying.  Little, of  courfe could
be done.  In about two  hours after my firft feeing the
child, fpots, refembling ink  fpattered on very white 
2.5
cloth, appeared  over the face, neck and breaft; and
it died  convulfed  in two hours more,  making eight
hours from the attack.
   March 4th 1809, was called to  fee a  man who had
been highly ftimulated for two days,  with ardent fpir-
its, laudanum, &c* the laft twenty-four hours, however,
he had not taken fo much, (only a pint of brandy from
funrife to 4 o'clock p. m.) of the ftimulus, as he did the
firft day.
   He appealed to me to  have too much excitement,
generally ; pulfe pretty full and frequent, and rather
ftrong th^n weak; pain in the head, bowels and an-
cles ;  face very red, eyes red and fuffufed, fkin dry,
and rather  hot, thirft  confiderable, fome deliriumj
reiiieffnefs &c—Ordered the ardent fpirits to be  difcon-
tinued, the feet to be put into warm water, in bed, di-
rected  tinct.  of Opium and Antimor.'.al  wine, five
drops of the former,  with fifteen of the latter, to be
given in warm aromatic tea, once in three hours, for
the purpofe of inducing fweat, finapifms to the feet;
calomel to be given in dofes of a few grains often, till
' it operated, which it did in about twelve hours, and
afforded fenfible relief*
   The  next day,  his pulfe was moderate,  rednefs of
the face and  eyes gone, heat and thirft  diminished^
fkin moift &c<   He recovered rapidly.   I faw him but
four or five times.
   The fame month, I vifited a woman aged about 30*
 She went out at the door to get fome  wood, and fell
fenfelefs on the ground,  and lay  a confiderable time-
before fhe was  difcovered, fhe  did not recover her
 reafon fhort of two or three hours.  I faw her about
 four hours after the  attack.   Reaction had began to
 take place.  She had violent pain in the head, naufea
 and diftrefs at ftomach, fevere pain in one arm  and
 one fide, numbnefs  of the limbs,  extremities cold.
 She took an emetic with  advantage, afterwards lauda-
 num, next day a fmall  dofe of phyfick.  She was dif- 
26
 treffed confiderably, but moderate dofes of laudanum
 controlled the diftrefs, for the moft part.   She had fe-
 veral turns of being diftrefied at ftomach, and vomit-
 ing for two or three days.  The julep above mention-
 ed had an excellent effect in her cafe ; blifters to  the
 fide and limbs &c.   She  had feveral dofes of phyfick
 in the courfe of her difeafe.  She was well in about a
 week.
   The fame month, I faw a lad of thirteen, who was
 taken yery  fuddenly, while fitting by  the fire.   He
 had been in  ufual health till the moment he was taken
 —he  was  feized with a chilly fit, followed by violent
 pains  in the  head, ftomach and limbs.  He was imme-
 diately put to bed, and attemps  were made to get him
 warm.  I faw him in about half an hour from the at-
 tack.   Before I arrived, he  faid  he was blind, and the
 bed was whirling round; and he was holding on by
 the bed to prevent being thrown off.
   I immediately exhibited  an emetic of ipecac, and
 tartarized antimony, he took a very large dofe before
 it  operated,  but was much  relieved by it.   At.  eve-
 ning he had a dofe of calomel, which operated freely—*
 laudanum  was given after the emetic, and after the op-
 eration of the calomel, blifters &c. were ufed, as occa-
 fion feemed  to require.   He left  the room in three
 days.
  I faw in the courfe of two or three years, feveral o-
ther cafes, moft of which  were lefs violent than thofe
 I have detailed.  They were  all treated, as nearlv as
circumftances would permit, according to the general
plan above laid down.  I faw one child aged fix y^ears^
who died in fix hours and a half after I faw it, convul-
fed and fpotted.  I loft but  two patients, which were
both fpotted, and they were the only cafes which were
 fpotted, that I faw..
                           TIMOTHY HALL. 
27
                 ON ALIMENT.
The subjecl of the following remarks, is, the nature and
        uses of Aliment in the Animal Economy.
     AS a firft ftep, I afk affent to the following po-
fitions, viz. That by aflimilation of  matter, to the
firft ftamen,  depofited in the uterus of the female,
the future  adult is formed:  That all the material par-
ticles,  which have been once vitally united to the or-
ganized  mafs, constituting the  frame, fo neceffary to
fublunary  existence,  are constantly fleeting,  and—
That  new  ones,  in fucceffion, from the fame fource,
and by the operation of the fame agent,  are made to
fupply their places.
   How, therefore, is this  difficult, and apparently
almost impoffible work .accomplished ? It is anfwered,
by the powers of the fystem, operating upon aliment.
   By the powers of the fystem, is meant, the animal
fibre, in a  state of excitability, or, in  other words,
poffeffing the power of action, on the right application
of excitants, or flimuli.   Aliment may be defined to
be every fubftance, taken into the fyftem, upon which,
the excitable fibre, is capable of fo acting,  either  di-
rectly, or through fome medium, as to convert it into
principles, homogeneous with the different proximate
ones, of the body.  That the firft ftamen  poffeffes ex-
citability, is fufficiently evident, from the obfervations
of phyfiologifts  ; but on account of its minutenefs and
the feeblenefs of its powers, it is, at firft, unable to e-
laborate v/hat is neceffary for its own fupport.  It is,
therefore, placed in a fituation, whether every thing
needful is brought, ready prepared, for its ufe;  and
its whole exertion need only be to abforb nutriment,
that comes into contact with it.  This is, undoubted-
ly, what takes  place in the imperceptible embryo
ftate, for in procefs of time,  in confequence of its eh- 
28
 largement, we begin to fee its motion ;  next,  we dis-
 cover  its organization ; and finally, we perceive  its
 demands  from the mother.  After a certain  period,
 it acquires vigour enough to difcharge, by itlelf, all
 the functions of digeftion and  affimilation ; its foetal
 life ceafes, and it is brought into the world.  By con-
 tinuing the difcharge of thefe functions, for a few
 years only, its body is expanded to about the fize of the
 bodies of its fellow mortals.  It feems foon, however,
 to reach its acme ; its  capability of action begins to
 wear away, without the power  of accumulating ; it is
 gradually exhaufted,  and at laft,   becomes extinct.
 This conftitutes death.   This is  the feries of phenome-
 na, which invariably takes place, from  the uterus to
the tomb, unlefs fome  violence, or  acute difeafe, cuts
prematurely, the thread of life.
  An examination of the chemical, and other proper-
 ties, firft of the ingefta,  fecondly of the ingredients,
and compofition of the body, and thirdly of the ex-
creta, will affift, in demonstrating the dependence of
the production,  and continuance  of the phenomena
of life, upon Aliment.   The articles taken  into the
ftomach, are animal, and vegetable fubftances, fermen-
ted liquors, and water.  By the lungs, oxygen only is
received.  Thefe, I am of opinion,  are  the only ave-
nues, defigned by  nature, for  the admiffion  of any
thing nutritive  into the fyftem.  I am aware,  that to
cutaneous abforption has been  afcribed a confiderable
quantity of the water  found in the great mafs of our
fluids ;  and that the increafe of weight, which it is
well known the body fometimes receives,  without
any thing having been taken into the ftomach, has
been thought to prove  it  inconteftibly.    When it
was fuppofed  that any fubftance that fhould be occa-
fionally prefented to the mouths of the  abforbents,
might be taken into the circulation, and botched upon
the  body, without any  modification,  this doctrine
might do well enough  ;  but now, when it i$ knowrj, 
29
that thefe veffels have an elective power, and are ne-
ceffarily intended to be incapable of taking up every
thing, the notion becomes abfurd.  This fubject is in-
tended to be glanced at, in the fequel, fufficiently to
explain  the circumftances which have been fuppofed
to prove it; or at leaft to fhow, that nutrition cannot
take place  by this paffage.  It may be proper  to re-
mark here too, that the ftomach and lungs, are not
only the exclufive natural avenues  for the introduc-
tion of Aliment, but that art has not yet, and doubt-
lefs never will fucceed, in making any other.  It is be-
lieved, that it will  appear, from what follows, that
certain impreffions upon, and actions  of the ftomach,
are neceffary, occasionally, in order to keep up  affimi-
lation and excretion ;  and that, for want of this nutri-
ent enemata, and transfufion of blood, can never fup-
port life but  little longer than it could exift without
them.   That individuals have lived fome weeks, un-
der their ufe, without taking any thing by the mouth,
I fhall not pretend to deny ; and fo, we are informed,
by refpectable, and unqueftioned authority, they have
likewife done, without even thefe.
  Animal fubftances, that are employed for food, con-
fift principally of nitrogen, carbon, hydrogen, and a
fmall quantity of oxygen.  Befides thefe, a few other
principles,  fuch  as  fulphur,  phofphorus,  and certain
metals, appear in exceedingly fmall quantities.   Veg-
etables  confift principally of carbon,  and  hydrogen,
in combination with much oxygen.   Some contain a
fmall quantity of nitrogen ;  and in all, as in animal
fubftances,  there is  occafionally detected,  certain  me-
tals, fulphur, and  phofphorus. Fermented liquors,
are compofed entirely of carbon, hydrogen, and oxy-
gen.  Water confifts of the two laft named principles.
   Various  other fubftances, are occafionally thrown
into the ftomach, for  medicinal purpofes ; but wh< u
they confift of any  other than  the above mentioned
elements, or even of thofe, in fuch a ftate of combine 
30
tion as to be indecompofable by our organs, they anfwer
no other purpofe than to make a certain  impreflion
upon the parts  with which  they come into contact.
Notwithftanding the experiments of a late celebrated
writer on therapeutics,  from which it is concluded,
that opium is actually applied  to the  brain, by the a-
gency of the fanguiferous fyftem, when it produces its
fedative effect; I ftill think, that the notion,  that me-
dicines, as fuch, and in the form in which they are ex-
hibited, are ever taken into the circulation, ought to be
exploded.   As far as medicines are convertible  into
chyle, fo far are they taken into the mafs of our flu-
ids,  and no  further.   Whoever found antimony,
quickfilver, lead, or copper, in blood ; and how  is it
poffible for thefe articles to  leave the primae-vise for
any other part of the fyftem, except  by  the  medium
of the blood-veffels; and if thefe do not operate, by
taking fuch a  courfe, what evidence have we,  that
others do ? Where fhall  the  line be  drawn,  between
thofe that are applied to every part of the body, by
the fanguiferous fyftem,  and thofe that produce their
medicinal effect, by acting upon the alimentary canal ?
I  would not  be  underftood, to queftion the experi-
ments of the celebrated writer above mentioned.   In
only this inftance, perhaps, has he drawn any other
than the obvious conclufion, from the phenomena be-
fore him.
  In defcribing the different forts of  aliment, the re-
al ultimate principles of a human body have  been na-
med, as their elements.   The proximate ones, are too
numerous  to be mentioned  and defcribed, on this oc-
cafion, and too well known to need fuch  a detail.   In
the courfe of the following  obfervations, therefore,
each will be fpoken of, by its appropriate name, with-
out any efpecial explanation.
  The obvious and palpable excreta  from the human
body, are the perfpirable matter and.fweat, the hali-
tus from the lungs, the urine and fceces: To thefe, per- 
tl
haps, may be added, a few other fecretions, which are
not of fufficient  confequence  to  be here  mentioned.
The chemical-compofition of thefe feveral excreta, it
is now unneceffary to fpecify,.  as it will be comprehen-
ded in what follows;  fuffice it to fay, that they con-
tain no one principle, which cannot fairly be traced to
the Aliament.
  I might now proceed to  the actions of the  fyftem,?
in confequence of the reception of  nutricious matter,
within the fphere of its influence, but I chofe firft to
notice its manifeft, and furprifing ability, of accommo-
dating itfelf to peculiar circumftances,  in regard to
this point: I allude to the balance, between appetite,
and action, between refpiration and digeftion.  A toad
buried in  fand, it is fuppofed, by naturalifts, will live
for ages without food.  The  fads which fupport this
opinion, fay they, are too numerous and  circumftan-
tial, not to deferve fome credit.  In fome animals of
the foreft, the  vital flame,  throughout the winter, is
kept alive merely by the fat, accumulated  during the
fummer, in the cellular fubftance.
  This could not be adequate  to fuch an effect, unlefs
the annimal fhould become inactive, and in fome mea*
fiire torpid.   The fame phenomenon, is likewife very
obfervable in men, who at one time labour, and at a-
nother are unemployed.  A late phyfiological writer
relates, that perfons inactive, weak, and flow of refpi-
ration, have many times lived weeks, without receiv-
ing the leaft nutriment.
