»' . * ->» "f . ' • ■ .1' :-Vj-> '•■■->**•• A>*'<* > . o A A ^" ''*'. *■ ''&■ . .--'•■:.jr^imZ ft --'j-'IP ■riwr^ w^ '& ,„*» ».«i Jr&tf&! .'Jj'irei y /; ffaJfj? a- .- s w'3s SURGEON GENERAL'S OFFICE LIBRARY. ■-----------------------■ / Section.fj^p ..--■ -«»*=A 1 3—513 • .'-* . . O ■■^ MEDICAL REPORTS, . Si/s s^j sv*.s*^f^ ON THE C^S* (pAt^/tk>€*~+ EFFECTS OF WATER, COLD AND WARM, AS A REMEDY IN FEVER AND OTHER DISEASES, Whether applied to the Surface of the Body, or used Internally. VOL. I. Including an Inquiry into the Circumstances that render Cold Drink, or the Cold Bath, dangerous in Health. To which are added, Observations on the Nature of Fever;—and on the Effects of Opium, Alcohol, and Inanition. VOL. II. Consisting of the Author's Experience of this Remedy subsequent to the second Edition of Volume I. And of important Com- munications from others on the same Subjedt. To which are added, Four Letters;—One on the Sphere of Febrile Conta- gion ;—Two on the Establishment of a Lunatic Asylum in Li- verpool ;—and One on the EfFedfs of Nitrous Acid in Lues Venerea. BY JAMES CURRIE, M.D..F.R.S. Fellow of the Royal College of Pbyjtcians, Edinburgh. Jntenthnet operationum, quas propofuimus (ut arbitramur) njeriffma: funt, remed'ia inters- tionibus fida. * * * Rem ipfam experimentum et comprobavit <.t promovebit. * * * Opera conjtli'i cujufque prudentiorh, Junt effeilif admirar.da, ordine quoque egregta, modis faciendi tanquam Bulgaria, Bacon. Hiftoria vitae et mortis. FROM THE FOURTH LONDON EDITION, CORRECTED AND ENLARGED, PHILADELPHIA PRINTED ; "OR JAMES HUMPHREYS, AND FOR BENJAMIN AND THOMAS KITE. 'ffXlZ? ?/?=>■ .w-»<- v\ TV .-•.'■• TO THE RIGHT HONOURABLE SIR JOSEPH BANKS, Baronet, and Knight of the Bath. President of the Royal Society, &c. Zsfc. &c. Sir, IN presenting this volume to you, I beg leave to say a few words on the views with which' it was written, and the circumstances that gave rise to the publication. About eighteen years ago, when I was at Edinburgh, it fell to my lot to write a paper on the influence of cold on the living bo- dy, for one of the societies of students, of which I was a mem- ber. In defending my speculations against some ingenious oppo- nents, a perpetual contradiction occurred as to facts, which a re- ference to original authorities, did not enable me to remove; for I discovered, that the accounts given of the temperature of the human body under disease, even by the most approved authors, are, with a few exceptions, founded, not on any exact measure- ment of heat, but on the sensations of the patient himself, or his attendants. Impressed with the belief, that till more accurate information should be obtained respecting the actual temperature in different circumstances of health, and disease, no permanent theory of vi- tal motion could be established, nor any certain progress made in the treatment of those diseases in which the temperature is dimin- ished or increased. I have occasionally since that time, observed and recorded such facts as related to the subjedl ; intending, one day or other, to lay my observations before the public, if they acquired an importance that deserved attention. In the outset of this undertaking, nothing seemed wanting but accurate thermo- meters, and a moderate portion of time and attention ; and I era- braced in imagination the whole effects of temperature upon healt- ir dtnd disease ;—a range of inquiry which experience has convinced me it would be temerity and folly to hope to go through. In this general view of the subject, some valuable communications have however been made to me by my much respected friend Dr. Per- cival ; which do not apply to the particulars treated of in the fol- lowing volumes, but which I am not without the hopes of specify- ing at some future period, when I may have occasion to employ them. Though I have some time seen, that the delay of publishing till my original plan was executed, was likely to render my la- bours wholly abortive, or to convert the imperfect product from ?. gift into a legacy ; yet I should not have given to the world so detached and unfinished a work as the present, according to the views I had originally entertained, but for the circumstances I am about to relate* By the accounts received at the beginning of the present yeaf^ the fever of the West Indies appeared to continue its desolating progress with little abatement, and in America to be beginning its ravages anew.—With this pestilence, science seemed hitherto to have contended; in a great measure, in vain, and new methods of opposing it, were not merely justifiable, but requisite. At this time an account of the success of the nitric acid in Lues Venerea and Hepatitis, as employed by your correspondent Mr. Scott, of Bengal, Was, through your means, given to the public. His the- ory, suggested by the new ehymistry, did not appear promising j but k was neither wise nor candid to reject his experience on that account. The first trials which I made of his practice persuaded me, that, though the success of the nitric acid might have been exaggerated by a warm imagination and a benevolent heart, it as* sttredly did succeed in certain cases of the diseases in question, anel that a remedy of considerable power and of perfeti safety, was intro- duced into medicine. These opinions subsequent experience has served to confirm. In the fever of the West Indies mercury had been mirch employed, and though different notions were enter- tained of its mode of operation, it seemed on the whole the most approved remedy. Since the nitric acid appeared to be a substi- tute for mercury in other cases, it seemed reasonable to tfy its ef- fects in this fatal fever.. I suggested this practice by letter to some practitioners in the West Indies, and I submitted my notions on the subject to you •, sensible that your character and station might bring that into immediate notice, which the influence of a private individual could but slowly effect.—Whatever difference there ^ight be in some of our opinions, I was confident there was non-p V in our wishes for alleviating human misery, and mitigating the destruction of this desolating war. Your conduct even exceeded my expedtation. Our correspondence on this occasion turned my views to the other means of opposing this pestilence. Ablution with cold water in fever had been so long employed at the hospital here, and in private practice, by my friends and colleagues Dr.- Brandreth and Dr. Gerard, as well as myself, that it was become general in Li- verpool, and common in the county of Lancaster. So long ago as the year 1791, a general statement by Dr. Brandreth of its advan- tages had been published by Dr. Duncan, in the medical Commen- taries of that year. It had also been noticed by me in the Philo* sophical Transactions for 1792, and I had repeatedly mentioned it in private correspondence ; it had often been recommended to the surgeons of African ships in those examinations required by the legislature, and which are chiefly made by the physicians and surgeons of our hospital. On different occasions likewise I had not only explained, but exhibited the practice, to practitioners from a distance, and particularly to one or two going to the West Indies. A method of treatment so bold, and so contrary to com- mon prejudices, made however, as it appears, slow progress. The mode of operation of our remedy has been misapprehended; the proper period for using it has not been understood; and on some occasions having been resorted to improperly, the consequences have brought it into disrepute. Reflecting on these circumstan- ces, and exposed by situation to the reiterated sounds of death from the Western world, my decision was speedily made: I re* solved no longer to delay an account of our treatment of fever, in the expectation of including it in a larger field of discussion, and of presenting it in a form more conducive to reputation ; and the fruit of this determination is the work now presented to you. In treating my subjects, perspicuity has been studied rather than ri- gorous method ; I have every where endeavoured to make my steps so plain, that they may be distinctly traced ; the most important points are impressed again and again to guard against mistake; my thermometrical observations have enabled me to give a preci- sion to the directions for the use of the affusion of cold water which otherwise they could not have had ; and, if I do not flat- ter myself, have laid a foundation for my reasonings, which spe- culations on fever have seldom possessed. I have guarded against the unnecessary use of technical as well as of general expressions. It were better perhaps that medicine, like other branches of na« tural knowledge, were brought from its hiding-place, and exhi- bited in the simplicity of science, and the nakedness of truth. If VI it had been in my choice, I would not have adopted the language of theory, like Boerhaave, or Sydenham ; but have exhibited a medical work in the phraseology that Bacon, had he lived in our days might have used. Unfortunately in the present state of me- dical knowledge, wholly to avoid the language of theory is im- possible. The corruptions of false doctrines must remain more or less, in our phraseology, after the doctrines themselves are ex- ploded ; since custom has rendered the expressions in which they are found, intelligible, and human sagacity has not yet discovered those first principles of living motion, by which the doctrines and the language of physiology might at once be reformed. Hence the term re-atlion is applied to certain motions of life, though in a sense very different from that in which it is used in the science of inanimate motion from which it is borrowed ; and such words as tone will still be found in the following pages, though the theory that introduced them into medicine be universally abandoned. The use of such expressions is however an evil, justified only by necessity; and I have endeavoured to avoid it as much as lay in my power. Possibly this notice may procure me some readers among men of general science; and this I confess to be one of my objects in dedicating the work to you. It is naturally an author's wish that his book may be read by those who can appreciate it, and who from their situations may have it in their power to bring its pre- cepts into practice. In both these points of view I appeal to you— to your scientific knowledge, and to your generous heart. The work that I address to you is in a great measure practical. A man of genius, at the head of a fleet or arrny, would probably find lit- tle difficulty in understanding it; and possibly, if he understood it, there might be occasions on which it would afford scope to his humanity and patriotism. But whatever be its fate with men pro- fessedly military, I trust it will not be overlooked by the medical practitioners of our fleets and armies ; a most meritorious class of the profession, to whom a great part of the improvements in the modern practice of medicine is to be ascribed. Conceiving that the circulation of this volume, as well as its usefulness, might be extended by connecting the history of the af- fusion of cold water in fever, with other views of the same reme- dy, and with a few observations on the other remedies in fever, I have entered upon these points, without any very strict regard to method; and have been insensibly led to speak of some of the operations of temperature on the body in health, a subject which I had reserved. Such as it is, this volume may serve as the first of vii i series on similar subjects, if I should ever write them; and it may I hope, stand alone, if I should write no more. I am sensible that some of these particulars would have appear- ed with more propriety in a professed preface; but having enter- ed on certain explanations in my address to you, I have given the whole of these preliminary observations in the same form ; a free- dom that I trust you will forgive. I cannot conclude without declaring the sense I entertain of your candour and politeness, Accept the tribute of my respect.