   The  balance between refpiration  and digeftion -f
clearly appears, from attention to the quantity of air
confumed, in a given time, when the ftomach is empty,
and when it is full; when it is charged with oxygena-
ted food, and when with that, which is more entirely
combuftible.   It is related  that  Mr. Spalding,  who
made fo  many  experiments with the diving-bell, con-
stantly found, that when he  had eaten  animal food,
or drank fermented  liquors,  he  confumed air much 
e>i
fafter, than when he lived upon vegetables, and dram<
water.   On the other hand,  when from the increafed
rarity,  or denfity, of the atmofphere,  the fame  num-
ber of inhalations, caufes the lungs, to receive a great-
er,, or lefs quantity of air, the appetite is increafed, di-
minished, or otherwife varied.—In the one  cafe, we
crave more food, and that, which is little oxygenated,
in the other, we need lefs, but that efpecially which is
acid.  This difference of appetite,  happens to  every
one, in winter and fummer, on  the  tops of moun-
tains, and in the vallies.   It is flated, to be remarked,
by Doctor Ingenhous, that flrangers feel a remarkable
increafe of  appetite, on  their arrival at Vienna; and
experiments there, with the eudiometer, prove, that
the atmofphere contains a greater proportion  of vital
air, than at Holland.  Every fagacious phyfician, fays
Mr. Townfend, muft have had frequent opportunities
to remark,  that  when the  ftomach  is oppreffed, ref-
piration labors ;  but that when the lungs are plentiful-
ly fupplied with vital air, the fuperabundant quantity
of food i9 no longer a burden.
   The utility, and great  importance of the above-men-
tioned balance,  it is thought, is very manifeft,  from
the facts, that on it depends, firft, the due excitability
of the fibre ; fecondly, the proper, and falubrious tem-
perature, of the whole body  ; and thirdly, the affimi-
lation of new matter from, and the excretion of the
detrita, which afe inceffantly brought  into the  great
mafs of the fluids.—The truth of the laft propofition,
it is believed, will be fufficiently evident, from what
is to fallow; but here it may with propriety be aiked,
how that of the  other two,  can be made to appear*.
fince it is confeffed, that the lungs  imbibe no element,
but what may be, and actually is received, by the fto-
mach ?  The anfwer is ready.  Subftances taken into
the ftomach, cannot be  appropriated,  to  the buildinp-
up of the body, except, by the action of the fibre ; but
by this very  action, excitability is rapidly exhaufted, 
33
U) that, of seceffity, there muft be fome other iource
of renewal.   The oxygen then, received by the lungs,
is the principle of excitability.  This is evident, from
die following facts ; firft, an  obftruftion  to, or pre-
vention  of its reception, as in non-ciofure of the fo-
ramen ovale, ^eonfinemenin mephitic-airs, or bronchi-
al inactivity, as happens  fometimes to new born in-
fants, to Haves confined  in ill" ventilated holds of  vef-
fels, etc.  or as happens, either in fymptomatic, or idi-
opathic dyfpepfia, invariably occafions diminution of
excitability, manifefled by weak and intermitting pulfe,
fpeedy fatigue from labor, frequent fyncope, somnolen-
cy,  livid-fibre, and at laft complete ataxy, and death.
  Plants, and either animate,  or  inanimate mufcular
fibre, may  be deprived of excitability, by fubftances
that poffefs  a ftrong deoxydizing power.  Animals,
that naturally poffefs little excitability,  and little pow-
er of locomotion, have lungs,  diminished  in capacity,
in the fame proportion ;  and they actually confume fo
much lefs air.  Their powers of digeftion, very often,
are not diminished, in the fame degree,  which makes
it plain,  that excitability  does not depend  on what is
elaborated by the ftomach.
- Secondly, it is obferved, on the other hand, that an
increafed fupply of oxygen, by the lungs, occafions in-
creafed excitability,  or fufceptibility of action, ftrong,
hard pulfe, cerebral energy, infomnia, and florid fibre.
  Animals, that have increafed capacity of lungs,  and
increafed bronchial  action,  and that, of courfe,  con-
fume a greater proportion of oxygen, have ftrong, and
quick powers, of loco-motion, and that, in  the fame
degree.  This is the cafe  with wreftlers, who, as Rich-
erand obferves, aftonifli  us  by the developement of
their mufcular organs, and the vaft efforts of which
they are  capable ; and of birds which are obliged to
fupport themfelves  in the air, by rapid  and  ftrong
exertions, and many of which  live by prey.   The lat-
ter, frequently, have  exceedingly weak powers of di- 
54
 geftion.   Children are more excitable, in proportion
 to their fize, than adults, and vitiate more air.  Vege-
 tables, and animate,  or inanimate mufcular fibre that
 have been deprived of excitability, may have  it again
 reftored, by  treating, with oxy-muriatic-acid.  The
 florid colour too, returns by the fame means.   To the
 ioove remarks, it may be added, that intoxication, fa-
 tigue, and immoderate panting, from violent exercife,
 are almoft inftantly relieved, by the refpiration of vi-
 tal-air ; and that great exhilaration, and  excitement,
 from the inhalation of nitrous-oxyd,  and pure  oxy-
 gen-gafes, are not fucceeded by any depreffion,  as
would  invariably happen, were  their modus-operandi
analagous to ordinary ftimulants.  This I have often
 experienced  in my own perfon, and have had oppor-
tunity  to witnefs in two or three of my friends.   In
moft inftances, the perfon  refpiring thefe  gafes is  ir-
 refiftably impelled, to the moft violent exertions, fuch
 as dancing, running  jumping, hallooing, etc. as it
were, to relieve himfelf from a fuperabundant quan-
tity of excitability; and all this, is not attended with
 fatigue.  That animal heat, depends upon oxygen, re-
 ceived by the lungs,  appears,  from its bearing precife
 proportion, in a given time, to the quantity of air vi-
 tiated  ; but more of this hereafter.   The manner in
 which  oxygen produces excitability,, feems to be bv
 its combining loofely with the fibre ; and action, I am
 of opinion, is a motion  effentially  attended   with  a
 difengagement  of this oxygen. This appears from
 the fact, that oxygen is inhaled in the form  of gas ;
 and by the bronchial action, is combined with  the
 blood, in but a flightly folidified ftate, (for little calor
 ic is given out in  that  organ) and being   carried
 round  in the circulation, is proved to become ftill far-
 ther concrete, by the additional heat, generated in ev-
 ery point of  the body.  Now  the  oxygen  that Las
 difappeared, it \, probable,  lias  united with the muf-    *
 cular fibre, as the colour of  this is changed  from a 
35
purple to a florid red, and its fufceptibility of action
from the impreffion of flimuli,  is much increafed.—
That by action this oxygen is difengaged, appears from
the circumftance of the  reduction of the fibre  to its
former purple colour, and unexcitable ftate.  But du-
ring action,  the lungs continue to imbibe  oxygen,
whilft the fibre gives it out, and yet the blood is not
preternaturally charged with it.  It does not recom-
bine with the fibre to produce excitability and animal
heat, in afmuch as the lungs  are ftill provident of a
new quantity, and as it muft be now too far folid:fied
to anfwer thefe purpofes.   We find however, that the
detrita, confifting principally of effete  hydrogen and
carbon, brought into the circulation by the abforbents,
are conftantly making their efcape  from the  fyftem
by way of the renes, fkin, and lungs, in the forms of
water, and carbonic-acid.  The oxygen then, which
is now equally ufelefs with the hydrogen and carbon,
and juft in a fufficiently  concrete  flute, to combine
readily wTith  them, is undoubtedly the vehicle of their
efcape.   This account, apparently, does away confide-
rable difficulty in the commonly received doctrine of
the ufes of refpiration.  I allude to the notion, that
oxygen is taken  into the  lungs, merely to form in
that organ,  the water and carbonic  acid of excretion,
and there likewife, to give out its caloric,  and that it
anfwers no other purpofes in the animal economy.—
On fuch a fuppofition, fuperficial heat would not be
fufficiently accounted for, as I conceive, the increafed
capacity of arterial blood  for caloric, and the diminu-
tion of the capacity of that of the veins is not adequate
to it, though it fho.uld undoubtedly be taken into the
account ; nor could we explain the  union of the vital
with the combuftible principle:-., as it is well known
that the latter have little or no affinity for the former,
when it is in its gafeous ftate, or nearly fo.
   In the foregoing  account of the courfe and offices
of that part  of the  aliment, which is received by the 
36
lungs, no notice has been taken of the  doctrine that
fecretion is the fource  of animal heat ;  or of G irta
ner's opinion,  favoured indeed by Richerand, in his
work on phyfiology, that the combination of oxygen
with the fibre, may take place  from the water in the
blood, by the action of the nervous fluid, which he
fuppofes to be identical with the galvanic.
   With regard to the  firft of thefe notions, it is in
fome  refpects what appears the truth to me; for the
oxygen  muft manifestly be depofited with the fibre, by
the fecerning arteries.  As it refpects glandular fecre-
tion, where the fubftance produced is 'not more denfe
than that from which it is feparated, I cannot well dif-
cover how it can difengage much caloric.  The  opini-
on of Girtaner,  I deem untenable, in two refpects.—
Firfl, the oxygen in water is too far folidified  to an-
fwer the purpofe of producing excitability and  heat ;
and fecondly,  I think  Wilfon has demonstrated, and
even  Richerand himfelf, made it probable  that cere-
bral influence is altogether unnecessary ; for the ac-
tion of involuntary organs ;  and that  nerves  are of
ufe only, for voluntary  motion, fenfation and fym-
pathy.   The famous  experiment  of  dividing the
nerves of the heart, and its ceffation of action there-
upon, amounts in my view,  to  nothing more than
that for the operation, fo much violence  muft be done
as to deftroy its capability of motion; or that a commu-
munication with fome other viicera,for the fake of fym-
pathetic excitation is neceffary to its due excitement.
   In  detailing the ufes of that nutriment which en-
ters by  the pulmonary avenue, actions have been fpok-
en of, the caufes of which were notr.fpecified.   In treat-
ing of  what is  received by the  ftomach, it  is hoped
fome light will be thrown on  this branch of the fub-
ject.  When therefore, from the fenfuions,   ftyled
hunger and thirft, we are  induced  to  take into the
 mouth, either  vegetable or  animal  matter, in pro-
portion to its quality and quantity,  does it  ftimulate 
37
the falivary ducts,  to pour forth  the  fluid fecreted
in their glands, and by the operation of  the teeth,
tongue, etc. it is broken  down ; and  by a mixture
with atmofpheric oxygen, and faliva, reduced to a u-
niform pulpy mafs.   This by the voluntary action of
the mufcles of deglutition, is carried down into  the
ftomach, to undergo that change which moft emi-
nently is termed digeftion ; a procefs accomplished by
actions according to a late phyfiologift, at once me-
chanical, chemical, and vital; mechanical,  in that the
food is agitated  by a gentle periftaltic motion, by
which all parts of it are prefented to the action of the
gaftric juice, and the chyme carried through the py-
lorus ; chemical, in that the food is acted upon  by a
peculiar fluid, which the ftomach is flimulated to fe-
crete ; and vital, in that a peculiar  excitement is occa-
fioned according to the quantity and quality of the
fubftance digefting.   Although the food is  commonly
faid to be digefted in the ftomach, yet it  muft  not be
forgotten,  that it really undergoes as important chang-
es in the fmall inteftines,  as in that  organ.  By the
admixture of the chyme with the bile, pancreatic, and
enteric juices, etc. it becomes  an effentially different
fubftance,  and is termed chyle.  It is probable too,
that it is fomewhat modified by the lacteals and  mc-
fenteric glands, through which  it muft pafs to  reach
the thoracic duct, the canal which runs near the aorta,
and empties its contents into the left fubclavian vein,
near its termination in the cava.  The large inteftines,
though a direct continuation of the fmall, anfwer but
little other purpcfe but that of conducting out of the
body, fuch matters as were indigeftible, and refufed 1 y
the lacteals.  The vital motion of the ftomach,  is now
to be confidered, for by  means of this, it  is believed
the wdiole actions of affimilation, fecretion,  and cxcre
tion, are carried on.  All  the organs employed in dif-
chargingthe natural functions, have nervous commu-
nication with the ftomach, by means of the  intercoftal, 
38
 and par-vagum, undoubtedly, for the purpofes of fym-
 pathy.—Each of thefe organs is probably fo conftruct-
 ed, as to be capable of fympathizing with thofe pecu-
 liar actions of the  ftomach,  that are excited by  the
 kind of aliment,  the preparation for, or difpofal of
 which, neceffarily requires the exertion of fuch organ ;
 and on the contrary, thofe whofe exertions are not re-
 quired for fuch purpofes, are fo formed, as  not to be
 athVtedby fuch excitement.   If flefh,  for inftance, be
 the food ftimulating the ftomach, (and this perhaps is
 one of our moft nutricious articles of diet, and confifts
 principally, of combuftible  matter) the action of the
 whole fanguiferous fyftem, will be increafed, that  the
 detrita may be thrown off, the fat depofited in greater
 abundance in the cellular fubftance, and in fhort,  all
 the fecretions increafed, in order to make room for the
 new matter about to come into the circulation, and to
 bring about the great purpofe of building up our bo-
 dies.  The quantity of this action muft be proportion-
 ed to the quantity of the chyle, that can be elaborated
 from the aliment received, and its rapidity to  the
 fpeed, with which this chyle  can be formed.
  Animal fubftances afford more chyle than vegetable,
 are quicker digefted, and occafion much more irrita-
 tion and heat.  Hence, while the ftomach is acting up-
 on  them, more matter  muft be affimilated from  the
 blood, more excreted, and more of the excitable prin-
 ciple imbibed.  Vegetable fubftances, on the contrary,
 afford lefs nutriment, are not fo  readily acted upon by
the digeftive organs, and occafion both lefs irritation
 and heat.   This difference may very plainly be traced
 to the difference in the  quantity of combined oxygen
 in each ;  and it at once explains the balance  between
 refpiration and  digeftion   Thefe  principles are every
 day recognized by the practice of phyficians ; for, in
 difeafes of more and ftronger action than natural,  ani-
 mal food, fermented liquors, narcotics, etc. are never
 allowed, while the neceftity of abiVmence, to a certain 
39
extent,  is invariably inculcated; and in difeafes  of
weaker and lefs action,  both the ftimulus and  nutri-
ment of combuftible diet, is univerfally acknowledged
to be of the  utmoft fervice to the patient.  Excite-
ment without nutriment, however, in what manner
foever occafioned,  caufes debility and emaciation ; as
is feen in all febrile affections.   The oxygen which is
difengaged from  the fibre  by the  action, muft take
combuftible matter to help it off, by the feveral emunc-
tories ;  and this is, accordingly, brought into the cir-
culation by the abforbents ; its  wafle not being fup-
plied by the ftomach.
   The opinion  that the vital action of the ftomach is
by fympathy propagated to  thofe organs whofe affift-
ance is neceffary  to difpofe of its contents, may be
illuftrated and confirmed by the fact, that immediately
on the reception of unufually aqueous aliment, even
before any of it can have paffed the pylorus, the  re-
nes, as fuddenly, fecrete an unuiual quantity of watery
urine.  Indeed, the peculiar excitement of the ftomach,
occafioned by certain forts of liquid aliment,  feems,
often,  to  be  fo exactly  propagated to other organs, as
to occafion an almoft   fimilar  fecretion  from  them.
This has become proverbial, with regard to mucilages,
the albumen of the egg, etc.;  and I have known one
cafe, where, in a very fhort  time, from  fwallowing  a
large draught of peppered cider, after a long expofure
to cold, that urine was very foon  evacuated,  having
fomewhat the fmell, and producing on  the urethra
fomewhat the  fenfation of  the then  contents of the
ftomach.  Such phenomena are notorious alfo  of  the
milk, and have induced many to fuppofe that there
muft be a more direct communication of the renes and
mammae with the ftomach, than through the medium
of the circulation.  There does not, however, feem to
be a neceflity for this ;  for it may be as eafily fuppofed
that the impreffion of any particular fluid will occafion
a fecretion of a fomewhat fimilar one, by the renes, as 
40
that the application of but a particle of variolous vac-
cine, pforaic, or fyphilitic-virus,  to a furface,  from
which the epidermis has been  abraded, fhould pro-
duce a fecretion of a fimilar one, all over the  body.—
In fhort,  there  is confiderable foundation for fuppof-
ing, that in every inftance, the urine bears fome refem-
blance to the liquid on the ftomach at the time of its
fecretion; though,  in ordinary cafes, from  its  fmall
quantity,  it does not ftimulate the vefica, to evacuate
it, till it has become changed  by the abforbents.
  No objection to the above notions can be made, on
the  fcore of the fize of the renal arteries ; for Haller,
from the niceft calculations, has determined, that their
diameter is one eighth of the aorta ; and Richerand
afferts, that a thoufand ounces of blood pafs through
the renal ftructure in the fpace of an hour ;  and that,
admitting this fluid  to contain only a tenth part of the
materials neceffary to form urine, an hundred  ounces
could be feparated from it in  this fhort interval; and
a larger quantity is never fecreted in an hour, however
copious and diuretic the drink may be.
  Excitement occafioned in  the  fkin,  as well as the
ftomach, is fometimes propagated to other parts,though
lefs powerfully.  By immerfion in a warmbath, bron-
chial and renal action becomes  greater ; a circumfhmce
which  explains the increafed  internal formation and
fecretion of water, the additional weight of which has
been deemed a proof of cutaneous abforption.
  Although it is the natural  courfe for the digefting
organs to occafion the action  of  the fecreting, yet, in
certain difeafes,  the order  of nature feems to be fo
completely inverted, as that the  contrary takes place.
In diabetes, for inftance, the ftomach and lungs feem
to fympathize with the renes ;  for there is a continual
appetite for fluids ;  and an increafed quantity of oxy-
gen received  by  the lungs, which, with the  affiftance
of the hydrogen and carbon, that the body every
where  lofes,  abundantly  indicates the  fource of a fo 
41
much greater weight of faccharine urine, than all the
aliment vifibly  received.   Hereby another  fuppofed
proof of cutaneous abforption is done away.   Indeed,
diabetes, from the  acknowledged torpor of the fkin
that always attends it, never afforded  a very ftrong
evidence of the doctrine.
  The fyftem, in a ftate of health, or incipient difeafe,
feems to ftruggle, as it were, to keep up a juft balance
in the excitement of  the feveral parts ; yet certain
caufes may fo weaken particular organs, or increafe the
power of others, as completely to deftroy it.   The phe-
nomena of a few maladies, feem to refult from this con-
ditition ; fcorbutus, for inftance,  and phthifis puimo-
nalis, according to fome of the moft celebrated writers
upon them.  The fymptoms of the former, which are
fuppofed to depend upon a deficient fupply of oxygen
by the lungs, in proportion to the combuftibies by the
ftomach, and  the bodily exercife, are immediately re-
moved by a reftoration of the balance. The fymptoms
of the latter have, certainly, been palliated  by the op-
pofite treatment; and in cafes where there  has been
no  organic lefion, it is believed, a cure has fometimes
been effected.   It is related, that  the French  academi-
cians, upon the  fummit of Pinchincha, where, inde-
pendent of rarefaction, the air contains a lefs proportion
of the vital principle than the middle regions, were at-
tacked with fcorbutic fymptoms ;  and thofe who  live
in very damp  and low Situations,  according to feveral
eminent writers, experience .them likewife.
  Pregnancy, in its latter flages, as Denman informs
u% has  the fame effect ; and is attended likewife with
an infatiable appetite  for vegetables, and other acel-
cents.  It is fuppofed that this is caufed by the demands
of the foetus for  the principle of life ; and by the hin-
drance of its free reception, from obftruction, to the
motion of the diaphragm.  As animal fat confifts prin-
cipally of hydrogen and carbon, the explanation of the
phenomena of obefity, from a disturbance of the bal-
                        F 
42
 ance, feems to me highly probable; and it receives
 farther confirmation from the fact, that a free  ufe of
 liquors, with  which oxygen is  but loofely and in a
 flightly folidified  ftate combined, moft commonly ob-
 viates  them.
   Indeed, it is a common obfervation, that thofe who
 live in a cider country, and ufe  this liquor freely, are
 more commonly lean, than thofe who make beer their
 common beverage ;  and that certain opiates, and me-
 tallic  oxyds, and acids, are antidotes to each other in
 the animal body.   I was, not long fince, informed by
 a gentleman, who was totally ignorant both of the the-
 ory and practice of medicine, but  who had  a fmattering
 of chemiftry, and  was frequently  making fmall experi-
 ments, that, one day, having accefs to an apparatus for
 the refpiration of the gafes, he determined to make a
 trial of oxygen upon himfelf.   As the firft effects were
 not adequate to what he expected, he continued the
 bag to his mouth  longer than was prudent,  the confe-
 quence of which was, a pretty violent pneumonical af-
fection,  precifely fimilar to the firft ftage of phthifis.
It muft be remarked, that he had naturally a very flen-
der constitution, and never enjoyed very  firm health.
  Much has been faid by writers of eminence, of a cer-
tain fomething, fuppofed to belong to a living  body,
and ftyled vis-medicatrix-naturae..  The principal phe-
nomena of  fevers are, by Dr. Cullen, referred to it.
  I take it, however, to be  nothing  more  than this
 fympathy of one part with another, this nervous com-
 munication of the organs of digeftion with thofe  of
 affimilation, fecretion, and excretion, by which, if one
 is flimulated into  action,  the reft are incapable of re- '
 maining torpid.   Townfcnd refers the effects of the
 application of  an  epifpaftic to the furface, and  of an
 exhibition  of a cathartic or emetic to a vis-medicatrix ,
 but it is believed, however,  that  the organization of
 the fkin, and prima? vice, is limply fuch, that their ex-
 halent  veffels  are capable  of being flimulated  into a 
43
Ipecific action,  by fpecific applications;  fo that the
epispaftic, the cathartic, and the emetic, are in reality
the efficient caufes of the phenomena occafioned.
  That the final caufe of the effufion of lymph, in a
blifter, is to preferve a tender organ of fenfe from too
violent irritation ; and the effufion of fluids, during
the operation of a cathartic, and emetic, to wafh away
the offending matter,  is readily granted;  and in that
light may be ftyled a vis-medicatrix ; but on the fame
principles, even fo may be moft of our voluntary mo-
tions.   I am even unwilling to allow, that the particu-
lar determination of matter to form new fubftance, in
every  breach of continuity, is any thing more than the
immediate effect of irritation.
                             WILLIAM TULLY.
Case of an AFFECTION of the right OVARIUM;  com-
          municated by Dr. John Barker.




    A Mrs. W---r, of the county of Windham, aged
about forty years,  for more than twelve months pre-
vious to my being called to confult with her attending
phyfician, had the ufual fymptoiris of pregnancy; and
v/as fufpected, the greater  part of the time, both by
herfelf and her acquaintance, to be in a pregnant ftate.
At the expiration of the firft nine months, as the ordi-
nary  refult  of geftation did not follow, a phyfician,
who practifed and was confidered fkilful in the obfte-
tric art, was confulted,  and decided that fhe was not
pregnant, but that her diforder was an hydropical af-
fection of the right ovarium.   I  was requefted to call
and fee the lady with him, and confult upon the expe-
diency of attempting to relieve her by an operation. 
44
The whole abdomen appeared enlarged, and fhe looked
like a woman ready to parturiate.   After making what
examination was neceffary, to latisfy myfelf of the na-
ture of her diforder, 1 was convinced that  not only
the ovarium was morbidly affected, but likewife that a
fluid ot fome kind was fluctuating in the cavity of her
body;  but fo great was the diftention of the abdomen,
that although "the ovarium could be felt through the
i.uteguments, and it was eafy to decide as to its en-
largement, it could  not be very well determined as to
ks confluence.  An operation was agreed upon, to re-
lieve her of the fluctuating fluid, which  appeared to
occafion great diftrefs ;  but we had a further  object in
view. viz.  to be better able to decide as to the practi-
cability of relieving  the ovarium.   On the 27th April,
1 793,  I performed  the operation, (with  a trocar  at
leaft one half larger than the  ufual fize, > and drew
from her about feven quarts of a gelatinous fubftance.
This afforded temporary relief.   She was  then treated
by her attending phyfician  with carminatives, gentle
cathartics and diuretics; and on the 6th of May fol-
lowing, I was again  called to affift her by a fecond ope-
ration.  It was agreed to perforate the enlarged ovari-
um, in this operation,  and relieve it  of  its  contents,
(for the prevailing opinion of the council was, that it
c ntainea n/.e ter of a fimilar confiftence with  what had
been drawn off at the preceding operation.) The refult
was, we drew fix quarts of gelatinous matter more te-
nacious than before ; her ftrength  had failed her confi-
derably fince the former operation ; a lofs of apetite
had followed  the lofs of ftrength, and her  days and
nights were one continued fcene of diftrefs ;  her urine
in fmall quantity and high coloured ; 'twas difficult to
decide by the feel whither the ovarium was  much di-
minished by the operation or not—She continued in
the  ufe of carminative , diuretics  and cathartics,
without deriving much benefit from them, until I was
called upon the third time to operate, viz. on the 18th. 
45
of June, at which time I drew from her about five pints,
of the confiftance and appearance of new  foap when
boiling.