—May you live long to cultivate and protect the sciences—the sciences, whose utility is beyond dispute ; whose progress is superior to ob- struction ; and which, of ajl the possessions of man, seem least to partake of the imperfection of his nature! I have the honour to be, Sir, Ypur faithful and very obedient Servant, JAMES CURRIE. Liverpool, Slst Oaober. 1797. ADVERTISEMENT TO THE THIRD EDITION. AN Apology is perhaps required for the delay -which has occur- red in presenting the third edition of this ivork to the Public*. and especially to those Gentlemen by whose communications it is en* nched. The immediate pressure of my professional duties, and an im- perfeB state of health, have occasioned this delay. These circumstan, ces must also plead my excuse for the work being printed with less accuracy than could be wished, and without the advantage of a new arrangement, which it was once my intention to have given it. But the r0pwus Table of Contents and Index, will in some measure sub- ply this defecl. y q r CONTENTS OF VOLUME I Chap. I. Narrative of Dr. Wright. In a voyage from Jamaica to Liverpool, he employed affufion of cold water in fever, 17 Chap. II. Hiftory of a fever -which broke out in the Liverpool Infirmary. The affufion of cold wacer firft pra&ifed in this fever by the author, Decemb. 1787, 21 Chap. III. tiiftory of a fever -which occurred in the $otb Regiment* H w produced, - - • - - 23 Situation and fymptoms of the fick, - - - 2* The progrefs of the infection how flopped, - - - a5 \n what lituations this practice may be imitated, - . - 26 Chap. IV. The manner in -which the affufion of cold -wtter Jhould be ufed in fever. The kind of fever in which it is to be ufed, - - - 27 The time and manner of ufing it, . - - - 28 Not to be ufed in the cold ftage, nor when the heat is below what is natural, nor in the fweating flag?, - - -. - - 29 Chap. V. Cafes in -which the affufion of cold water -was ufed in different ftages of fever. Seven cafes detailedi - - - - - 3£ Compatifon xii Chap.II. Thefubjefl continued. Remarks on Scaoatina from different writers, - - - 275 Remarks by the author, with his practice in this difeafe, - -376 Cafes of confluent Small-pox ending fatally, - - - 285 Communications from Dr. Giegory on Scarlatina, - - 287 Application of the cold affufion to Cynanche Tonsillaris, - - 295 j.'_..- ■ ■■---------Influenza, - - - ib. Effect of the warn affufion in a.cafe where laudanum wat fwallowed by miftake, 296 Chap. III. Communications to the Author refpeSiing the ufe of the cold and tepid affufion in diffe ent parts of Great Britain. Vie ot the cold affufion, by Dr. Dimfdale, - 299 1 —Gregory of Edinburgh, - - - 304 Dr. Reeve's account of its ufe in the clinical wards by Dr« J. Home, - ib. Communication from Dr. Bree of Birmingham, - 306 Ufe of the cold affufion by Mr. Marfhall, ... 310 —■—>----■--------- by Dr. Reid, London, - - . - 314 -' '" . "-by Dr. Scott, Ifle of Man, - - * ib. Chap. IV. Some account of the ufe of the cold affufion in Fevers on ship-board. Ufe of the cold affufion by Mr. Wilfjn of the Huffar, - - 316 Ule of ;he cold lavation by Dr. Trotter, phyfician to the rteet, - - 317 Ufe of the cold affufion by Mr. Farquhar of the Tartar, - - ib. V(e of the cold affufion by Mr. Magrath of the Ruffel, - 318 Account of the fever on board the Acfa;on, - - - 320 Communication from Dr. Carfon, - 322 Ufe of the cold affufion by Mr. Simpfon of the Naiad, - - 323 -----——----------by Mr, Nagle of the Ganges, - - 324 ; .------by Dr. Baeta of Lifbon, - - 331 " ---—by Dr. Gomez, phyfician to the Portuguefe fleet, 332 Chap. V. Some account of the ufe of the cold affufion on fhore in the -warmer climates. Ufe of the cold affufion in Minorca by Mr. Dewar, - - 340 - ;---—■------.----in Egypt, - 344 Communication from Mr. McGregor, fuperintendant furgeon of General Baird's army there, - - . . . - 345 The cale of Sir John Chardin in Perfia, ... 347 Quotations from Biuce on the ufe of the cold affufion in Abyflinia, - 352 Dr. M«Le»n's account of the ufe of the cold bath in two cafes of fever in India, 353 -----——in the fever of St. Domingo, - - _ 354 Dr. Jackfon's ufe o; the cold bath there, T ... 355 Ufe of the cold affufion by Dr. Orde in Demarary, . . . 358 - ---— Dr. Chifholm, . . . 360 ».<■' Dr. Macneill, in Guiana, . .361 Ufeof the col affufion by Dr. Robertfon in Barbadoes, 365 ■ Dr. Davidson in St. Vincents, . . 367 Account of its introduction at Philadelphia bv Dr. Stevens, with remarks, 370 Ufe of the cold affufion by Drs. Selden and Whitehead, of Virginia, . 373 Conclusion—Communications with Dr, Wright, . . 377.378 C"AJ'rV1'r Addlt'l0nal '^formation refpeSing the ufe of the cold and tepid affufion of -water in fever, fince May, 1804, . . Communications from Dr. Barry and Dr. Daly of Cork, og< Hiftory of a fever among the French prifoners at Stapleton, . . * 387 '■ "-.—"------———in the Horfe-Guards at Canterbury, . . ,q, borne particulars of the fatal epidemic at Gibraltar ' ,06 Notice qf a fever in the Suffex Militia at Chelmsford, . . IL 9 Concluding obfervations, . H * 405 APPENDIX. Two l,ne?r' ^k*' 4nur?vPr°Priet? °f, annexin8 Feve<--Wards to general hofpitals, 407 Two letters on the eftabl.lhment ot a Lunatic Afylum at Liverpool, T,a letter to Dr. Beddocs on the Nitric Acid, P * 4£ xiii INDEX TO THE FIRST VOLUME. ABLUTION of the body with cold water, its ufe in fever, r - 17 m________________________employed by De Hahn, in the fever of Breflaw, 1737, 69 Affufion of cold water on the furface of the body ufed by Dr. Wright, - 17 -mp1"-""* in a fever in the Liverpool Infirmary, 21 trmpt'"'"'4 in a fever in the 30th regiment, - 23 ___^_________manner of ufing it in fever with cafes, - - - 28 ___,--------------—ufed with different impregnations, 4° precr'tJT" required in ufing it, illuftrated by cafes, - - 43 trnfr of fever in which it was not falutary, - 49 ufed in fmall-pox, - ■< - - - 53 fcarlatina anginofa, . - - 60 Affufion, temperature of the water employed, - - - - 63 its effects in fever explained, - - - - J77 various accounts .of its fuccefs in fevers on fhip-board, - - 18* Affufion of tepid water on the furface of the body, its cooling effects, - - 64 1---------.—how and when to be employed, *>4 _______________________not fo effectual in fever as the affufion of cold water, 65 this explained, ----- 179 Alexander the Great, fuffeiings of his army from imprudent drinking of cold water, 84 ________________________his own illnefs from bathing in the Cydnus, explained, 91 Alcohol, obfervations on its effedts in health and difeafe, - - 2°° Antimonials, their effects explained, - J97 B Bath, cold, fome account of its ufe in fmall-pox, - 59 - ufed by Galen in fever, - - - - _ - 85 1 when fafe, in health and difeafe, 9° ---------—cafes and hiftories illuftrating this, ' - - - 93 ———— ufe of it in convulfive difeafes, - 105 ------------cafe of infanity in which it was fuccefsful, - - *34 ------------precautions neceffary in employing it in infanity or convulfions, - 138 ------------propofed to be employed in fever of the Weft Indies, and in the plague, 183 Bath, warm, ufed in infanity, -- - - - - '35 ——— ufe of, propofed to he revived in the Weft Indies, - - 194 i. its reftorative effects after fatigue, - - - - 194 ———— general obfervations on it, - - - *95 Baths, Ruffian, their temperature, - - - - I01 1 ancient, obfervations on. - - - - - I02 c Cold, its ftimulant powers afferted and explained, - - - 67 ■ external, dangerous after profufe fweating, - 193 -----its operation in inflammatory difeafes, - - - 2°3 Convulfive difeafes, cafes of, with various remedies, - 106 Cydnus, river, account of, » - - - 95 D Diet of the poor, remarks on - - - * 239 Digitalis ufed in infanity, - - - * "I53 XIV E Emetics, their operation in fever explained, - J97 Evaporation, fuppofed to regulate the animal heat. - - - 189 F Fever, hiftories of, - - -.- - I7-J97 ■cafes of, detailed, - - - " 31 remarks on the nofological arrangements of, - - 48 cafe of, not included in thefe, - - 49 ■ hectic, remarks on, - - - - " "5 theories of, ancient and modern, - - - - - 162 H Heat, animal, ftate of in fever, cafes which fhew this, - - 31 ------------method of examining, - - • - 41 -------------hiftory of the changes of, in the paroxyfm of fever, - 172 ■------------ its origin, - 184 how regulated, •- 186 Hydrophobia not an inflammatory difeafe, - - 133 ——— diftindt in its nature from tetanus. - - 133 I Immerfion in water fait and frefh, cold and warm, experiments on, - 145 Inanition, cafes of, - - - - - 207 Inhalation by the fkin, generally believed by the ancients, - - 187 » afferted by Haller, and the moderns in general, 205 __————— experiments which render it doubtful; - 206 . denied by Seguin, - 219 —^—————— extract of an account of his experiments refpedting it, 222 ■ experiments of Dr. Rouffeau which difprove it, 227 Intoxication, lingular method of recovery from, - 201 Inunction of the furface of the body mentioned by Homer, - - 74 . ■ the ufe of by the Romans, - 93 _______________ general among the ancients,, - - "93 L Liverpool, population of, with remarks, - 230 ————i- prevalence of fever among the poor, - - 231 .--------charitable eftablifhments, account of, - - 232 --------comparative ficklinefs of the different months among the poor, 234 houfe of recovery, hiftory of the - . - - 245 M Mania, remarkable cafe of, cured - 134 Maniacs, their refiftahce of cold and contagion, - - 139 Merfey river at Liverpool, not falter at high than low water, 40 Miffiffippi river, waters never injurious to thofe who drink them, and why, 98 o Opium, ufed in a cafe of infanity, - - - 134 —— operation of in fever and in health, remarks, on, - - 198 P Perfpiration, infenfible, its effects in cooling the body, - - 187 '■■■ more plentiful in warm than cold weather, - - 188 ——— quantity of, - - ■ - - ib. ————— fenfible, remarks on, - - - - 190 ——— matter of in the European, not fitted to the torrid zone - 193 Plague, cured by immerfion in the fea - . - 183 R Refoiration, modern theory of . . _ 185 XV S Shipwreck, remarkable hiftory of, with an account of its effects on the mariners, 140 Small-pox, obfervations and experiments refpedting, - - 58 Springs, temperature of in different climates -* - - 97 T Tetanus, cafes of, ----- 106 Two new cafes of, treated fuccefsfully - - . - 127 Thermometers, account of - - » 41 ————— how to be applied in taking the human heat, - 41.160 Thirft, nature of, - - - - - 178 Thirft, obfervations on the relief obtained in, by the affufion of water, orim- metfion in the bath, - - - - 178.219 Tobacco, its ufe in convulfive difeafe - 123 w Water, cold, ufed as a drink in fever by the ancients, - 69 ————— authorities for this practice, 75 againft it, - - - 76 1. rules for ufing it in fever, . - - - 78 1 in health - 79 1 cafes illuftrating the circumftances under which cold drink is dangerous, - - - - - - 81 ————— cafe of convulfions cured by it, - 126 ■ how to be ufed in fever of the Weft Indies, and in plague, 181 ® INDEX TO THE SECOND VOLUME. A Adtaeon, receiving fhip at Liverpool, fever on board of her extends to the channel fleet, - - 320 Affufion of cold water, cafes in which it was lefs fuccefsful than ufual, - 2^3 remarkable inftance of its fuccefs communicated by Mr. Dal- rymple of Norwich, ----- 268 ' -communications to the author refpedting its fuccefs in different parts of Great Britain, ----- 298 ■ various accounts of its fuccefs in fevers on fhip-board, 314-354 various accounts of its fuccefs in fevers on fhore in the warmer climates, . - - - - - 340 ■unfuccefsful at Philadelphia, as communicated by Dr. Stevens, 370 Affufion of tepid water ufed by the author in certain cafes of typhus, . 