   At this operation I left a tent in the perforation, to
keep it open, and attended daily every morning to
draw off the  matter,  which continued of the fame
confiftence until the 24th at  night—From the time I
firft faw her until now, her fever  had been flight—In
the night of the 24th, a violent fever came on, and on
the morning of the 25th, fuch a quantity of a thin
watery fluid had difcharged from the  orifice of the
wound, where the trochar entered, that upon intro-
ducing the canula, I obtained but about half a pint of
clear lymph at firft, followed by about the fame quan-
tity of purulent matter; it retained this confiftance,
and I continued to draw  off about the fame quantity
every morning, until her  death, which took place on
the SOth.  Leave was obtained to examine the body,
and accompanied by my friend Dr. Lee, we proceeded
to the examination,—appearance was as follows :—Up-
on removing the integuments of the abdomen, the o-
mentum being wholly confumed,  the right  ovarum
prefented, rather in an oval form, confiderably larger
than a goofe-egg ; it adhered on one fide to the perito-
neum  ; at is apex, it adhered to  the diaphragm, the
left ovarium confiderably  enlarged, fuch an entire ad-
heiion had taken place between the right ovarium, ute-
rus and vefica urinaria, that they appeared one compact
and entire body, tho of an uneven furface, the right ova-
rium upon being laid open had the appearance of a hog's
liver, very porous,  and interfperfed with a number of
cysts,  containing a mixture of purulent and gelatinous
matter, of a very offenfive fmellin quantity about|half a
pint._The uterus and vefica urinaria, prasternaturally
thickened ; it was difcovered on diffection, that the tro-
car had perforated  the right ovarium, but no particu-
lar advantage or difadvantage had refulted from  it,—
 Attached to the diaphragm and  peritoneum,  were a 
46
variety of fmall cyfts,  containing from  a tea-fpoonful
to half a gill of a thin fluid—The whole  abdominal
vifcera befides, tho  to appearance found,   were im-
merfed in a body of offenfive and purulent matter.
  A partial Analyfis of the Waters of Stafford Spring, ex-
tracted from a Communication made to the Medical Society
ofConneclicut, by Dr. Samuel Willard.
    POWDER of the galls of Aleppo, of Peruvian
and white oak bark, and hyfon tea, flrike a dark pur-
ple colour, almoft immediately, on being mixed with
this water—Diftilled fpirits produce the fame effect,
but more flowly.
   The purple juices of vegetables,  fuch  as  violets,
flower de luce, &c. give to the water a moft beautiful
green tinge—Cauftic fixed alkah produces a precipi-
tate, of a  reddifh brown colour.   In this experiment,
the carbonic acid attaches itfelf to the alkali,  leaving
the iron with which it was before combined, to fall to
the bottom in the ftate of oxyd.
   Silver on being wet with the water, acquires  a black-
ifh hue—Pruffiates of lime and potafh  produce in
it  a very difcernable blue tinge.
   Two gallons of the water afforded, by evaporation,
twelve grains of fediment;  this fediment appears to
confift of oxyde of iron, and aluminous and magnefian
earth—It  effervefces ftrongly with the fulphuric acid.
   On the  fide of the vats where  the water  trickles
down in a very gentle manner, I obferved a very light
fediment adhering ;  this  appeared  to  be carbonate
of magnefia,  combined with a very fmall portion of
the oxyde of iron.   On fome of this fediment I pour-
ed a few  drops of the fulphuric acid, a lively effervef-
cence immediately enfued, a quantity of fixed air was 
                        47

 extricated,  a new combination took place, which on5
 examination, appeared to be fulphate of magnefia or
 epfom falts.  In this inftance,  I fuppofe  the  fulphuric
 acid feizes on the magnefia,  and the carbonic acid,
 which was before united  with the magnefian  earth,
 being fuddenly difengaged, flies off.
   The water will not unite with foap, but curdles on
 being mixed therewith.
   For want of chemical apparatus adapted to that pur-
 pofe, I have not  been able to  examine the different
 gafeous principles which heat would probably extricate
 from the water.
   The experiments which I have made, have been de-
 fultory—They cannot, by any means, be confidered as
 forming a complete analyfis of the water ; fome expe-
 riments which I wifhed to have made, I could not for
 want of fome of the agents or tefts which are generally
 ufed, in the examination of mineral waters—From the
 above related experiments, I have however deduced
 the following conelufions, viz.
   lft. That iron is  the prevailing ingredient in the
 water—that it is  held in folution  by the carbonic acid
■ —that when the  water is expofed to the action of the
 atmofpheric air, or is acted on by heat, the acid is ex-
 tricated, and the  iron precipitated—the purple colour
 {truck by the vegetable aftringents, and by diftilled fpi-
 rits—the precipitate produced by the cauftic fixed al-
 kali, and the  blue tinge communicated to the water,
 by calcareous and alkaline pruffiates all  indicate the
 prefence of iron.   2d. That the water is  alfo impreg-
 nated with the fulphurated hydrogenous  gas,   its Sul-
 phureous fmell, its poffeffing the property of blackening
 filver, and its receiving a green tinge, from the admix-
 ture of vegetable purple juices,  i confider as  proofs.
 3d. That the water contains aluminous and magnefian
 earth, its effeas on foap,  its effervefcing with the ful-
 phuric  add, when depofited  as a fediment, and the
 new combination which takes place on the admixture
 of that acid, induce a belief of this fact. 
48
 The following Cafe of an enlarged LIVER, was communi-
       ted by Dn Joseph Foot, of North Haven.
     IN January,  1810, I was called to vifit Thankful,
 wife of Solomon Linfly, efq. of Branford,  aged 49.—
 On enquiry' it appeared that  her natural conftitution
 had been good—that fhe had uniforjnly enjoyed good
 health—excepting periodical turns of  head ache, at-
 tended with  naufea,  accompanying  the  menftrual
 flux, and fometimes  flight hemorrhoidal affections.
  As the menfes difappeared, the hemorrhoids increaf-
 ed, and for two years paft,  particularly the preceding
 and prefent feafon, had been attended with fo great
 an evacuation  and pain, as  very much to debilitate
 the fyftem.  Previous to my feeing her, by the appli-
cation of white lead and oil, the difcharsre was fudden-
ly checked, and no apparent ill confequences refulted
from it, excepting a ftrong appreheniion of future evil.
  My enquires wliethei any tumors, pains, or fore-
nefs, had ever been perceived in  or near the ftomach,
were anfwered in the negative ;  but on examination
the following night, a large indurated tumor was dif
covered apparently in the ftomach, rather inclining to
the left ; at this time the appetite and digeftion were
but little impaired, the pulfe  almoft natural.—She was
immediately put on a free  ufe of mercurials and cicu-
ta^internally and externally, and a moderate hemorr-
hoidal affection was again induced,  by ftimulants lo-
cally applied ; the  fyftem was moderately affected, and
a gentle ptyalifm continued for feveral weeks, with oc-
cafional ufe of abforbents, bitters and phyfic, as  fvmp-
toms indicated.
  Comparing the  fituation and fize of the tumor with
the fymptoms, I could not be fatisfied what part was
difeafed—Counfel was  called, and after determining
fucceffively, that it muft be the liver, fpleen, pancreas
and an organic fubftance in the ftomach,  we left the 
4-9
p"atient as wife as we came.   Under  the ufe of medi-
cines mentioned, fhe continued  gradually  to decline
until about the 8th of February, when file wa., fud-
denly attacked with moft excruciating pain, efpecially
on moving, in the left hypochondrium—Bleeding, fo-
momentation, antifpafmodics and bliftering we*;e ufed,
and in a few days the pairi abated ; during the feverity
of pain, the tumor entirely difappeared, and by fome
was tho't to have difcharged ; but immediately return-
ed of the ufual fize, as the fpafms gave way  ; from this
time flie gradually declined (and  as far as I could judge
by the fight and touch, through  the  integuments, the
tumor very flowly increafed) until the 29th of May,
when death clofed the fcene.
  Leave had been previoufly obtained to examine the
body ; but in confequence of the diftance and acciden-
tal circumftances,  it was not  opened until  nearly  24
hours after deceafe.    Upon diffecting  the  integu-
ments, almoft the  whole cavity of the upper region of
the abdomen, was filled by the enlarged left  lobe of
her liver, which appeared to be  in  an imtermediate
ftate between fchirrus  and ulceration,  refembling the
cortical part of the brain.  The right lobe  of  natural
fize,  and, excepting a few  fchirrofities, preserving a
healthy colour—The  gall-bladder moderately full of
healthy looking bile, the ftomach very  fmall and  preff.
ed to the left, the right kidney very  much enlarged,
the liver when diffected' out, weighed nine pounds and
feven ounces, the exterior edge being  about feven in-
ches thick—Owing to the length of  time after death,
and fatisfaction being obtained as to the difeafe,  no
further examination was made.
G 
50
An inflame of the fatal efefis of CANINE MADNESS.
   JAMES REMINGTON, a lad of about fix years of
 age, was on Saturday the 28th of October,  1797, on a
 vifit at his  uncle's, Mr. Eraftus Grangers,  in Suflield,
 the boy obferved that his uncle's dog growled at him,
 when he firft faw him, and told fome of the family
 that the dog  threatened to  bite  him—he  efcaped at
 that time, however, unhurt; but  foon after this lad
 with fome other boys, were  at play in the ftreet, at
 fome diftance from the houfe, the fame dog followed
 the boys to the place, and  there fell upon  faid James
 and bit him in the face, the boys beat the dog off, and
 he ran home.  This adventure produced fome  disor-
 der among the boys, and put an end to their diver li-
 on—James, with his mates attending him, returned to
 his uncles with his face wounded and bloody ;  as he
 drew near the houfe of his uncle,  the dog was by  the
gate ; as he came up the dog  flew at him with great
violence, threw him down, and wounded his face in  a
 moft defperate manner ;  one of his  tufks entered  the
lids of the right eye, and rent them both open—one
 tufk perforated the cheek on the left fide, and tore  out
 two of his teeth ; at the fame time wounding his face
 badly in feveral other places :  In this mangled condi-
 tion he was carried into the houfe, and  the dog im-
 mediately killed ; I was directly called to fee him, after
 washing off the blood and examining the wounds,  the
 eye-lids were united by a future on each lid, and  the
 wounds dreffed in the ufual manner.  The boy com-
plained of g •- at pain in his face at intervals, which pro-
bably was in confequence of the wounds which he had
 received.  A confiderable degree of inflammation fuc-
 ceeded, and in ^bout  two days Ins f;v. e was fo much
fwelled that both eyes were entirely clofed, and lie was 
5,1
totally blind for fome days; after the inflammation had
fubjided, a pretty good digeftion fucceeded, and the
wound difcharged freely, which wa,s encouraged by
ftimulating digeftions, in order if poflible, to prevent
the effects of infection in cafe the dog fhould prove to
be mad, which began to be apprehended by many, and
the accident excited a general alarm in the neighbor-
hood, particularly in the family and among the friends
of the wounded boy.  At this,time no pains were ipared
to obtain the beft advice as to the mode of treatment
op fupppfition that the virus had been communicated
to the lad ; he was put  upon a mercurial courfe of
medicine, and the mercurial oitmenf frequently appli-
ed to the parts affected ; as the inflammation abated,
he began foon to recover appetite, cheerralnefs and ac-
tivity ; fome of the wounds were  healed by the firft
intention, others  fhewed a difpofition to unite, and
would have clofed up, but our  object was to  keep
them, open and excite a free difcharge ; fymptoms ap-
peared favourable, and the boy in a fair way of recov-
ery^, until Tuefday the 10th  day from his  receiving
the wounds ; towards evening the family obferved he
began to droop and did not appear fo cheerful and ac-
tive as before ; the night following, he was rather reft-
iefs and difturbed in fis fleep, and did not reft fo well
as ufual; Wednefday morning on removing  the dr.ofll
ings, the  wounds were dry without any  difcharge,
notwithftanding they had difcharged freely at drel£
ing; the preceding morning he appeared  rather liftlefs
and dull, complaining of fome pains  hi the  wounded
eye and in his head,  accompanied with a flight fever,
with other fymptoms nfually attending a  cold, and it
was hoped his complaints originated from that fource ;
in the afternoon of the fame day, however, the family
obferved as he attempted to drink, he was  attended
with flatting and twitching, particularly in  his neck,
which drew his head back.   On being afked why rhe
did fo, he replied he could not help it.  This fymptom 
52
alarmed the family, and I was immediately called in—
he was now frequently  attacked  with fliarp darting
pains through  his head  and breaft,  attended with
fpafms, particularly when he attempted to drink ;  the
night following he was reftlefs and uneafy,  flept  but
little, and that in fhort difturbed naps, ftarting as in a
fright.  Thefe fymptoms increafed during the courfe
of the night. On Thurfday morning all the foregoing
fymptoms had increafed to an alarming degree ; he lay
on the bed and chofe  not  to be moved, his counte-
nance was pale, attended with momentary flufhes in
the cheeks, anxiety and diftrefs were vifible in his face,
he appeared in a llate of general debility, yet the ner-
vous fyftem excited to the higheft ftate  of fenfibility.