265 Affufion of warm water, remarkable cafe of the effects of, . • 296 Antimonials, their effects explained, . . . 367, 382 c Contagion, febrile, fphere of, letter to Dr. Clark respecting, • • 407 D Digitalis ufed in the inflammatory difeafes, . . • 273 Dyfentery, epidemic, in Liverpool, account of, . • • 261 XVI F Fever, hiftory of, . . , 264 ■ cafes of, detailed, ..... 299 • icarlet, cured by affufion of cold water, . . . 283 remarks on, . . . . . 275 G Gomez, Dr. Bernadino Antonio, his account of the extraordinary fuccefs of the cold affufion and lavation, on board the Portuguefe fleet. . 332 I Influenza, ufe of tepid affufion in, . . . .295 ■ ufe of cold affufion in ... . 378 L Liverpool, Lunatic Afylum at, letters refpedting, • - . 414 N Nitric acid, its effects in Syphilis, letter to Dr. Beddoes refpedting, . 426 P Perfian phyficians, their practice in dyfentery, . . . 347 ■ their practice in fever, . . . ib. Plague, cafes of, cured by expofure naked to the dews of night, 260.345 ■ ■ cold drink, and the cold bath recommended in, . . 345 ——— cured by immerfion in the Nile, - . • 260 ■ treated fuccefsfully by fponging the furface with vinegar, &c. 345 s Small-pox, cafes of, treated by the affufion of cold and warm water, . 285 w Water, how ufed by the Egyptians in their burning fever, . ... 351 in Nubia and Abyflinia, ... 352 MEDICAL REPORTS, &c. a CHAPTER I. i® Narrative of Dr. Wright. IN the London Medical Journal for the year 1786, Dr. William Wright,* formerly of the ifland of Jamaica, gave an account of the fuccefsful treatment of fome cafes of fever by the ablution of the patient with cold water. " On the id of Auguft, 1777," fays Dr. Wright, " I embarked in a (hip bound to Liverpool, and failed the fame evening from Montego Bay. The matter told me he had hired feveral failors on the fame day we took our departure j one of whom had been at fick quarters on fhore, and was now but in a convalefcent ftate. On the 23d of .Auguft we were in the latitude of Bermudas, and had.had a very heavy gale of wind for three days, when the abovementioned man relapfed, and had a fever, with fymptoms of the greateft malignity. I attended this perfon often, but could not prevail with him to be removed from a dark and confined fituation, * Ndw Prefident of the College of Phyficians, Edinburgh, (1833.) i8 to a more airy and convenient part of the fhip; and as he refufed medicines, and even food, he died on the eighth day of his illnefs. " By my attention to the fick man I caught the con- tagion, and began to be indifpofed on the 5th of Sep- tember, and the following is a narrative of my cafe, ex- tracted from notes daily marked down : I had been many years in Jamaica, but, except being fomewhat relaxed by the climate, and fatigue of bufinefs, I ailed nothing when I embarked. This circumftance, how- ever, might perhaps difpofe me more readily to receive the infection. " Sept. 5th, 6th, 7th, Small rigors now and then—a preternatural heat of the fkin—a dull pain in the fore- head—the pulfe fmall and quick—a lofs of appetite, but no ficknefs at the ftomach—the tongue white and flimy—little or no thirft—the belly regular—the urine pale and rather fcanty—in the night reftlefs, with ftart- ing and delirium. " Sept. 8th, Every fymptom aggravated, with pains in the loins and lower limbs, and ftiffnefs in the thighs and hams. " I took a gentle vomit on the fecond day of this illnefs, and next morning a decoction of tamarinds; at bed time, an opiate, joined with antimonial wine; but this did not procure deep, or open the pores of the fkin. No inflammatory fymptoms being prefent, a drachm of Peruvian bark was taken every hour for fix hours fuc- ceffively, and now and then a glafs of port wine, but with no apparent benefit. When upon deck, my pains were greatly mitigated, and the colder the air the better. This circumftance, and the failure of every means I had tried, encouraged me to put in practice on myfelf what I had often wifhed to try on others, in fevers fimilar to my own. *9 <■' Sept. 9th, Having given the neceffary directions, about three o'clock in the afternoon I ftripped off all my cloaths, and threw a fea- cloak loofely about me till I got upon the deck, when the cloak alfo was laid afide: three buckets full of fait water were then thrown at once upon me; the fhock was great, but I felt immediate relief. The head-ach and other pains inftantly abated, and a fine glow and diaphorefis fuceeeded. Towards evening, however, the fame febrile fymptoms threatened a return, and I had again recourfe to the fame method as before, with the fame good effect. I now took food with an appetite, and for the firft time had a found night's reft. " Sept. 10th, No fever, but a little uneafinefs in the hams and thighs—ufed the cold bath twice. " Sept. 11 th, Every fymptom vanifhed, but to pre- vent a relapfe, I ufed the cold bath twice. " Mr. Thomas Kirk, a young gentleman, paffenger in the fame fhip, fell fick of a fever on the 9th of Aug. His fymptoms were nearly fimilar to mine, and having taken fome medicines without experiencing relief, he was defirous of trying the cold bath, which, with my approbation, he did on the nth and 12th of Sep- tember, and, by this method, was happily reftored to health. He lives at this time (Jan. 1786) near Liver- pool." To this interefting narrative, Dr. Wright adds fome general obfervations on the traces that are to be found of the ufe of cold water internally and externally in fevers, in feveral works ancient and modern. But whether he himfelf purfued this practice any farther, I have not been informed. Having before experienced that Dr. Wright was a 20 fafe guide,* I immediately on reading this narrative, determined on following his practice in the prefent in- ftance; and before an opportunity occurred of carrying my tntentioo into effect, I was further encouraged, by learning, that my refpectable colleague, Dr. Brandreth, had employed cold water externally in fome recent cafes of fever with happy effects. * See a paper in the Memoirs of the London Medical Society, vol. A p. 147, to be found in a subsequent part of this volume. 21 CHAP. IL Hiftory of a Fever which broke out in the Liverpool Infirmary. ON the 9th of Dec. 1787, a contagious fever made its appearance in the Liverpool Infirmary. For fome time previoufly the weather had been extremely cold, and the difcipline of the houfe, owing to caufes which it is unneceffary to mention, had been much relaxed. The intenfity of the cold prevented the neceffary degree of ventilation, and the regulations for the prefervation of cleanlinefs had been in fomemeafure neglected. Thefe circumftances operated particularly on one of the wards of the eaftern wing, employed as a lock-hofpital for females, where the contagion firft ap- peared. The fever fpread rapidly, and before its pro- grefs could be arretted, fixteen perfons were affected, of which two died. Of thefe fixteen, eight were under my care. On this occafion I ufed for the firft time the af- fufion of cold water, in the manner defcribed by Dr. Wright. It was firft tried in two cafes only, the one on the fecond, the other on the fourth day of fever. The effects correfponded exactly with thofe mentioned by him to have occurred in his own cafe ; and thus encouraged, I employed the remedy in five other cafes. It was re- peated daily, and of thefe feven patients, the whole recovered.—In the eighth cafe, the affufion of cold water feemed too hazardous a practice, and it was not employ- 22 cd. The ftrength of this patient was much impaired by lues venerea, and at the time of catching the contagion, fhe laboured under ptyalifm. I was not then aware that this laft circumftance formed no objection againft the cold affufion, and in afituation fo critical, it was thought imprudent to ufe it. The ufual remedies were directed for this patient, particularly bark, wine, and opium, but unfuccefsfully; fhe died on the 16th day of her difeafe. From this time forth, I have conftantly wifhed to em- ploy the affufion of cold water in every cafe of the low contagious fever, in which the ftrength was not already much exhaufted j and I have preferved a regifter of a hundred and fifty-three cafes, in which the cure was chiefly trufted to this remedy. Of thefe, ninety-four occurred in the hofpital in the four years fubfequent to the period already mentioned, twenty-feven in private practice, and thirty-two in the 30th regiment of foot, when quar- tered in Liverpool in the year 1792. Of late (1797) I have not thought it neceffary to regifter all the cafes in which this remedy has been employed. Having fatisfied myfelf of its extraordinary efficacy, and of the precautions neceffary in ufing it, I have found it the £horter method, as well as the more inftructive, to re- cord the inftances in which it has proved unfuccefsful. To detail the whole of my experience would be a tedious and an ufelefs labour. I purpofe to digeft the refults under a few diftinct heads, fupporting and il- lustrating each general propofition by an ample detail of cafes. Before, however, this preliminary account is clofed, it will be ufeful to enter more particularly into the hiftory of the contagious fever which broke out in the 30th regiment, beeaufe the account of its rife, pro- grefs, treatment, and termination, will fupport in a ftriking manner, the doctrines I wifh to eftablifh, and if I do not greatly deceive myfelf, may afford important inftrudtion, as well as encouragement, to thofe whofe duty may call them to oppofe the progrefs of contagious Acver in fimilar fituations. 21 CHAP. III. Hiftory of a Fever which occurred in the $Qtb Regiment, THE 30th regiment, as is ufual with troops in Liverpool, was billeted in the town, but paraded and mounted guard in the fort, fituated north of the town, on the banks of the river. The general guard- room had been ufed previous to the arrival of the 30th, as a place of confinement for deferters; it was extremely clofe and dirty, and under it was a cellar, which in the winter had been full of water. This water was now half evaporated, and from the furface iffued offenfive exhalations. In a dark, narrow, and unventilated cell, off the guard-room, it was ufual to confine fuch men as were fent to the guard for mifbehaviour, and about the 20th of May 1792, feveral men had been fhut up in this place on account of drunkennefs, andfuffered to remain there twenty-four hours, under the debility that fuc- ceeds intoxication. The typhus, or jail fever, made its appearance in two of thefe men about the firft of June, and fpread with great rapidity. Ten of the foldiers labouring under this epidemic, were received into the Liverpool Infirmary, and the wards allotted to fever could admit no more. The contagion continuing its progrefs, a temporary hofpital was fitted up at the forr, 24 and I was requefted to give my affiftance there to the furcreon of the regiment, by Captains Brereton* and Torriano.f In two low rooms, each about fifteen feet fquare, were fourteen patients labouring under fever. They were in different ftages of its progrefs: one was in the fourteenth day of the difeafe, two were in the twelfth, and the reft from the ninth to the fourth inclufive. The fymptoms of the fever were very uniform. In every cafe there was more or lefs cough, with mucous expectoration : in all thofe who had fuftained the difeafe eight days and upwards, there were petechias on the fkin; in feveral there were occafional bleedings from the noftrils, and ftreaks of blood in the expectoration. The debility was confiderable from the firft, and it had been increafed in feveral cafes by the ufe of venefection, before the nature of the epidemic was underftood. The pulfe varied from 130 ftrokes in the minute to 100 ; the heat rofe in one cafe to 105 deg. of Fahrenheit, but was in general from 101 deg. to 103 deg.; and towards the latter ftages of the difeafe it was fcarcely above the tem- perature of health.