Fearfulnefs in particular feemed to be a predominant
fymptom, which  was even apparent  in his counte-
nance, refpiration was difficult and laborious, efpecially
in the return of the paroxyfms which were become
frequent; at each infpiration fpafmodic catches  refem-
bling fhort fighs, interrupted his breath ; when he at-
tempted to drink he was feized with  violent fpafms,
particularly in the neck,  which drew his  head back
with great force, notwithftanding his utmoft exertions
to prevent it; even  the mentioning of drink would
produce fimilar agitations, and bring  on a return of
the fits ;  he was able only to get down a tea-lhoonful
of liquid at a time, and that with great difficulty, which
he feized with eagernefs, trembling and agitation ; he
feemed to have the fame averfion to the wet clothes
which were ufed in fomentation  and applied  to  his
ftomach, and renewing them produced nearly the fame
effect as drinking.   At intervals of ten or fifteen  mi-
nutes, he was feized with a violent catching  for once
and no more at  a time ; this fymptom was lingular and
what I had never before noticed in any difeafe ;  the
noife produced by this effort was fharp and fhrill, differ-
ent from what is ufually the effect of retching to vomit
(lience remarked by many that were  prefent, that i; 
53
refembled the noife made by a dog) it  feemed- to be
occafioned by violent fpafms of the diaphragm with-
out ficknefs,  as he had never difcharged any thing
from the ftomach except  a little wind, he remarked
that he felt a little better  after it;  this fymptom  re-
fembled in fome meafure  a ficknefs, but bore a nearer
refemblance to retching from  ficknefs of the ftomach,
and attended him at longer or shorter intervals through
the courfe of the difeafe.  He would frequently fhriek
out in great diftrefs from  the acute darting pains in his
head ancl breaft ; thefe  fhrieks refembled thofe of in-
fants in convulfion fits,  as they are commonly called,
and feemed to be the effect of fearful apprehenfions as
well as of pain ;  at this ftage of the diforder he often
complained of the cold,  and  was  attended with fre-
quent rigors.  His pulfe at this period was about one
hundred  in a minute ;  he retained the exercife of his
reafon, unlefs fearfulnefs might induce  fome degree of
derangement in the rational faculties.   The white of
that eye which had not been wounded, appeared a lit-
tle inflamed.
  Under thefe threatening fymptoms,  no doubt could
be entertained as to the iniection.   By advice of feve-
ral phyficians, who were called, he was  put  on  the
ufe of opium and mufk, in large and repeated dofes,
and the room direfted to be  filled with the fumes of
vinegar.   Is  the fpace  of about three  hours  from ra-
king the  firft dofe of opium, the retching was become
lefs frequent, and not quite fo violent, the other fymp-
toms continued much  the fame ;  in the evening the
pulfations of the arteries were about one hundred and
ten in a minute ; he complained of a dyfuria, and at-
tempted frequently to make water without effect ; he
inclined  rather  to be  up than in bed ; the catching
for breath was not fo frequent nor fo hard ; the turns
of shrieking were rather more frequent, attended with
extreme  agitations, and  fome degree  of delirum in
time of tjie paroxism  In the courfe of the imdit the- 
54
 dyfuria abated, and whenever he attempted to drink
lie would void urine,  which fymptom continued thro'
the remaining progrefs of the difeafe.  He would fwal-
low with lefs agitation and pain than before the ufe of
the opium and muik; he patted the night without
any fleep.  On  Friday morning there appealed a fen-
fible alteration or variation of the fymptoms ; the pul-
fations in the night had increafed to 120 jn  a minute;
they were now fallen  to about 00, with frequent m-
termiflions j he rerafed altogether to iie oi) the becj,
chofe to continue in an erect pofture; he appeared wild,
in great hurry and agitation, conftantly talking and in
continual motion j  the fighing had fubfided in a great
meafure, but the retching continued ; he could tafce li-
quids with lefs terror and agitation.
  About this time he began to complain tljat his throat
was full and felt fore, and at evening a hoarfenefs fuc-
ceeded the other fymptoms ; the puliation? had fallen
to about 85 in a minute, with frequent hitermiffions,
and were now become very feeble, the violent  retch-
ing ftill continued, a  coldnefs of fhe  hands jtnd feet
had begun to appear fome time before, hut was now
more apparent.   He had taken about 16 grains of opi-
um in  the fpace of twenty-four hours in divided do-
fes, and mndry portions of muffc, which had in fome
meamre moderated the violence of the fpafxns, but not
fubdued the difeafe.  Friday eves jag, 7 o'clock, fymp-
toms began to grow more alarming, hi§ loquacity fub-
fided, and was fucceededby great anxiety and reftleff-
nefs, conftant tenefmus, and after about two hours in-
deavour, he evacuated a fmall quantity  of  extremely
fetid matter.  About 8 o'clock, with much difficulty,
he got down a final! portion of mujjk.  ater which the
racing increafed faft—extremely .difticuli to retain him
on the bed—-pidlevery low And fluttering—eyes fierce
and flaring—countenance very wild—9 o'clock he
with great exertion got  down' the ufua] dofe  of opi-
um—anxiety and  reftleffnefs increafing to a moft  a 
as
diftrei&ng degree, unttil about 20 mimates after 9, when
he evacuated from the stomach a quantity of vifcid
phlegm-, wMch gave him "temporary relief;  at which
time he lay down quite cahn until about 10,  when by
attempting to fwkHow a tea-fpoonful of tea, was ex-
treriielyconvulfod, and every fymptom returned widi
redoubled force : violent fubfultus of the tendons, fre-
quent retchings to vomit, was almoft ilrangled with a
toug"h vifcid phlegm in the  throat, his whole nervous
fyftem was in the moft violent agitation, his mind in
conftantperttebatioft, he ftarts often,  afked if there
was not a dog in the room, foams  and froths at his
mouth, &c. he now lofes his fpeech, his  extremities
grow cold, pulfe intirely gone, and exhaufted with
ftriving, he finks down upon his pillow ; at this time
his friends  anxioufly hope that his fufferings are foon
to be at an end; at about 11 o'clockhe fuddenly revived,
fat up, took a cloth and wiped off the faliva from his
mouth, quite calm and free from convulfions—Thus
he continued till about 12 o'clock with an anxious me-
lancholy on his countenance, and unable to fpeak, but
would point to any one in the room, whofe name was
mentioned to him, gave his hand to each one of the
family, while his looks fpoke  more than words can
defcribe.  He now made feveral  fruitlefs  attempts to
convey a fpoonful of tea to his mouth, but after many
trials fucceeded, but was shockingly convulfed by at-
tempting to fwallow.
   About one o'clock Saturday morning, he puked up
a very  vifcid mucus with a little tea which he had laft
taken,  the fight of which threw* him  into the moft
extreme convulfion, grinding of the teeth, involunta-
ry fits  of laughing and crying by turns, even the fight
of liquids-now threw him  into great diftrefs—2 o'-
clock more terrible ftill, frequent grinding and gnafh-
ingof the teeth,  foaming and  frothing at  the mouth,
eyes extremely fierce and flaring,  ftarting with the
moft fearful apprehenfion,  catching at  things in the 
50
 air, and at  the bed clothes, ftriking violently with his
 hands  and feet, though not  at  any particular object,
 he never made any attempts  to bite or injure any per-
 fon—he could now fpeak fo as to be underftood ;  he
 continued thus to rave with the moft fudden and vio-
 lent contractions of the body, with frequent retchings
 to vomit, but little  difcharged until  between 3 and 4
 o'clock, quite exhaufted, he again funk back upon the
 pillow, when with a ghaftly countenance, flaring eyes,
 laborious and interrupted refpiration,  but  free from
 convulfive affection, retaining  the faculties of feeing,
 hearing and knowing his friends, and able to fpeak
 pretty diftinctly, he continued till 5 minutes paft 5 o'-
 clock,  when in a  moment  without a ftruggle or a
 groan,  death clofed the fcene.
                           HOWARD ALDEN.



An unfucccfsful cafe  of HYDROPHOBIA, treated upon
                the ftimulating pi n-.
    February 18th, 1806—This day I vifitcd for the
firft time, a patient bitten feven weeks ilnce by a dog
fuppofed to be mad.  The patient was a lad of feven
years, the circumftances were thefe :—As the boy  re-
turned from fchool he faw a dog fitting by the fide  of
the path upon his hind legs, the  boy was frightened
at the unufual appearance of the dog—began to run,
the dog purfued Wm,  threw him down and bit him
feveral times in his wrift, making a very deep and la-
cerated wound.  The  inflammation  and pain of the
wound was very confiderable, which was treated with
poultices, and fuppuration induced.  From the time  of
the accident until the fymptoms of hydrophobia came
on, the boy was under an alterative courfe of mercu- 
 ry as prophylactic.   On the 17th the parents be raise
 alarmed at the appearance of the difeafe, viz. pain in
 his arm, fhoulder and bowels, with reftlefsnefs and in-
 creafed fenfibility, and fome  difficulty in fwallowing.
 The attending phyfician gave him calomel in dofes of
 two grains every two hours, with laudanum fufficient
 to reftrain it from palling off by the bowels.  On the
 18th l found him with pain  in  his arm,  fhoulder and
 bowels,  tongue  covered with white fur, the wound
 put on a livid appearance, had  entirely ceafed to dil-
 charge, difficulty of fwallowing at this time great; yet
 he was  able  to  overcome it,  had  frequent and sad-
 den infpirations,  like a perfon  fuddenly  immerfed in
 cold water, pulfe flow, fmall and irregular, fometimes
 a full ftroke, quick fucceeded by a fmall one, pupils ve-
 very fenfible   to  light, and  extremely fo to found ;
 when he drinks he has a wild ftate with his eyes, roll-
 ing them back ;  he fpeaks with great earneftnefs,  and
 a commanding tone .of voice;  if any one comes into
 the room he commands them to go out immediately ;
 when he is informed it is  one of the  family, he be-
 comes quiet;  frequently he calls for water,  as foon as
 the veffel is brought into  the room lie fprings up in
 the bed and cries," carry it out, it will kill me ;' when
 he is told it is the drink he  called  for,  fays O  ! III
 drink it, I thought it was fomething that was going to
 hurt me."  Mercurial ointment was  rubbed into  the
 thighs very freely ; injections were given  with tempo-
 rary relief of the pain in the bowels  ; the matter  dif-
 charged was of a  dark green color.   At 11 o'clock, A.
 M. a council was called, confifting of the phyficians of
 the town.—Influenced by Cullen s nosological arrange-
 ment, and Dr. Meafe's fuppofed analogy between this
 difeafe and tetanus, the  council  advifed  to  treat the-
 patient upon the ftimulating plan—Increafe the dofe of
 laudanum andfubmuriate of mercury—give injections
of the bark, wine and opium—-bathe the body with
fweet oil.  Altho' feveral oz. of ftrong mercurial oint-
                        H 
58
ment. were applied to the furface by frictions,  and for-
ty grains of fubmuriate of mercury given, not the leaft
effect was produced upon the mouth and bowels, un-
lefs the pain in the latter was increafed by it.  The
difficulty of fwallowing  and all the other fymptoms
were very much aggravated in the afternoon.   He be-
gan now to froth at the mouth—the convulfions be-
came more frequent and continued  longer, agitating
the whole body in fuch a violent manner as to require
two men to keep him  in bed.  During his paroxyfms
he became delirious,  imagining fome perfon  was go-
ing to kill him—frequently begged to go  home—he
frequently attempted to bite, tore  pieces out of the
bed-clothes, and continued to chew them for  a confi-
derable length of time.  The frothy faliva difcharging
from his mouth in  great quantities, was very  trouble-
fome to him, though it did not appear to be vifcid ; he
often attempted to wipe the faliva from his mouth,
which he rarely fucceeded in doing on account of the
fpafms—In the intervals of the convulfions he expreff-
ed much anxiety left he  fhould bite his attendants.—
His fkin was uniformly dry until within  an  hour or
two of his death.   At  7 o'clock, P.  M. a mild deliri-
um came on ; in the intervals of the fpafms he laughed
and tryed to excite laughter in others by obfcene lan-
guage—imagined himfelf Aiding on the  ice with  his
companions—attempted to be witty with them.  Du-
ring this  mild delirium, fwallowing  was not as diffi-
cult as it had been—touching his body  excited the
fpafms  ; when any thing was given  him to drink,  he
was directed to open his mouth wide, and  the liquid
was poured far back upon  his tongue ; if the fpoon
touched his mouth before the liquid was poured into
it, he could not receive it—Oil was applied to his bodv
with fome little relief,  or at lealt it was  agreeable to
him.  Sulphuric ether given in tea fpoonful  dofes di-
luted with water, produced convulfions nfach  more 
59
 violent than thofe which  were occafioned by fwallow*
 ing water.