—Great pain in the head, with ftupor, pervaded the whole, and in feveral inftances there oc- curred a confiderable degree of the low delirium. Our firft care was to ventilate and clean the rooms, which were in a high degree foul and peftilential. Our fecond was to wafh and clean the patients themfelves. This was done by pouring fea-water, in the manner already defcribed, over the naked bodies of thofe whofe ftrength was not greatly reduced, and whofe heat was fteadily above the temperature of health. In thofe ad- vanced in the fever, whofe debility was of courfe great, we did not venture on this treatment, but contented our- * Now Colonel Brereton of the 63d foot. f The gallant and accomplished officer who fell, soon after at the heights of Pharon3 in the defence of Toulon. 25 ilves with fpunging the whole furface of the body with. tepid vinegar, a practice, that in every ftage of fever is falutary and refreshing. Our next care was to flop the progrefs of the infection. With this view, the guard-houfe was at firft attempted to be purified by warning and ventilation, the greateft part of its furniture having been burnt, or thrown into the fea. All our precautions and exertions of this kind were however found to be ineffectual. The weather was at this time wet, and extremely cold for the feafon; the men on guard could not be prevailed on to remain in the open air; and from paffing the night in the infected guard-room, feveral of the privates of the fucceffive reliefs, caught the infection, and fell ill on the 10th, nth, and 12th of the month. In feveral of thefe the fever ran through its courfe; and in others it was im- mediately arrefted by the affufion of fea-water as already defcribed. No means having been found effectual for the purification of the guard-room, it was fhut up, and a temporary fhed erected in its ftead. Still the conta- gion proceeded; on the morning of the 13th three more having been added to the lift of the infected. On that day, therefore, the whole regiment was drawn up at my requeft, and the men examined in their ranks: Seven- teen were found with fymptoms of fever upon them.—It was not difficult to diftinguifh them as they flood by their fellows. Their countenances were languid, their whole appearance dejected, and the tunica adnata of their eyes had a dull red fuffufion. Thefe men were carefully feparated from the reft of the corps, and im- mediately fubjected to the cold affufion, always repeated once, and fometimes twice a day.—In fifteen of the number the contagion was extinguifhed; but two went through the regular difeafe. On the fame day, the com- manding officer, at my defire, iffued an order for the whole of the remaining part of the regiment to bathe in the fea; and for fome time they were regularly mufter- 4 26 ed, and marched down at high water, to plunge into the tide. Thefe means were fuccefsful in arrefting the epidemic: after the 13th of June no perfon was attacked by it. It extended to fifty-eight perfons in all, of which thirty* two went through the regular courfe of the fever, and in twenty-fix the difeafe feemed to be cut fhort by the cold affufion. Of thirty-two already mentioned, two died. Both of thefe were men whofe conftitutions were weak- ened by the climate of the Weft Indies; both of them had been bled in the early ftages of the fever; and one of them being in the twelfth, the other in the fourteenth day of the difeafe when I firft vifited them, neither of them was fubjected to the cold affufion. The water employed on this occafion was taken up from the river Merfey clofe by the fort. It was at that time of a tem- perature from 58 deg. to 60 deg. of Fahrenheit, and it contains in folution from a 3 2d to a 33d part of fea- fait. In hofpitals, manufactories, and prifons—fituations in which the low contagious fever fo frequently origi- nates, the practice I have detailed may be followed with great eafe, fafety, and advantage; but it is in a more particular degree applicable to this contagion when it appears on fhipboard, becaufe in that fituation the ufual means of prevention or cure are neceffarily limited, and the imminence of the danger requires a remedy that operates with fpeed as well as efficacy. The waters of the ocean afford this remedy; in every point of view a moft happy one for mariners, fince it can be applied almoft as eafily as it can be procured. 27 CHAP. IV. The Manner in which the Affufion of Cold Water ought to be ufed in Fever, HAVING given this general account of my expe- rience of this remedy in fever, it will now be ne- ceffary to enter more particularly on the rules which ought to govern its application, and on the different effects to be expected from it, according to the different ftages of the difeafe in which it is employed. It will be proper to premife, that when the term fever is ufed in the prefent work without any adjunctive, it is the low con- tagious fever that is meant. This is the Typhus of Dr. Cullen; the contagious fever of Dr. Lind ; the Febris inirritativa of Dr. Darwin. In popular language, it is generally called the nervous fever, and where particular fymptoms appear, the putrid fever. It is ufually pro- duced in fituations where there is a want of cleanlinefs, and more efpecially of ventilation; and when produced, it is propagated by contagion. This is the common fever of England; its fymptoms have been detailed with great minutenefs in a variety of modern publica- tions, and I have therefore declined repeating defcrip- tions that are every where to be met with. Dr. Cullen has defined the difeafe as follows:—" Morbus contagi- " ofus; calor parum auctus; pulfus parvus, debilis, " plerumque frequens; urina parum mutata; fenforii c< functiones plurimum turbatse; vires multum immi- 28 " nut^e." In fixteen years practice I have found the contagious fever of Liverpool remarkably uniform, and in general to correfpond exactly with this concife and perfpicuous definition. This difeafe prevails chiefly among the poor, who from the nature of their diet and habits, are peculiarly expofed to the caufes that produce it. Seldom extending itfelf in any confiderable degree among the other claffes of the community, it has been fuppofed that Liverpool was little fubject to fever; but this will be fhown from authentic documents, to be a great and a pernicious error. Let us proceed at prefent to inquire into the rules that ought to govern the ufe of the affufion or afperfion of cold water in this difeafe. Whoever has watched the progrefs of fever, muft have obferved the juftnefs of the obfervation made by Cullen, Vogel, De Haen, and others, that even thofe genera which are denominated continued, are not ftrictly fuch, but have pretty regular and diftinct exa- cerbations and remiffions in each diurnal period. In this fpaceof time, Dr. Cullen contends, that an attentive obferver may commonly diftinguifh two feparate pa- roxyfms.* My obfervations do not enable me to con- firm his pofition in its full extent—but one exacerbation, and one remiffion in the twenty-four hours, feem gene- rally obfervable. The exacerbation ufually occurs in the afternoon or evening, the remiffion towards morn- ing. Thefe exacerbations are marked by increafed fiufhing, thirft, and reftleffnefs. If the heat of the patient be, at fuch times, taken by the thermometer, it will be found to have rifen one or two degrees in the central parts of the body above the average heat of the fever, and ftill more on the extremities.-—The fafeft and mod advantageous time for ufing the afperfion or affu- fion of cold water, is when the exacerbation is at its height, or immediately after its declination is begun; and this has led me almoft always to direct it to be * Paroxysmis quovis die binis. Gen, Morbar. vol. ii. p. 67.. 29 employed from fix to nine in the evening; but it may be fafely ufed at any time of the day, when there is no fenfe of chillinefs prefent, when the heat of the furface is fteadily above what is natural, and when there is no general or profufe fenfible perfpiration.—Thefe particu- lars are of the utmoft importance. i. If the affufion of cold water on the furface of the body be ufed during the cold ftage of the paroxyfm of fever, the refpiration is nearly fufpended; the pulfe be- comes fluttering, feeble, and of an incalculable frequen- cy; the furface and extremities become doubly cold and fhrivelled, and the patient feems to ftruggle with the pangs of inftant diffolution. I have no doubt, from what I have obferved, that in fuch circumftances, the repeated affufion of a few buckets of cold water would extinguish life. This remedy fhould therefore never be ufed when any confiderable fenfe of chillinefs is prefent, even though the thermometer, applied to the trunk of the body, fhould indicate a degree of heat greater than ufual. 2. Neither ought it to be ufed, when the heat, mea- fured by the thermometer, is lefs than, or even only equal to the natural heat, though the patient fhould feel no degree of chillinefs. This is fometimes the cafe towards the laft ftages of fever, when the powers of life are too weak to fuftain fo powerful a ftimulus. 3. It is alfo neceffary to abftain from the ufe of this remedy when the body is under profufe fenfible perfpi- ration, and this caution is more important in proportion to the continuance of this perfpiration. In the com- mencement of fweating, efpecially if it has been brought on by violent exercife, the affufion of cold water on the naked body, or even immerfion in the cold bath, may be hazarded with little rifque, and fometimes may be reforted to with great benefit. After the fweating has continued fome time and flowed freely, efpecially if the 3° body has remained at reft, either the affufion or immer- fion is attended with danger, even though the heat of the body at the moment of ufing it be greater than na- tural.—Sweating is always a cooling procefs in itfelf, but in bed it is often prolonged by artificial means, and the body is prevented from cooling under it to the na- tural degree, by the load of heated clothes. When the heat has been thus artificially kept up, a practition- er, judging by the information of his thermometer only, may be led into error. In this fituation, however, I have obferved that the heat finks rapidly on the expo- fure of the furface of the body even to the external air, and that the application of cold water, either by affu- fion or immerfion, is accompanied by a lofs of heat and a deficiency of reaction, which are altogether inconfift- ent with fafety.