   Previous to his delirium, and in his lucid intervals,
- he  took medicines very well, exhibited decifion  of
 mind and ftrength of refolution in taking liquids be-
 yond what would have been  expe&ed  from a boy of
 his years. The tincture of opium (ozjj of opium to lbj
 proof spt.> was given on the  l'/th, in dofes of 8 drops,
 and increafed gradually  until he took a tea-fpoonful
  every hour ;  os the  afternoon of the 18th, in the
  fpace of 5 he hours took ozfs of the above tincture,
 without any perceptible effect in flopping the progrefs
  of the difeafe ; he was taken out of bed and a pail-full
  of cold  water fuddenly thrown upon him, he was im-
  mediately wrapped in blankets  and laid in bed ; the
 affufion produced violent convulfions, which continued
 longer than ufual, after  being laid  in bed was more
  quiet for a little time.  At 11 o'clock the fpafms fub-
 fided, pulfejfcarcely perceptible,  became comatofe, had
  a cold fweat, continued in  this  condition until one
 o'clock, when he died,
    Diffeclion.—The brain was firft  examined.   The
  blood  veffels  of the dura and pia mater  were very
  much diftended with blood,   the other  parts  of the
 'brain exhibited no marks of difeafe.   The  glands of
  the throat were tumefied ; papillae at the root of the
  tongue were very much fo, and  the  excretory ducts
  of the fublingual glands were livid  like the fpots pro-
  duced on the fkin by the bite of leeches.   The ton-
  fils were larger  than  common, and contained feveral
  puftules filled with purulent  matter. The trachea con-
  tained a froth, like that  which  had been thrown out
  of the mouth, in fo great abundance in the latter fla-
  ges of the difeafe. The lungs appeared healthy—In the
  left ventricle of the heart was a polypus.  The intef-
  tines were much  diftended with  flatus and  a dark
  green matter.  The gall-bladder was unufually large,
  and filled with dark coloured bile. 
60
  Would not the remedies  ufed in this cafe probably
have had more effect if the  excitement had been redu-
cedprevioufly to their adminiftration, by depleting the
blood veffels and evacuating the contents of the primae
viae ?  If ftimulants were proper, would not local fti-
mulants, fuch as acetite of copper, fanguinaria canaden-
cis, lobelia inflata or tinct.  of cantharidcs with more
certainty than diffufible ftimulants have removed a dif-
eafe which had a local determination ? Is there any a-
nalogy  between the orgasms of hydrophobia and the
tonic fpafms of tetanus ; if there  had been,  would
ether have aggravated the fymptoms; and if the difeafe
had been of a weak action,  would the meninges of the
brain fhewn marks  of inflammation ?
                                      ELI IVES.
          To the Committee of Publications.
    Gentlemen,
Confidering experiments andfacls,  tejlcd by  experience,  as
  the only fur e ground of medical improvement, Ifubmit to
  your confideration the following cafe, to  publijh or not,
  as you Jhall think moft conducive to the good of Society.
    S. J.  Aged 34, of a robuft conftitution, pletho-
ric, and of an irritable habit, indulging in a free ufe
of ardent fpirits—January 2d, 1806, was attacked on
the road by a dog, and bitten in feveral places on the
buttock,  near  the gluteus maximus mufcle.   As no
cafes  of difeafed dogs  had occurred, he purfued  his
bufinefs,  without any apprehenfion  of danger, wash-
ing the wounds with fpirits.   A lad in New Haven
had been prcvioufly  bitten by  the  fame dog on the
fame  day,  and another afterwards in North Haven.
   The dog purfued his courfe,  making  an unprovok-
ed and violent attack on every animal  in his way ;
thL foon alarmed  thofe who were bitten; the boy in 
61
North Haven applied to me on the 3d of January ; by
applying cauftic  freely, giving mercurials, and cortex
peruvianus, a violent inflammation was excited, a free
fuppuration enfued,  and continued for fix weeks, no
ill confequences have refulted from the bite.   January
5th, S. J. applied to me  for  directions relative to his
wound, the fame courfe as above defcribed was adopt-
ed, but the inflammation and fuppuration  were much
more moderate than in the other cafe ; the calomel
powerfully infufed the fyftem, and was continued as
long as was thought prudent.  Although extremely
alarmed  at his fituation, he made a free but forbidden
ufe of fpirits.  February 22d, the wound  gradually
healing, S. J. being at work, about 12 o'clock was fud-
denly attacked with a fenfe of great weaknefs without
pain, but of fhort duration ; it was foon fucceededby
another fimilar attack; about this time, attempting to
eat dinner, he was affected with a violent  pain  in the
ftomach and  breaft, difficulty of fwallowing,  followed
by retching to vomit.  Being at a diftance, I did not
fee him until about 5 o'clock, he was  then exercifed
after fhort intervals with  the moft excruciating pain
in the breaft, ftomach, lumbar region and throat ; an
almoft entire inability to  fwallow, fpafms of the ex-
tremities, motions of the eyes and body inftantaneous
as lightning, countenance bordering on furious deliri-
um, fenfibility and  hearing far more  exquifite than I
had ever feen, thirft great, but very averfe to attempt
to fwallow. I immediately bled him about two pounds,
with little mitigation of pain ;  in about twenty mi-
nutes two pounds more were drawn ;  faintnefs imme-
diately followed, the pains abated,  and he ftept fome
part of the night, with occafional fpafms, and twitch-
ing of the tendons.  It  may be remarked in this place,
that after he was bitten he procured a recipe from Dr.
John Crous,  of the ftate of New-York, in  which he
placed confidence.   Soon after  the fecond  bleeding,
it was prepared and given him ;  at this time  he had 
62
not fwallowedany thing from the time of attack.  The
firft portion was fwallowed with difficulty, and as he
thinks with great  relief to the fpafms  in the throat.
From this time he gradually regained his health.
  Dr. John Croufe s  recipe.—" Take  of  the lower
jaw of a dog burnt and powdered, one tea-cup full,
fulphur of Venice one half tea-fpoon full, and if you
pleafe one third of  a colt's falfe tongue, and a fmall
quantity of blood-root and poke-root, reduce them to
a compound, and give the patient one  half tea fpoon
full in water, in half an hour give  the  filings of one
half copper ; repeat the  application on  the following
day—The above are fufficient dofes for  an adult.  To
a child give difcretionally—Ufe no fweet milk for two
or three days."
  This, like the amulets of old,  muft  require  great
credulity, and ftrong faith to prove curative.—In what
manner could the fudden depletion operate ?
  N. B. The lad in New-Haven died with fymptoms
of hydrophobia the week previous to the attack of S. J.
And almoft every animal  known to be  bitten, died
difeafed, unlefs deftroyed before  the common period
of attack.   The above named  S. J. feveral years be-
fore this period, when inebriated, had one or two fits
refembling epilepfy.
                               JOSEPH FOOT.
The following, as a marked cafe of the powerful and fud-
  den effecls  of unequal excitement, and difproportioned
  action of the arterial and venous fyjlem, conflituting the
  characleriflic difference of petechial from common fevers,
  is fubmitted to the public.

     MERIC LINSLY, of Branford, aged  2G, of a
healthy habit, remarkably ftrong digeftive powers, on
Saturday, March 10, 1810,  after eating a  full dinner, 
63
was fuddenly attacked with the  common fymptoms
of fever.   My father, Doct. Jared Foot, was applied to,
adminiflered an emetic, and after the operation, an ac-
tive cathartic, directing after the operation, mild dia-
phoretic drinks.   Early on Sunday morning, it was
difcovered that the body  and lower limbs were inter-
fperfed with vibices, fome nearly as large as the hand,
and down to the fize of a cent; totally black  and in-
fenfible, the upper limbs with petechias of a fmall fize.
In this fituation I was called to vifit him about 10 o'-
clock ; his pulfe full but not hard, great anxiety and
reftleffnefs, with oppreffion of breathing ; countenance
highly morbid,  fkin  moderately  warm,  intellectual
functions  evidently impaired.—Being equally alarmed
with his friends, with the approbation of the attending
phyfician, he was immediately put on a free ufe of dia-
phoretic powder, compofed of opium, camphor, fal.
nitre  and  ipecacuanha, foft  wood boiled in water, and
wrapped in woollen, was applied  near  the body and
limbs, andfrequently changed; a moderate ufe of warm
wine, and a frequent ufe  of fai.foda.diffolved in watery
in an  hour or two a free and equal fweat was induced,  t
and moderately continued ; the anxiety and uneafinefs
fomewhat abated ; at evening Doct. Jared Potter came
as council, it was agreed  to continue the above  prac-
tice with a mild purge  of oleum  ricini during  the
night.-—March 11, in the morning the fymptoms of
danger were not increafed, the effufion had not fpread,
but was evidently circumfcribed by  a lighter color, the
phyfic operated freely, the difcharge highly fetid, and
flightly difcolored, the fame treatment moderately con-
tinued with a very free ufe in fubftance, of camphor.
The afternoon exacerbation increafed with more activ-
ity of the  vital functions, and lefs derangement of the
animal.  For feveral fucceflive days, the above  prac-
tice was continued with the addition of ether, laven-
der, &c. and daily purging, an abforption from  the
margin of the effufed blood gradually progreffed until 
64
nearly one half of the extravafated blood was reabsor-
bed.  The fkin and cellular fubftance too torpid to be
reftored, floughed off, and the ulcers were treated as
ufual ; at one time there were  about thirty ulcers to
drefs ; the uniformity of the fubfequent fymptoms and
mode of treatment, preclude the neceffity of following
the difeafe from day  to day.   Early in the difeafe it
was difcovered that the mufcles and optic nerve of the
right eye appeared to be* in a ftate of partial inactivity,
during the convalefcence, this  ftate was succeeded by
a moderate inflammation in the eye, by the application
of cold water, and the common remedies,  the action
of the eye was fo far reftored as to be fufceptible of vi-
fion, when by a fudden expofure to the full rays of the
fun, vifion was entirely deftroyed, and is now confider-
ed by fome a cataract, and others a gutta fercna.—The
health of the young man by a moderate ufe of the dif'
fufible flimuli and mild tonics, is perfectly rellored.
                              ' JOSEPH FOOT.
   To the Medical Society of the Si ale of Connecticut.
       Gentlemen,
     AN anfwer to the qucftion, viz.—cc What is  the
rirft  eligible method to promote Medical Knowledge in the
State of Connecticut ?
  In profecuting the fubject I fhall confider and  treat
the matter as tho' every phyfician in the ftate was in-
corporated, and of courfe fubject to be  iniiuenced by
the cenfures and encouragements of the  Preiident and
Fei!<;w.^, and conitrained by their law.;.
  Admitting this to be the cafe  (which is  in a great
meafure  trueN it is from  the  fald  encouragements,
frowns and conftraints we are to expect theVroateft
ftimulus ; hence proper regulations become matters of 
63
the higheft importance.  The arrangements hitheftd
adopted (by your refpectable body, do them much ho-
nor; in fome points have failed in their  operation ;
this no doubt gave rife to the queftion now before me,
and to obviate the difficulty, I would fubmit to  your
wifdom the following confederations, viz.
   The fociety have  propofed  feveral important quef-
tions to be difcuffed by the faculty, with the flattering
encouragement of the  public thanks  of the fociety to
whomfoever fhould make the moft fatisfactory reply :
But unhappily the importance of the medical fcience is
fo little attended to by the people at large in this ftate,
that a public declaration of a man's learning and inge-
nuity in this laudable profeflion, does not raife him to
that degree of eminence  as to excite him to purfue an
intricate fubject with that perfevering induftry which
an accurate inveftigation might require.
   But how is this to be remedied ? I  anfwer,  by ad-
ding a pecuniary  reward.  But  (fay fome) is not the
caufe of humanity, and the applaufe of his  fellow citi-
zens a fufficient incentive ? Why truly at firft fight, it
feems it ought to be ; but when we look into all other
focieties we find it otherwife ; and you will pardon me
for fuppofing phyficians to be like other men.  To il-
luflrate this we have only to  reflect  that  among the
numerous faculty in this  ftate, a very fmall proportion
have  hitherto  been induced to put pen to paper.—
This neglect I impute to the  particular circumftances
of a great proportion of phyficians in this ftate, whole
moderate prices and neceffary attention to  a common
fubfiftance, will not permit them to devote any confi-
derable proportion of their time, merely to obtain ap-
plaufe.—This in fome inftances I know to be the  cafe.
  But admitting a pecuniary  reward to be neceffary,
the next queftion is, How is money to be raifed with-
out burthening thofe very men who are already cramp-
ed by  their poverty ?  With becoming defference to
I 
66
your better judgment, I would propofe the following
methods.
  firfl—Let our reprefentation be leffened.  From the
county of Fairfield, which contains about thirty mem-
bers, are font five fellows ; this makes the ratio as one
to fix, which appears to me  a very great  proportion.
The neceffary expence of this reprefentation  will re-
quire, every feffion, a tax of at leaft one dollar on each
member, which I confefs is nearly as much (confidering
the prefent advantages refulting from the inftitution) as
will be cheerfully fubmitted to.  Now if inftead of five
fellows, only two,  or even three  were to be deputed
(which I conceive would be amply fufficient for every
legiflative purpofe; there would be a faving of twelve-
dollars in this county only ;  and admitting the county
of Fairfield to be an average ratio for the ftate of Con-
necticut, ninety-fix dollars might  every feffion be de-
pofited for the benefit of the ii. ftitution, without any
additional burden to individuals.   This properly mod-
ified into premiums,  with the applaufe naturally con-
nected, would, I believe, prove a  fufficient incentive
to put the wheels of genius in motion, and that many
ufeful communications would be the refult.
  Secondly—Should this  method be deemed ineligible.
or on experiment be found inadequate, let us  look up
to the hon. legiflature of the ftate, whofe patronage of
learning in general has of late been fo confpicuous, as
to afford a well grounded confidence, that they would
lend a helping hand in fo laudable a purfuit.
   And, thirdly—Should  fuch folicitation prove  abor-
tive, lot a fubfeription  be opened and  prefented to the
beneficent of the faculty and other patriotic gentlemen.
   In the next place, permit me to offer a few hints re
fpectingkhe growth and difcipline of our in ftitution.
The defigfli of every incorporation is, that each compo-
nent part fhould add a value and efficacy to the gene-
ral mafs ; aiso" on this principle is founded the afiocia-
tion of our prefent fociety ;  that  each  member  from 
67
his different genius and opportunities, fhould by his
difcoveries contribute fomething to the improvement
of the  medical fcience  and the benefit of mankind.
And while each  individual is engaged in his own pro-
per fphere, he is deriving  to himfelf the accumulated
advantage of the labors of the many.
   Hence the utmoft caution ouscht to be exercifed in
the initiation  of members.  Every applicant who  is
not likely to add utility or refpectability to the fociety
ought ever to be excluded. And when admitted,  let
him be punctual in his attendance at the periodical
county meetings to  which he belongs ;  which I am
forry to fay, has, fo far as my acquaintance  extends,
been" too generally neglected. To remedy this, I would
propofe the enaction of a bye law, making it the duty
of every member, once in  a reafonable time, to exhibit
a narrative of fome interefting cafe which fhall have oc-
curred in the courfe * of his practice, marked with the
moft ftriking peculiarities,  together with his fyftem of
cure.  And if nothing fhould occur which might me-
rit a relation,  let him produce a differtation on fome
medical fubject.   And  in cafe of neglect, let the delin-
quent be fubjected to a  reafonable fine,  and  let a re-
peated and obftinate omiffion  amouut even to an ex-
pulfion.
   Secondly—Let  our honorary  degrees be adminiftered
with the moft fcrupulous impartiality.—Let  merit be
the only ladder to diplomatic honors,  and whether in
youth  or in age, in affluence or penury, let the defer-
ving applicant receive a hearty welcome; and let a
perfonal  application, accompanied with proper  fpeci-
mens of meritorious worth, inftead of being deemed
an arrogant prefumption, be encouraged as a laudable
emulation.
   Finally— From the various  combinations of honor,
emolument and  improvement, may we not expect to
fee the faculty incited to a more clofe attention to the
laws of animal nature ; to  the power  and  operation of
medicine on the human fyftem ; and  a cheerful readi- 
C8
nefs to communicate whatever  may be interesting or
ufeful.  Genius arid induftry, however obfcurely lodg-
ed, will be encouraged by finding free accefs to honors
and emoluments; and the medical meetings in the fe-
veral counties, will, from the many sfeful communi-
cations, become interefting periods.   And, no doubt,
fuch collections  of knowledge  might  frequently be
made, as would adorn the clofet of every phyfician.
                         GIDEON  SHEPHERD.
A cafe of'that fpedes of Dropfy called ANASARIA, com-
 municated by Abraham Tomlinson,M. D. ofMilford.
    DANIEL BURNE, aged 58 years, middle flats re,
narrow chefted, light, eyes and hair, complained of
fhorl.iefs ofbieath and laflitude,  attended with  tumor
of his iesrs, fcrotum, end abdomen, to that decree as
nearly to hi1 a common  fized"flint  and trowfers,  and
was fo unwieldy as scarcely to  walk.   I had been  fick
during this period of Mr. Burne's illnefs, till he had ar-
rived to the ftate above defcribed.
   On my firft vifit, July 11, 1803, I found him given
over by his phyfician and friends, defparing of recove-
ry.  At this time his pulfe was feeble, little thirft, u-
rine fmall in quantity and high  colored, with coitive-
nefs and lofs of apetite.
   On confidering this cafe, I was of opinion that it o-
riginated from an  enlarged liver, occafioned by a too
free potation of ardent fpirits,  which over  ftimulated
the abforbent lymphaticks of the cellular  membrane,
and produced a paralyfis or torpor of the fame  (which
I name indireel debility) in confequence of which  the
cells of the cellular membrane  become  replete with a
mucilaginous fluid, which constituted the difeafe. 
69
  Having investigated the complaint,  (to my own fa-
tisfaction) I proceeded to the method of cure, found-
ed on the following data.
  I faid, (agreeing with Doct. Brown) it was neceffary
to begin the cure with ftrong ftimulants, fuch as fox-
glove, fquills, cuprifus falts, &c. and gave them in fuch
quantities as to produce naufea, by a continued irrita-
tion until  the lymphatic abforbents that open into the
cellular membrane, fhould become inverted and  pro-
duce a large flux of urine.
  For promoting this intention,  I felected the digita-
lis,  which I ufed in decoction,  prepared by boiling an
ounce of the dried leaves in a pint and a half of water
to half the quantity, to which I added one gill of fpi-
rits.f
  I gave two large table fpoonfuls for a dofe once in 4
hours for about 24 hours, which produced ficknefs and
gentle vomiting, at  this time a copious flux of  urine
commenced and continued for two or three days. The
quantity evacuated on the fecond day amounted to 3
gallons one pint and a half, afcertained by actual mea-
surement  ; the amount for the other days  was judged
to be more than  that on  the  fecond day, the whole
quantity difcharged was about 7 gallons.
  About  the  5th day the evacuation was completed,
and left him (to ufe a vulgar expreffion) nothing but
fkin and bones.
   When  I firft vifited this patient, the  compreffion
(occafioned by the tumor) on the arteries and abdomi-
nal vifera was fuch as greatly to impede the circulation
and fufpend  the periftaltic motion of the inteftines,
whence coftivenefs, &c.
  The  fudden removal of this preffure, reduced the
patient to great langour, fo much fo, that I found it ne-
ceffary to ufe opium in fmall repeated dofes' to prevent
fwooning, alfo to give a dofe of  rheubarb to evacuate
the contents of the bowels, which had the defired  ef-
  t Two additional decoctions were used in this c'is.e. 
70
feet.  After this I completed the  cure  by the ufe of
bark and iron, aided by wine and  occafionally opium.
  I gave as much as two drachms of filings, and half an
ounce of bark in fubftance, in 24 hours, in alterative do-
fes, at the end of 17 days difmiffed my  patient, conva-
lescent.
 A cafe of UTERINE POLYPUS removed by ligature.



  June 15th, 1809,  I was called to vifit Mrs. V. with
difeafe of the uterus.   Previous to her prefent com-
plaints fhe was very healthy, and induftrious, has one
child  twelve years, of age, her parturition  with  that
child without any extraordinary fymptoms, and en-
joyed perfect health for feveral years afterwards.  At
the time of my firft vifit, fhe complained of pain in
the facrum,  hips,  pubis, extending down the thighs,
with fenfation of bearing down, when in an erect posi-
tion.   Sometimes fhe paffed urine in fmall quantities
with  pain,  at other times in very large quantities,
without pain.  The menfes  were regular  as to the
time of their commencement, begining with pain, and
terminating  with hemorrhage.    For two years paft,
the catamenial evaucations were fmall in quantity and
without pain, for the  firft twelve hours after their
commencement, then began the moft violent pain in
the groin darting through to the facrum illium and
down the thighs to  the knee. Thefe pains were refer-
red to the bones by the patient.   The cafe had been
tleclared by  the phyficians who had vifited the patiest
afchirrous os tincce.  The patient had taken aftringents
both vegitable and mineral, to reftrain the hemorrhage,
and made ufe of injections into the vagina of prepara-
tions of lead, alfo worn fponge,  and taken conium 
71
  maculatum -9 under the ufe of thefe remedies the dif-
  eafe conftantly increafed.
     On examination, the parts exhibited the following
  appearances; paffing the finger about two inches into
  the vagina, a convex body was felt diftending the fides
  of the vagina.  The lower part of this body was per-
  fectly fpherical receding upon preffure like a prolapfed
  uterus, by preffing the tumor to  one fide of the vagi-
  na the finger paffing about an inch further, came to
  indurated parts, which upon fuperficial examination,
  appeared like the continuation of the fame tumor.
  Upon further examination, however, the finger could
  be paffed between the indurated parts and the tumor*
  until its diameter  was not more than half or three-
  fourths of an  inch.   Thefe indurated parts which
' furrounded the body of the tumor, and embraced a-
  bout two thirds of it, proved to be os tincce very much
  enlarged and indurated.  The enlargement of the os
  tincce was principally upon the right fide,  where it
  gave the feel of  another tumor.   The furface of the
  tumor was very fmooth and refilling to the touch.
    In uterine affections, it is of the laft importance, to
  discriminate between fungous excrescences and inver-
  fions of the uterus.  The infenfibility of the tumor,
  while the adjacent tumefied parts were very fenfible ;
  the form of the tumor, perfectly fpherical below, and
  diminishing its diameter above, until it terminated in
  a mere peduncle of an inch and a half in circumference;
  the fact that no caufe had been known to have exifted
  which could have produced invertion together with
  the frequent and profufe hemorrhages, were  the rea-
  fons which induced me to think the difease a fungous
  excrescence commonly called polypus.
    Not relying upon my own opinion folely in a cafe
  of fo much confequence, I afked counfel:—Dr. Eneas
  Monfon (whofe fuperior talents, and continued friend-
  fhip to me, I am  happy on every  occafion to acknow-
  ledge,) was the phyfician  who was called in confulta- 
72
 tion.  It was agreed that the  tumor was a polypus,
 that the only remedy was  extirpation, and the moft
 eligible mode, that by ligature.
   The  operation was delayed for fome weeks on ac-
 count of the debility of the patient, and her reluctance
 to the operation, and alfo, from the expectation that
 the  neck of the tumor would become elongated,  fo
 that the place of its infertion might be better ascertain-
 ed, and the application of the ligature facilitated.
   The laft catamenial evacuation previous to the appli-
 cation of the ligature came  one week fooner than or-
 dinary.   The evacuation as ufual was  moderate,  and
 without pain, for the firft twelve hours, then came on
 fevere  pain, for which warm teas were given and fo-
 mentations applied to the parts affected ; the pain cea-
 fed and the hemorrhage came on  fo violently  as  to
 threaten the life of the patient.  *Compd. tinct. ofvitl.
 and phofphorous acid were  given, cold vinegar and al-
 lum  applied without any effect. The hemorrhage was
 finally flopped by plugging  the vagina with a napkin,
 as directed by Mr. Burns in his treatife on uterine he-
 morrhage.  It was now determined to apply the liga-
 ture as foon as the hemorrhage fhould ceafe,  it being
 apprehended left the irritation of applying the ligature
 during the hemorrhage would increafe the evacuation,
 and the patient die in our hands.  The hemorrhage
 continued for three weeks, fome  part of the time pro
 fufely.   The patient had now loit her  color, and  was
 fo weak as scarcely able to  raife  herfelf in bed.  The
 patient  was now informed  by her phyficians that her
 flowing would  continue until the commencement of
 another period, which would not be far diltant,  and
 which {he could not furvive.  She  now gave her en-
 tire confent to the operation.   Hie common  double
 canula was ufed, bent to apply to  the convexity of the
tumor.  The ligature was a common fkein of fewing
filk braided.  The ends of the ligature were introdu-
  *See tenth vol. Med. Com. Phi lad, Dobson. 
*3
ced, through each tube of the canula, leaving a rioofe
out of the canula, fufficiently large to pafs over the bo-
dy of the polypus,  I attempted to pafs the ligature,
by firft paffing the canula, up  the fides of the  tumor ^
hut the polypus with  the canula fo completely filled
the vagina, that tjie finger could not be paffed to car-
ry over  the  ligature.   The  canula was  then with-
drawn, and the ligature attempted to be paffed before
it. After two hours exertions  to apply the ligature, it
failed, and it was very evident that it could not be done
by the common canula.  At this time the hemorrhage
was moderate, and the exertions made to pafs  the lig-
ature had not increafed it.   Mr. Coopers's improved
canula would have,  no doubt, anfwered the purpofe in
this cafe, but could not be procured at this time ; as a
fubftitute for it, I procured a very large probe needle,
eight inches in length, and about one eighth of an inch
in diameter ; above the eye of the probe was a large
head, to avoid lacerating the parts.  This probe an-
fwered the purpofe perfectly well,  and had the  adyant-
ageof Mr. Cooper's canula, on account of its fimplicity,
and in avoiding the danger of wounding  the tumor,
which muft attend the paffing the ferrules os the tubes
with his fork.*
   I threaded the eye of the * probe with the filk, the
probe being bent to apply to the convexity of the  tu-
mor.  The probe was readily paffed with the right
hand as far as the neck of the tumor, when with the
fore finger of the left hand,  the filk was kept in  its
place, while the probe was carried  round   the tumor,
until it came to the finger of the left hand, then with-
drawn and fliped off the ligature.  The two  ends of
the ligature without the vagina were drawn  through
both tubes of the canula, and made faft to its ears.