—Each of thefe points will be illuftrated more fully in the fequel. Under thefe reftrictions the cold affufion may be ufed at any period of fever; but its effects will be more fa- lutary in proportion as it is ufed more early. When employed in the advanced ftages of fever, where the heat is reduced and the debility great, fome cordial fhould be given immediately after it, and the beft is warm wine. The general effects of the cold affufion will be more clearly illuftrated by the following cafes. They are a felection from a great number, the records of which have been preferved, and which lead to the fame refults. They are fo arranged as to exhibit the falutary effects of this remedy in the different ftages of fever, and illuftrate the precautions laid down againft ufing it improperly. If they fhould appear tedious af- ter what has already been mentioned, this muft be for- given ; on a fubject fo important and fo little under- ftood, it is better to incur the charge of tedioufne/s than the hazard of being obfcure. 3* CHAP. V. CASE I. Cafes in which the Affufion of Cold Water was ufed in the different Stages of Fever. January i, 1790. A NURSE in the fever-ward of the Infirmary ha- ving feveral patients under her care, caught the infection. She was feized with violent rigors, chillinefs and wandering pains, fucceeded by great heat, thirft, and head-ache. Sixteen hours after the firft attack, her heat at the axilla was 103 deg. of Fahrenheit, her pulfe 112 in the minute and ftrong; her thirft great, her tongue furred, and her fkin dry. Five gallons of fait water, of the temperature of 44 deg. were poured over her naked body, at five o'clock in the afternoon, and after being haftily dried with towels, fhe was replaced in bed : when the agitation and fobbing had fubfided, her pulfe was found to beat at the rate of 96 ftrokes in the minute, and in half an hour afterwards it had fallen to 80. The heat was reduced to 98 deg. by the affufion, and half an hour afterwards it remained ftationary. The fenfe of heat and head-ache were gone, and the thirft nearly gone. Six hours af- terwards fhe was found perfectly free of fever, but a good deal of debility remained. 32 Small dofes of columbo were ordered for her, with a light nourifhing diet, and for feveral days the cold affu- fion was repeated at the fame hour of the day as at firft; the fever never returned. During the progrefs of fever when epidemic, a great number of cafes fimilar to the above have occurred, in which the difeafe was fuddenly cut fhort by the ufe of the cold affufion on the firft and fecond day; twenty-fix of thefe cafes were in the 30th regiment, as has been already ftated. In fuch inftances, the refult was fo precifely fimilar to what occurred in the cafe I have re- lated, that it would be to no purpbfe to detail them. When an epidemic fever is fpreading, and the danger is known, patients will take the alarm on the firft attack, and the power, as well as the utility of fuch a remedy as the cold affufion, in fuch fituations of general dan- ger, will be eafily imagined.—It cannot be employed too foon after the firft attack, provided the original chill is over, and the hot ftage is firmly eftablifhed. In cafes in which the affufion was not employed till the third day of fever, I have feen feveral inftances of the fame complete folution of the difeafe. I have even feen this take place when the remedy had been deferred till the fourth day ; but this is not common. The fol- lowing cafe will point out the ufual effects of this reme- dy in the third and fourth days of the difeafe. CASE II. Jan. 17, 1790. A. B. aged nineteen, a pupil of the Infirmary, caught the infection in attending the fe- ver-ward. When I faw him, feventy-e-ight hours had elapfed fince the firft attack: he was of courfe in the * $ fourth day of the difeafe. He had all the ufual fymp- toms—head-ache, thirft, furred tongue, pain in the back and loins, with great debility. His heat was 101 deg. and his pulfe 112 in the minute. A bucket full of fait water was poured over him as ufual, at noon on the 17th. His heat funk to 99 deg. and his pulfe to 98 in the minute. A profufe perfpira- tion followed, with the ceffation of all his fevenfh fymp- toms.—This intermiffion continued for feveral hours, during which he enjoyed fome comfortable fleep: but at five in the afternoon he was again feized with feverifh rigors, followed by heat, thirft, and head-ache as before. An hour afterwards, the hot ftage was eftablifhed; his heat was 100 deg. his pulfe 100. The fame quantity of cold water was again poured over him, and with fimilar effects. His pulfe fell immediately to 80, and became more full; his heat became natural. The following night he took twenty drops of laudanum and flept well. On the 18th at noon his pulfe was 96 and foft; his fkin moift, but a little above the natural heat. His tongue was a little furred, and his head ached: he alfo complained of thirft; the heat at the axilla was iocj deg.—The fame remedy was again applied. He was greatly refrefhed by it. The pulfe fell to 90, the fkin be- came cool, the thirft went off, and all the feverifh fymp- toms vanifhed. On the 19th his pulfe was 88, his heat natural, the thirft and head-ache were gone, and his appetite im- proving. The affufion was repeated for the laft time at fix o'clock in the evening. On the 20th his pulfe was 78 and foft, his tongue clean, and his appetite further improved. He had ftill fome remains of debility on the 21ft, but on the 22d he was free of complaint. This patient during his fever 5 34 took no medicine but the effervefcing mixture, the dofe of laudanum excepted.—The affufion was ufed four times. CASE III. Dec. 8, 17 91. A woman aged fifty-feven, who had caught the infection in her attendance on a poor family labouring under fever, came under my care in the hof- pital, fifty hours after the firft attack. She was of courfe in the third day of fever; fhe had the ufual fymptoms— head-ache, pain in the back and loins, and thirft: her tongue was furred and her eyes heavy: her pulfe 96, her heat 101 deg. The affufion of cold water was perform- ed at noon. In a few minutes afterwards the heat under the tongue was 98 deg. the pulfe 80. Towards evening however, the feverifh rigor returned with all the ufual confequences. As foon as the hot ftage was eftablifhed, the affufion was repeated, and with the ufual happy effects. Dec. 9.—Noon—pulfe 90 and feeble—-refpiration eafy—heat 100 deg.—The affufion was immediately employed, and again repeated in the evening, fenfible perfpiration, coolnefs, and quiet fleep, were the confe- quence. Dec. 10.—This day the affufion was twice repeated as yefterday, viz, at noon, and at fix in the evening.—At eignt in the evening the pulfe was ~6, the fkin foft, the heat 97 deg. the refpiration eafy and natural.—The fever returned no more. This patient ufed no other re- medies but an enema, and after it an opiate, every night. The affufion was ufed twice every day ; in all fix times. 65 CASE IV. Feb. 2. 1792. S. C. a healthy man, aged forty-four, about feventy-two hours after the firft attack of fever, became my patient. His pulfe 100—his heat 104 deg — The other fymptoms as ufual—but the pain in the head and back particularly fevere. Two minutes after the affufion—pulfe 90, heat 101 degrees; fix minutes af- ter—pulfe 90 and weak -.—ten minutes after, pulfe 90, heat 100 deg.—This patient felt great refreshment, and was entirely relieved of the pain in the head and back.—In the evening however the exacerbation of fever was fevere, and the head-ache returned with violence.— He paffed a reftlefs night. About four o'clock in the enfuing morning, the affufion was repeated by his own defire. At 9. a. m. a general and gentle perfpiration covered the furface of the body; the pulfe was 84, the tongue moift, the fkin cool, and the pains of the head and°back entirely gone off. In the afternoon, however, the fever returned, though in a {lighter degree. The affufion was repeated the fourth time with the fame happy effects, and after this he had no return of the difeafe. Thus it appears, that the cold affufion ufed on the third and fourth days of fever, does not ufually produce an immediate folution of the difeafe; but that it inftantly abates it, and by a few repetitions, brings it to a happy termination in two or three days. CASE V. Ocl. 25. M.S. came under my care on the 24th Dec. 1791, on the feventh day of typhus, with the ufual fymp- 3^ toms—pulfe io8, heat ioodeg.—The cold affufion was immediately directed—two minutes afterwards the heat was 96 deg.—three minutes afterwards 98 deg.—the pulfe 98. This patient experienced great relief. The affufion was repeated on this and the following day—a gentle diaphorefis always fucceeded it, with tranquil fleep, and on the third day the fever was completely removed. CASE VI. A ydung lady of 19, in the 7th or 8th day of typhus, became my patient, Sept. 26, 1794. Her pulfe was 112 and feeble, heat 101 deg. She had great pain in the head, and much proftration of ftrength, her eyes were fuffufed and dull—her tongue furred—her fpirits greatly depreff- ed. Saline medicines were ufed for this patient, with lemonade for her ufual drink, and moderate quantities of wine were given mixed with water. The burning fen- fation in the palms of her hands and temples was affua- ged by frequent fpunging with vinegar, and every evening at fix p. m. three or four gallons of cold brine were thrown over her. The happy effects fo frequently de- fcribed, were in this cafe particularly ftriking :—The pulfe fell almoft immediately to 90, the heat to its na- tural ftandard, and the head-ache vanifhed—a gentle diaphorefis followed, with eafy fleep:—in a few hours, however, the feverifh fymptoms returned, and towards the hour of fix in the evening, the fever was in its highest ftate of exacerbation. At this hour therefore the affufion was repeated with the fame happy effects—though the fever returned as before, it was in a milder form ; the fame practice was continued, and on the fecond of Oc- tober, fhe was entirely free from the difeafe. 37 CASE VII. F. G. a foldier of the 30th regiment, aged 23y fell under my care on the 9th of June, 1792, during the prevalence of the epidemic in that regiment, of which I have already given an account. He was in the 9th day of the difeafe—his pulfe 100 and feeble—his heat 104 deg.—his thirft was very great—his tongue foul and black—frequent cough occurred, with ftreaks of blood in the expectoration—and petechias appeared all over his body. His mind was at all times confufed, and at times he was completely delirious. I directed that his ftrength should be fupported by adminifteringa bot- tle of wine every day, with an equal quantity of gruel;— that every night he fhould take an opiate draught, and that a complete operation of his bowels fhould be pro- cured by a clyfter adminiftered daily, and if this did not fucceed, by a few grains of calomel. I alfo directed that a bucket full of falt-water fhould be thrown over him immediately, and repeated according to circumftances. In a few minutes after the affufion, the heat was ^ de- grees—the pulfe 98—his mind was more calm and col- lected : two hours afterwards hehad relapfed into nearly his former ftate, but the night was paffed more tran- quilly. The whole of this practice was continued with nearly the fame refult, till the 12th day of the difeafe, the affufion having always been performed in the even- ing, and fometimes at noon alfo. The fever continued its ufual period, but on the 12th day, the heat having funk to its natural ftandard, the cold affufion was thence- forth omitted; we however, fpunged the whole body once or twice a day with vinegar.