The ligature could have been carried further up, but
it was feared left fome part of the uterus would be
  * See Mr. Sam. Cooper's first lines of the  practice of surgery,
pace 107.
                       K 
74
embraced in the  noofe  of the ligature, which would
have proved mortal.
  Auguft 23d, 1809, the legature was tightened,  and
the hemorrhage  ceafed  immediately, and never ap-
peared afterwards.   The ligature was tightened every
day, ufing moderate force at firft, until the denfity of-
the neck of the tumor was ascertained.  I found great
advantage by inferting fmall pegs into the canula, to
prevent the cords from  retracting, until I had time to
make faft to the ears.  I was neceffitated to make ufe
of this, or fome other expedient, to gain a mechanical
advantage, on account of the hardnefs of the neck of
the tumor.  The patient took bark and wine, and her
health mended during the time  of the application of
the ligature.  The eighth day the canula came down,
inverting the tumor and bringing the neck to the os
externum.  On the ninth day the polypus was remov-
ed with the blunt hook—a very fetid fmell  was  per-
ceived in 24 hours after tightening the ligature.
  The neck of the polypus was not cut off where the
ligature was applied, but soughed off like  an umbili-
cal cord.  Two weeks after  the  polypus  had been re-
moved, an examination  was made, and the parts found
almoft reftored to a healthy condition as to fize,  an4
relative fituation.  Within the os tincae on the cervix
of the uterus a  roughnefs was felt where the pedun-
cle of the polypus had been attacked.  The health and
ftrength of the patient mended very faft,  the catame-
niae became perfectly regular in every refpect,  and in
three months fhe was able to attend to the  ordinary
bufmefs of her family,  and at this time,  Auguft lft,
1810, enjoys  perfect health.   The  polypus  weighed
four ounces ; it probably loft  as  much as one third of
its weight, from the time of applying the ligature un-
til it was removed.
                                    EL! IVES. 
75
Cafe of BILIARY CALCULI, by Dr. Lemuel JJop-
                      kins.           ;  -jM
"  Mrs. Millar, aged 52, of a fanguine choleric tempe-
 rament, the mother of 13 children, commonly healthy,
 except that fhe had been fubject to tranfient turns of
 jaundice, of fhort duration, for about 20 years, was ta-
 ken with dyfentery late  in the fummer 1797   Some
 of her family alfo had the fame malady,' of  which fhe
 loft a little fon.  This together  with the lofs of a fa-
 vorite fon of flattering hopes and adult years, fome
 months before, deprefled her fpirits exceedingly and
 feemed to retard complete  recovery.   Several  of the
 reft of her family the fucceeding fall were ill of the late
 epidemical fever, of which one  was fick 70 and anoth-
 er 90 days.  The agency of thefe caufes was  aided by
 her having recently paffed the period of menflrual ceffa-
 tion, and her labouring under  mental  depreffion and
 bodily infifmities ufual with  the  fex at that period of
 life.  She continued fome weeks under the fymptoms
 of general debility, confiderable emaciation and men-
 tal depreffion, tempered, however, with native  forti-
 tude.  In the courfe of the fall  or early in the winter,
 her eyes and fkin grew yellotv ; ftrong pain feized at
 times the  pit of the  ftomach,  extending along the
 courfe of the bile ducts, affecting in a very  depreflmg
 manner, the back at its junction with the diaphragm.
 In theprogrefs of the winter  the paroxyfms of pain in-
 creafed in force and frequency  of attacjs, till fhe was
 in almoft continual pain ; her eyes and fkin paffed thro'
 all the fliades of bilious yellownefs, till  the  latter be- 
7(3
her turns of vomiting became frequent, her feces were 4
of a lio-ht afh colour and tough, her weaknefs and ema-
ciation arofe to an alarming degree, and fhe had alfo  ,|
much faintnefs, till the  laft  of  February,  or early in
March, 1798, fhe was treated chiefly with tonicsjxirk,
&c. together with  fmall  dofes of opiates, under the
idea of nervous debility.  At that time it was advert-
ed to that her diforder was of the  Icteric kind, and
that biliary  calculi, paffing  the duct,  were the real
caufe of all her fymptoim.   A faponaceous  diluent
courfe was prescribed, along  with a quantity of opiates
fufficient, at allje vents, to render her pains at all times
tolerable.  Finding this,  however,  difficult, fhe was
bled after fhe  had  followed the  courfe about a month.
Weak and em a anted as fhe was, the  bleeding  gave
great relief, and the blood taken,  which was about 6
oz. in quantity, was very buffy.   The  next day  after
bleeding fhe took falts and manna.  When fhe enter-
ed  on this eourfe  a ftrict fearch  was enjoined  to de-
tect any calculous matter which might  pafs off in her
flools.  It was not long before fmall gravel and a han-
dy grit were daily found in quantity from a third of a
teafpoonful to three teafpoonfuls a day.   In the laft  of
March or beginning of April, after a paroxyfm of pain
difficult'to reprefs by a very free ufe  of opiates, flie
voided a gall-ftone of the fiz. of a large hazelnut, arid
about a week  after another of the fize of a nutmeg,  or
5-8ths of an inch  in diameter.   In the nucleus of the
firft were fome particles of land a?> fhe voided cement-
ed loofefly, by glutinous bile.   The nucleus of the  o-
ther was not apparent.   Both were made up of con-
centric lamina,  like the coats of an onion ;  the two
 outermoft of which were of a  chocolate  colour, the
 reft of a bilious yellow.  The furface of each had the
 polish of the finootheft pebbles on the fea fhore.   The
 form of the larger calculus was nearly globular, and no
 part of its furface  ir.dcuted. For ten  hours  before it
 paffed into the bowels, fhe  ii.oi: il>e moft excruciating 
77
  $ain, incapaole  of being fenfibly repreffed hy  very
  large dofes of opiates, together with an almoft incef-
t fant vomiting.    On voiding this her pains all vanifh-
  ed, leaving only a fenfe of forenefs and preffure, as fhe
  exprefled it, at the pit of the ftomach  for a few days ;
  the yellownefs of her fkin and eyes went rapidly off;
  her appetite and power  to digeft hearty food return-
  ed ; bile flowed  freely into her bowels,  and her flefh
  within 10 days  was fenfibly  increafed.  Even  then,
  nowever, fhe continued  to  void fome fand in her
  flools of a yellower hue  than that which came off be-
  fore the large calculi; for that was of a light colour,
  almoft like  floor fand, with a fmall portion of a choco-
  alte colour, but  the gravel was in part like whitifh flint
  gravel for colour, of a roundifh fhape, the reft of cho-
  colate colour, and the moft part flat and angular, like
  fmall pieces of broken flate-ftone.   Some, however, of
  both fand and gravel refembled fpermaceti for white-
  nefs.  Her  medicines, after fhe was treated as ill of a
  jaundice, confifted (lft, of opiates in larger and fmaUer
   dofes as occafion required, which  were commonly giv-
   en once a day in an enema.—(2d) Of the  galls of ani-
   mals infpiffated  to the confidence of pills by a  very mo-
   derate hsat.  In this way fhe  took  the galls of  22
   dozen of eels, and ftill more of that of hogs.—(3d) Bit-
   ter faponaceous pills.—v4th) Neut effervefc. mift.—
   (5th)  Such  diluents  as decoctions of  the opening
   roots, cheefe whey, weak green tea and other pleafant
   herb teas.—(6th) In her turns of puking, weak lean
   fowl broth, falted to  her tafte.—(7th)  Occafionally
   purges, whenever the bowels were tardy.  Thefe me-
   dicines, hojMever, were all ufed at the fame time,  O-
   piates, diluetits and gall, the  latter alternated with' the
   bitter faponaceous piils abovementioned, were the on-
   ly medicines conftaniJy ufed.   The  neut. effervescing
   mixture much  reiicve'd a faintnefs which often attend-
   ed  her, and more than any other drugg, opium excep-
   ted, counteracted puking. 
78
   A little camomel (gr. 2)  with hefitation was added
 to 2 or 3 of her purges at firft ; but in the latter part
 of the treatment was difcontinued.
   Are not mercurials, efpecially when  fo ufed as to
 enter the  habit, improper in fuch cafes ?
   Did not the light coloured fand and  gravel, which
 fhe voided before the large  calculus came off,  form in
 the biliary ducts, in their courfe between the large cal-
 culus and the entrance of the ductus communis  into
 the. duodenum, and alfo in  the hepatic duct, and not
 back of that obftruction in the gall cift ?
   Is it not important in fuch cafes of a total and long
 obftruction of the flow of the bile into the bowels, to
 throw fubftitutes  for that peculiar fluid into the firft
 paffages, afliduoufly ? and is there any fubftitute which
 can at all compare  with the gall of fuch animals as di-
 geft the food of man ?
   Is not infpiffation, in a very moderate heat, to a con-
fiftence proper for pills, the beft mode of preparing the
bile, efpecially for fuch  as cannot  take  bulky bitter
dofes ?
            To the Committee of Publications.
     Gentlemen,
The following cafe of retroverted Uterus may be important,
.  on account of thefimple tntans ufed to reflore the Uterus.
     September 23, 1808, Mrs A----, of New-Haven,
a woman of forty years of age, the mother of eight
children, in jumping from a horfe, felt  fomething
give way in the pelvis ; at this time fhe fuppofed her-
ielf to be about three months advanced in pregnancv.
The  fliock  was followed with great weaknefs; fenfiu
tion  of bearing  down, coftivenefs, dyfuria,  naufea,
and vomiting, and all the train of hyfteric fymptoms,
arifing from the ftomach, fympathizing with an irril
tating and  inflamed uterus, .  Thefe fymptoms  were 
19
 mppofed by the patient to arife from her pregnancy,
 and of courfe were endured with patience, until they
 increafed to a very alarming degree.  A period of
 fifteen days elapfed,  during which fhe  took a lit-
 tle caftor, valerian, &c.   At this time fhe was  ex-
 amined.   Entering  the  vagina, the  finger  met a
 tumor twice the fize of a hen's egg,  between the va-
 gina and rectum, prefling itfelf forward into the va-
 gina, and occupying two-thirds of the  os externum.
 A finger of the other hand was paffed into the rectum,
 by which it appeared that this tumor was a fack of
 the rectum filled with indurated feces, which fack had
 been  formed by the  preffure  of  the fuperincumbent
 Uterus; paffing the finger into the rectum, a little far-
 ther up, the rectum was entirely obftructed by the
 fundus of the uterus, beyond which the finger could
" not pafs, and on which it could make no impreffion.
 The uterus at the fame time was  felt by the finger in
 the vagina,  wedged firmly  between the facrum and
 pubis  and the os tincae, in the fuperior  and anterior
 parts of the vagina.   At this  time the ftomach could
 retain nothing—Strong fpafms  agitated the  fyftem
 frequently ;  bowels  were full and tenfe, particularly
 above the pubis ;  frequent  inclination  to pafs urine
 and flool, with much pain and diftention  in  the pu-
 bis.  The urine had  been entirely obftructed ; but
 for two or three days paft the patient thought fhe had
 paffed the ufual quantity of urine ; however the cath-
 eter was introduced, and eight pounds and three oun-
 ces of urine drawn off.  The rectum  was alfoemptied.
 The patient was laid upon her back,  her hips railed;
 in this pofition, with two  fingers  in  the vagina, and
 two in the rectum, exertions were made to reftore the
 uterus, until her phyficians were fatisfiedthat it could
 not be reftored in this manner.  The  patient was pla-
 ced on her knees and elbows, and repeated trials made
 to reftore the uterus,  but with no better fuccefs. The
 uterus was finally reftored by an inftrument refembling 
80
a probang,  made of a cylinder, the fize of the finger,
and eight or ten inches in length, on the end of which
a head was formed, by winding flax and covering it
with foft leather, as  large as could be paffed into the
rectum.  With this inftrument, oiled and introduced
into  the rectum,  the  patient on  her knees,  the
thorax lower than the pelvis, two  fingers in the vagi-
na, and much force applied by the  inftrument and fin-
gers, the uterus was raifed above the brim of the  pel-
vis.  The patient was enjoined reft and  a recumbent
pofture ; and after the ufual period of jeftationy was
delivered of a healthy child.
                       A Member of the Society.
    New-Haven, July 10,  1810. 
 
 
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