—The patient was in a ftate of convalefcence on the 18th day from the firft attack. 38 I have related this cafe the more circumftantially, be- caufe it contains the particulars of my practice in the epidemic in which it occurred, at the fame time that it affords an example of the effects of the cold affufion ufed in the more advanced periods of fever. In fuch inftances, as might be expected, it does not procure the fame ad- vantages as in the earlier ftages, when the ftrength is lefs impaired, and the morbid actions lefs firmly affociated; neverthelefs, it is evidently advantageous while the heat of the patient exceeds the natural ftandard, though it ought to be employed with caution in the more ad- vanced ftages of the difeafe, and in fuch cafes, accord- ing to my later experience, of a temperature from fifteen to twenty degrees only, below the human heat. In the greater part of the cafes that I have related, the water employed was the pump-water of our hofpital, faturated with fea-falt, and of a temperature from 40 deg. to 50 of Fahrenheit. The cold affufion may alfo be employed with fuccefs in intermittent fevers, as I have found by repeated trials^ and as the following cafe will demonftrate. CASE VIII. Ann Hall, aged 22, was admitted into the Infirmary, July 19, 1792, under an obftinate quotidian of three months ftanding—fhe had from time to time taken the bark, but as the great delicacy of her ftomach, would not permit her to ufe it in fufficient quantities, fhe was become very feeble and much emaciated. A gentle emetic was adminiftered to her in the firft inftance, and on the commencement of the hot ftage of the paroxyfm, twenty drops of the tincture of opium were directed to be given to her, after the practice of Dr. Lind. During the intermiffion, the bark was ordered to be taken in fuch dofes as her ftomach would bear; fhe was put on 39 a nourishing diet, and was ordered a pint of port wine every day. This plan was purfued for fourteen days, but without fuccefs; the paroxyfms returned daily, though with fome irregularity—her ftrength was however rather improved. Still the delicacy of her ftomach continued, and the bark, except in very fmall dofes, was conftantly rejected. On the 8th of Auguft, two hours before the expected acceffion of the fever, four gallons of brine were dafhed over her, of the temperature of 66 deg. of Fahrenheit, and this day fhe efcaped the attack. In the interval be- tween this and the period of the next return, fhe took the bark in larger quantity, the power of her ftomach being increafed; but on the loth, two hours later than ufual, the paroxyfm returned with unufual feverity. Af- ter the hot ftage was completely formed, the brine was poured over her as before—the fymptoms inftantly aba- ted ; fhe fell into a gentle perfpiration, with profound fleep. She afterwards continued the bark as before, and from this time forwards was free of difeafe. It would be eafy to multiply thefe details, but their uniformity has already perhaps rendered them tedious; a few general obfervations fhall therefore conclude this divifion of the fubject. 4° CHAP. VI. General Obfervations. i.ripHQUGH the patients were often ftartled at the firft propofal of dafhing the cold water over them, yet, after one trial, there vvas feldom any difficulty in perfuading them to have it repeated. The effects were in general highly grateful and refrefhing to their fenfations; the extinction or abatement of fever was commonly followed by more or lefs diaphorefis, and this again by refrefhing fleep. 2. At firft I ufed frefh water—afterwards frefh water mixed with vinegar—and laftly, a faturated folution of fea-falt in water. In the inftance of the 30th regiment, I ufed the water of the river, which contains about a thirty-third part of fait, as has been already mentioned, and this I commonly employ in private practice.* I * It may be fuppofed, that the degree of impregnation of the river wa- ter with fait muft depend on the time of the tide when "it is taken upj thus, that it muft be falter at the height of the flood, when the tide has run fix hours from the fea, than at the period of low water, when it has run nearly the fame time from the land.—I expe&ed to find this the cafe, and endea- voured to aicei tain the difference; but in a trial which I made by evapo- rating 4olbs. of water taken up at the height of the flood tide, and the fame quantity taken up at low water, I could perceive no difference in the proportion of fait, a circumftance which I am unable to explain. The fmall difference that there was in the refiduum in favour of the water taken up at the top of the tide, arofe evidently from its being mingled with a large portion of dirt—the water at the top of the tide is mixed with dirt and feculcncies, that taken at the lowed point of ebb is nearly pure. 4* was led to prefer fait water to frefh on account of the ftimulating effect of fea-fait on the veffels of the fkin, by which I apprehend the debilitating action of cold is prevented. Salt water, either for the purpofe of im- merfion or affufion, is more grateful to the patient than frefh water and it is well known that it may be applied to the furface for a length of time, with much lefs hazard. Perfons immerfed in fea water, and efpecially in faturated brine, for fome time together, preferve the luftre of the eye and the ruddinefs of the cheek, longer than thofe in frefh water, of an equal temperature, and fuch perfons exhibit the vital re-action ftronger when removed from it. I preferred the brine to vinegar, as being cheaper, and more eafily procured of the neceffary quantity : otherwife, it is well known how grateful vine- gar is to patients in fever, and perhaps a mixture of vi- negar and water of the proper ftrength, might be pre- ferable even to brine. But though I gave the preference to brine over frefh water, I have very often ufed the latter, and it is feldom that any danger can refult from the want of a faline impregnation, where the cold is employed in fo ftimulating a form as that which has been defcribed; that is, fuddenly, and for fo temporary a duration. 3. In taking the heat of the patient, I have generally ufed a fmall mercurial thermometer of great fenfibility, with a moveable fcale, made for me by Mr. Ramfden, after a form invented by the late Mr. Hunter, and ufed by him in his experiments on the .heat of animals, and I have introduced the bulb under the tongue with the lips clofe, or under the axilla, indifferently; having found by repeated experiments, that the heat in thefe two places correfponds exactly, and gives a juft indication of the heat of the furface of the body, where fheltered by the neceffary teguments from the contact of the external air. Finding, however, confiderable rifque in ufing the ftraight tubed thermometer in contagious difeafes, I got fome inftruments of this kind made with a fmall bulb 6 42 and eurved at the end. The bulb being introduced under the tongue or the axilla, the obferver can Hand be- hind the patient, and mark the rife of the mercury, with- out coming into the immediate fphere of his refpiration. Though no injury was in any cafe incurred from the ufe of this thermometer, yet a farther improvement has fug- gefteci itfelf. By introducing a fmall piece of iron into the tube, after the manner of Mr. Six, a permanent indi- cation of the greateft heat is obtained, and the approach of the obferver towards the patient during the experi- ment, is rendered unneceffary. 43 CHAP. VII. Precautions requifite in ufing the Cold Affufion, illus- trated by Cafes. i. TT was before remarked that the cold affufion can- X not be ufed with fafety during the cold ftage of the febrile paroxyfm: the following cafe will illuftrate this truth. In the fummer of 1792, I was re luefted by Mr. Hoffman, an ingenious Pruffian gentleman, and a furgeon in the army then under the command of the Duke of Brunfwick, to give him an opportunity of feeing the method of ufing this remedy. At that time there was a patient labouring under a tertian intermittent under my care in the infirmary, on whom it could with propriety be exhibited. Accordingly a time for meet- ing Mr. Hoffman in the fever-ward was appointed, when the hot ftage of the paroxyfm might be expected to be fairly formed. It happened however that the ac- ceffion of the fever had occurred an hour later this day than might have been expected, and when we arrived, the patient was ftill in the cold ftage of the paroxyfm; ihe affiftants however proceeded: he was taken out of his bed fhivering, his pulfe fmall and frequent, his ex- tremities fhrunk and cold. In this ftate the brine was dafhed over him as ufual, but not with the ufual happy effects;—his breaching was for fome minutes almoft fuim- pended ; his pulfe at the wrift was not to be felt; the pulfations of the heart were feeble and flutrcring; a 44 deadly coldnefs fpread over the furface; and when refpi- ration returned, it was fhort, irregular, and laborious. After the ufe of frictions on the furface, and particular- ly on the extremities—of a fteady warmth applied for fome time to the fcrobiculus cordis—and of cordials cautioufly adminiftered in fmall quantities—the pulfe at the wrift returned; but for fome time it was exceffive- ly quick and feeble. He recovered however in the courfe of an hour, and it was found that the paroxyfm of fever had been extinguifhed : but the circumftances firft related, were evidently full of danger, and they produced at the time much apprehenfion and uneafinefs. The fame remedy was however ufed in the hot ftage of the enfuing paroxyfm, and with the ufual happy effects. Other cafes to the fame purpofe might be adduced if it were neceffary. I have frequently ufed the cold affufion in the hot ftage of the paroxyfm of intermittents, and almoft al- ways with the immediate folution of the fit; but in ge- neral, if no remedy be ufed in the intermiffion, the fe- ver returns at the ufual period. In fome inftances, however, the fucceeding paroxyfm has been prevented by ufing the cold affufion about an hour previous to the period of its expected return, and the difeafe ultimately removed by continuing this practice through four or five of the following periods. The ufe of the cold affufion in the abfence of fever, requires however a conftitutioo in a great meafure un- broken; and many of the intermittents which we fee in Liverpool, being tranfmitted to us from the warm cli- mates, adhere to conftitutions in which this practice is not perfectly fafe. In fuch cafes, it may notwithstand- ing be adopted in the hot ftage of fever with fafety and advantage. Indeed it ought never to be forgotten, that an application of cold, which is fafe in the violence of fever, is not Ufe when the fever is removed. Injury 45 has fometimes occurred from continuing the cold affu- fion in the period of convalefcence. 2. Neither is the cold affufion fafe after the fweating ftage of fever has continued fome time, and the body is paffing through that cooling procefs. The following cafe will illuftrate this pofition. In the fummer of 1791, a boy of eight years of age, in whom I am peculiarly interefted, was attacked by fever. On the third day his pulfe rofe to 130, and 140 in the minute, and his heat to 106 deg. and 107 deg. of Fahrenheit. His thirft was very great, and delirium commenced on the fecond day, and continued without intermiffion. Va- rious methods had been employed to abate the fever, and particularly to excite fenfible perfpiration, but un- fuccefsfully. His heat was not leffened by repeated fpunging of the furface of the body with cold vinegar and water: and after a copious bleeding, all the fymp- toms were as alarming as before. It feemed hazardous to repeat this evacuation, as the blood exhibited no fize, and there was a fufpicion that the difeafe originated in contagion. The patient had taken antimonials with- out any apparent effect, and after watching the ftate of the thermometer, with the bulb at the axilla, upwards of an hour, though the mercury had funk a fingle de- gree in that interval, it flood at the end of the time as high as 106 deg. In this ftate of things we rcfolved on trying the cold affufion, and every thing being prepared, he was ftripped naked and lifted out of bed. As we were about to throw the water upon him, it was obfer- ved that a fenfible perfpiration had broken out all over him, but the heat being fo great, we perfifted in our purpofe, and four gallons of frefh water of the tempe- rature of 60 deg. were dafhed upon him; the effects were altogether furprifing. On replacing him in bed, the mercury in the thermometer (the bulb at the axilla as before) rofe to ^ deg. only, and the burning heat of the extremities was converted into a coolnefs that was rather alarming; the pulfe had funk in frequency 46 to 90 deg. but was full and fteady. Gentle frictions were applied to the legs and feet, but they were not long continued, for the general warmth fpeedily return- ed ; the heat in the trunk of the body rofe in about an hour to 100 deg. and the pulfe to 100. His delirium went entirely off; the fur on his tongue fpeedily difap- peared; and twenty hours afterwards he was found free of every complaint but debility. Subfequent experience has however convinced me, that though in this cafe the termination was fo happy, the cold affufion was not unattended with hazard. Sweat- ing had commenced, and the heat was finking. It had perhaps funk more at the moment when the affufion was performed, than was indicated by the thermometer, for the bed clothes often keep the body from cooling under fweating, to the degree that would otherwifc be produced. In this cafe when the furface is fuddenly expofed to the external air, the heat finks rapidly. If the fweat had continued an hour longer before this re- medy was ufed, the heat would have been ftill more di- minifhed ; a torpor of the veffels of the furface, and of the extremities, would have been produced, followed by a great, and probably a dangerous re-action of the centre. This obfervation will be illuftrated in the fe* quel. In recommending the affufion of cold water as a re- medy in fever, an exprefs exception is therefore made againft its ufe during the feverifh chill, or after the fweat has begun to flow profufely, and more efpecially after it has continued to flow profufely for fome time. An exception is alfo made againft its being employed in the latter end of fever when the ftrength is much exhaufted, and the heat is fometimes as low or lower than the tem- perature of health. While, however, the heat rifes one or two degrees above the healthy ftandard, this remedy may be ufed even in the latter ftages of fever. I have employed it with advantage on the nth, 12th, and 47 13th day^ In inftances of this kind it will however be prudent to make the degree of cold very moderate, as has been already obferved; and as it is fcarcely to be expected, that at an advanced period of the difeafe the progrefs of it can be flopped, or its duration much lef- fened, it may perhaps anfwer every purpofe to employ in fuch cafes the tepid affufion. I have indeed often contented myfelf with fpunging the body all over with tepid vinegar, or vinegar and water, from the 9th or 10th day forwards; but I have frequently in cafes where the heat continued high, directed the general affufion of tepid water, by which the heat may always be fpee- dily and effectually reduced, when that is the only cbjeft in view. Under thefe reflections, the affufion of cold water may be ufed with perfect fafety in the low contagious fever of this country, and the facts already ftated, will fhow that it is a remedy of great power and efficacy. In the firft ftages of fever, it appears very generally to cut fhort the difeafe alrnoft inftantaneoufly; and even when it fails of this effect, as is ufually the cafe when it is applied in the more advanced ftages, it neverthelefs moderates the violence of the fymptoms, and fhortens the duration of the difeafe. 4» CHAP. VIII. General Remarks on Fever. Hiftory of a Cafe of Fever in which the Affufion of Cold Water was not falutary. SINCE the introduction of fcientific arrangements into medicine, difeafes have been much reduced in number, and their nature has been more clearly under- ftood. This is efpecially true of continued fever, which is exhibited by Dr. Cullen under three genera only, Sy- nocha, Typhus, and Synochus. Of thefe genera, how- ever, the Synocha, or pure inflammatory fever, without topical inflammation, is confeffedly a very rare occur- rence in this ifland; the venerable profeffor ufed to de- clare that he had not met with a fingle inftance of it in forty years practice.—And the Typhus and Synocus seem to be confidered by him as the fame difeafe, modi- fied differently, by the difference of climate, feafon, and conftitudon. Both are defcribed as contagious, and as occafionally producing each other. Doubtlefs the Ty- phus, or low contagious fever, is the prevailing fever of this ifland, and of Europe. It is the epidemic of all our great towns, of our jails, hofpitals, and manufaftories; its origin and progrefs are clearly afcertained, and its fymptoms generally underftood. It is to this fever that the preceding obfervations chiefly apply. I have my doubts, however, after much reflection and obfervation, whether we have not Amplified too far in our nofological arrangements of fever. The dreadful 49 difeafe which prevailed lately at Philadelphia, and which now ravages the Weft Indies, (1798), cannot perhaps be included without fome violence within our fyftems of Nofology ; and its fatality under all the eftablifhed modes of treatment, whilft it excites our deepeft regret, muft fcrve to abate the pride of modern fcience. Even in our own ifland, it appears to me that cafes of fever fometimes occur, which cannot be referred with advan- tage to any of the genera of Dr. Cullen*. The follow- ing is a defcription of a fever of this kind; I have not met with it often, but when I have met with it, it has very generally proved fatal, under the eftablifhed modes of treatment; and I am forry to fay, that in the only inftance of this fever in which' I have tried it, the effufion of cold water proved unfuccefsful alfo. The fever in queftion does not feem to originate in contagion, or to propagate itfelf by contagion. I have never been able in a fingle inftance to trace it to that fource, nor have I ever found it to be communicated from the patient to any of his attendants. The cafes which I have feen have occurred chiefly in the winter feafon, in perfons in the flower or vigour of life, poffefs- ed of confiderable fenfibility of mind, and in the habits of more than ordinary mental exertion. After fome days of indiftinct catarrhal complaints, the fever comes on, (in general after fome accidental expofure to cold), with a very violent and long continued attack of chills and rigor, and to this, as is ufual, fucceeds a ftate of heat and re-action. The patient complains of intenfe head-ache and of oppreffion at the prascordia, with occa- fional but not fevere cough, and with fome increafe in the frequency of. refpiration. His pulfe is not remarka- ble as to frequency or ftrength; his fleep is not p^rticu- • I am aware that all queftions respecting nofological arrangement Uav« a tendency to degenerate into verbal difputes, and I willingly avoid them, referring for my accuracy to thofe who have fhidied difeafes, not in books only, but in the volume of nature. 7 5° Jarly difturbed ; and for fome days the complaint goes on as if produced by catarrhal fever. From the firft, however, there appears a great quicknefs and impatience about the patienr: he talks more rapidly than ufual ; apprehends you quickly, and anfwers you inftantly. He cannot, however, command his attention long, and is fatigued with the effort. His heat, which was at firft moderate, becomes very great on the 7th and 8th day, reaching 107 and 108 deg. of Fahrenheit, he becomes delirious and talks inceffantly. Throughout the fever, his fenfes of hearing and tafte are uniformly acute, and this is true alfo of his feme of feeling. Great as his heat is, he is much alive to the impreffions of cold on the furface of the body and fhrinks from them. At times he appears furprifingly calm and natural, gets out of bed and dreffes himfelf, infifting that he is well. Often he llarti up fuddenly in bed and opens his curtains, feeining to look round the room for fome perfon he fuppofes prefent; and fometimes he rings the bell vio- lently, if within his reach, without appaient object. In- diftinct conceptions rife and vanifh in his mind, and the impreffions of fenfe are confounded with the ideas of imagination. As the fever advances, the refpiration be- comes more hurried and laborious, the pulfe more fre- quent and feeble ; and towards the latter end of the dif- eafe, but not before, fweats break out, at firft partial, and at length general and profufe, which however, though they reduce the heat, do not otherwife relieve him. The pulfe finks; the body is covered with pete- chias; wine, bark, opium, and blifters afford no relief: the patient dies on the twelfth or thirteenth day of fever, and after death the body runs rapidly into putrefaction. • I have feen this fever treated by venefection and an- timonials in the early ftages, with a ftrict attention to the antiphlogiftic regimen; and by bark and cordials, as the ftrength began to decline; but without fuccefs. I have alfo (etm it treated from the firft on the fame plan as ty- phus, but with an equally unfortunate iffue. In a cafe 5l of this fever which occurred lately, I made ufe of the cold affufion, and as the mercury rofe in the thermome- ter with the bulb under the tongue, to 107 deg. I em- ployed this remedy with fome degree of confidence. The effects did not correfpond with my former experi- ence or with my hopes. The patient felt the cold moll acutely, but was not relieved. His pulfe did not di- minifh in frequency ; his heat fubfided very little, and that for a few minutes only ; neither diaphorefis nor fleep followed. This remedy was not repeated, but the fur- face of the body was fpunged from time to time with vinegar, without however producing fenfible benefit or refrefhment. I have already mentioned that the affufion of cold water is not to be ufed after a profufe perfpiration has taken place; and that it is not to be ufed in the cold ftage which begins the paroxyfm of fever, nor till the hot ftage be fairly formed. In the typhus, however, this laft reftriction feldom requires us to wait long ; the affufion may be ufed in general in twenty-four hours from the original attack, and often much fooner. The cafe I have juft related is the only inftance, out of many hundred trials, in which I found, that even on the fixth day of fever, with the actual heat of the body far above the temperature of health, the affufion of cold water was neither falutary nor refrefhing. I have however to ob- ferve, that notwithstanding the great heat of the body, producing the utmoft reftleffnefs and anxiety, the fenfa- iion of heat was interrupted by chillinefs on the flighteft application of cold, and that the furface and extremities not only felt chilly, but grew cold, even on the acceffion of the external air. In reality, through the greater part of the fever, the ftate of the patient had a confiderable refemblance to what we fee in the paroxyfm of an inter- mittent, when the cold ftage is terminating, but the hot ftage not fairly formed—when the heat, as well as the blood, is accumulated in the centre of the fyilem and the vital power is fttuggling to give them that propul* 5?- lion to the fuperficies, which terminates in profufe per- fpiration, and carries off the difeafe. I have little doubt that immerfion in the tepid bath of the temperature that feels comfortably warm to the fkin, continued for fome time, is the proper remedy in the fever I have defcribed, as it doubtlefs is in the Struggle of the paroxyfm of in- termittent ; and when an opportunity offers, I mean to afcertain the truth on this point. But this opinion will be illuftrated when we come to fpeak of the warm, bath more particularly. If any one fhould contend that the fever I have de- fcribed is in reality only a variety of the typhus, or fy- nochus, I fhall not be difpofed to conteft the matter. The queftion concerning identity, leads to endlefs dif- putes in every branch of fcience where it occurs, and he muft know little of nofology, who fuppofes it has yet received a confiftency, that would render fuch a difcuf- fion profitable. It is fufficient for me to obferve, that the fymptoms of the two difeafes are in a confiderable de- gree different, though with that general Similarity that belongs to all cafes of fever; that the ftate of the ner- vous fyftem as to impreffibility is widely different; and what is of moft importance, that the methods of treat- ment, which according to my experience almoft invaria- bly fucceed in the one difeafe, are unfuccefsful in the other. Every practitioner knows, that in typhus, the fenfe of hearing is generally obtufe; and the fame may be laid of the tafte, fmell, and touch ; whether the ob- fervation is applicable to the fight alfo, and under what restriction, appears to me doubtful. The acutenefs of all thefe fenfes in the fever which I have defcribed, is very remarkable, and particularly in regard to the fenfi- bility of the furface. I have obferved this fymptom to be produced by feveral narcotics, and by fome poifons. It is very remarkable in the hydrophobia; and in the laft days of a perfon who died of inanition, the fenfes of rouch and vifion were extremely acute.* * Thi9 cafe will be found in chap. xix. 53 CHAP. IX. Of the Ufe of the Affufion of Cold and Tepid Water in Small-pox, with Cafes, THE lingular degree of fuccefs, that on the whole attended the affufion of cold water in typhus, en- couraged a trial of this remedy in fome other febrile dif- eafes. Of thefe the fmall-pox feemed more particularly to invite its ufe. The great advantage that is experi- enced in this difeafe by the admiffion of cool air, feemed to point out the external ufe of cold water, which being a more powerful application, might be more particularly adapted to the more malignant forms of fmall-pox. The refult correfponded entirely with my expectation. Of a number of cafes in which I witneffed the happy effects of the affufion of cold water in fmall-pox, I fhall give the following only. CASE I. In the autumn of 1794, J. J- an American gentleman in the 24th year of his ?ge, and immediately on his landing in Liverpool, was inoculated under my care; the prevalence of the fmall-pox rendering it imprudent to wait till the ufual preparations could be gone through, or indeed till he Should recover from the fatigues of the 54 voyage. He fickened on the feventh day, and the erup- tive fever was very confiderable. He had a rapid and feeble pulfe, a foetid breath, with pain in the head, back, and loins. His heat rofe in a few hours to 107 deg. and his pulfe beat 119 times in the minute. I en- couraged him to drink largely of cold water and lemon- ade, and threw three gallons of cold brine over him. He was in a high degree refrefhed by it. The eruptive fever abated in every refpect—an incipient delirium fubfided, the pulfe became flower, the heat was re- duced, and tranquil fleep followed. In the courfe of twenty four hours the affufion was repeated three or four different times at his own defire; a general direction having been given him to call for it as often as the fymp- toms of fever returned. The eruption, though more numerous than is ufual from inoculation, was of a fa- vourable kind. There was little or no iecondary fever, and he recovered rapidly. In Situations where the eruptive fever of fmall-pox is clearly distinguishable, and where it dors not abate Suf- ficiently on the admiffion of cold air, the affufion of cold water may be reforted to with confidence and fafety, re- gulated however in this application, as in every other, by the aflual ftate of the'patient's heat, and of his fenfa- tion of heat. In the confluent fmall-pox, however, af- ter the eruption is completely formed, this remedy can- not perhaps be ufed with advantage. The following cafe will illustrate this pofition. H. A. aged 23, an American mariner, fell under my care (Dec. 7,) on the third day of the eruption of the fmall-pox ; that is, on the fixth day of the difeafe. His pulfe 114 and feeble, his heat 109 deg. His head, back, and loins, ached feverely—thirft great—fkin livid— fmall-pox confluent. He was put on a milk diet—gentle mercurial purga- tives were ordered from time to time, and an opiate every 55 ivight at bed-time. Lemonade was given largely at firft by itfelf, and afterwards mixed with wine, and the affu- fion of cold water was directed in jthe ufual way. In ten minutes after the affufion, the pulfe was 96, the heat 98 deg.; the livor of the fkin was much diminifhed, but the pains were not relieved. Dec. 8. Noon—Pulfe 96, foft and regular—thirft gone—refpiration flow and natural—heat 97 deg. The affufion was ordered to be repeated; ten minutes after, pulfe 84 and feeble—heat 84 deg. Dec. 9. Noon—Pulfe 88, heat 93 deg.—the cold af- fufion was nor repeated in this very reduced ftate of heat; the decoction of bark was ordered, and a pint of wine daily in lemonade. Dec. 10. Noon—Pulfe 116, and full—heat 98 deg. refpiration ftill eafy—expectoration confiderable, and vifcid—thirft lefs—eyes quite clofed—head Swelled—a complete union of the puftules on the face.—Bark and wine continued, with the opiate at night. Dec. 12. Pulfe 118—heat 96 deg. A bucket full of water of the temperature of 92 deg. was poured over him. He appeared refrefhed at the moment; ten minutes after, pulfe 112, heat 94 deg. Complained of being chilly- Refpiration Still eafy—free of pains, and his face lefs fvvelled. Complained of his throat. A blifter was applied to it all round. Dec. 13. Noon—Pulfe 118—heat 96 deg.—refpira- tion ftill free, but his throat very fore. Medicines were continued, but the affufion of tepid water was not re- peated. Dec. 14. Noon—Pulfe 138—heat 100 deg.—ref- piration had now become laborious, and the expuition difficult. The throat was much fwelled. He was fre- 5<> quently fponged with tepid water, and the medicines continued. Dec, 15. Noon—Unfavourable fymptoms increafed. Dec. \6. Noon—Vomiting came on, which was re- lieved by opium. His fenfes and his intellect remained acute till within an hour of his death, which happened at eight o'clock in the evening of this day. If this cafe be more detailed than feems neceffary, let this be excufed, as it is the firft in which the actual heat in confluent fmall-pox has been recorded. It is here given accurately from the period when the difeafe came under my care. In regard to the effects of the cold affufion, it may be obferved, that this remedy was not ufed during the eruptive fever, nor till three days after the eruption had appeared, and the character of the difeafe was decided. In the ftage in which it was employed, the fever and the heat were abating, as is ufual after the eruption; and in all cafes in which the heat is finking, the application of cold muft be made with great caution, as has already been mentioned. After the fecond affufion (on the 8th) the heat funk below its natural ftandard, and continued below it for fome time; fo that this remedy became in- admiffible. The difeafe went through its ufual courfe. The tepid affufion on the eighth day of the eruption (Dec. 12) was ufed in part to wafh off variolous mat- ter, and in part to produce refrefhment. The heat which was before 96 deg. funk two degrees, fo that it could not with fafety be continued, for experience has proved, that the tepid affufion is a powerful means of diminishing heat. The heat rofe again with the fecon- dary fever, and the patient died of the affection of the throat, as I believe is general in the confluent fmall- 57 pox.* It will be at once perceived, on the principles already laid down, that in a difeafe like this, the affufion of cold water could only be effentially ufcful during the erup- tive fever. It is during the eruptive fever that the quan- tity of the affimilation is determined, as well as its kind. This is, I believe, invariably found to bear an exact proportion to the eruptive fever, and whecher we consi- der the eruptive fever as the can e or effect of the affi- milation, there is every reafon to expect from the laws of the living fyftem, that the diminution of this fever will diminish the quantity, and meliorate the quality of the variolous eruption. In the cafe juft related, the heat during the eruptive fever (judging from tri ils in fimilar Situations) had rifen to 106 deg or 107 deg;-)- but it had funk to 100 deg. before the cold affufion was employed. It may eafily be conceived that this remedy could have been employ- ed to a much greater extent, and that its effects would have been far more falutary, if it had been ufed throughout the previous fever. That it would have ef- fentially altered the character of the difeafe, I prefume not to affert. This however, I can declare, that in all the cafes in which I have ufed the affufion of cold water during the eruptive fever, however fevere the fymptoms may have been, thefe fymptoms inftantly abated, and the difeafe affumed a benignant form. The cafe of Mr. Johnfton (Cafe I.) already given, will illuftrate this ob- servation ; and fix or feven others I might adduce to the fame purpofe. As yet my experience extends no further. The inoculation of infants is fo very rarely followed by any lenous difeafe, that as far as refpects them, the affufion of cold water may be feldom required. The inoculation of adults is noc, however, quite fo fafe. r See Zoonomia, vol. ii. page 237. f 1803. I now helievr that tht heat does not rife fo high in any (raf A confluent small-pox. See the A.UiUnnai Report:. 8 5* Inoculation is feldom indeed performed in our illand on adults that are natives, but foreigners frequently require it; and in Liverpool, our intercourfe with America renders it often neceffary to perform it on adults from that continent. We may alfo obferve, that when the na- tural fmall-pox is epidemic, the eruptive fever will be generally distinguishable, and wherever it is diftinguifh- ed with fymptoms of violence, inftead of trufting to cool air only, the cold affufion, or cold bath, is Strongly recommended. To our brethren acrofs the Atlantic this is more efpecially addreffed.—In America, as well as many parts of the old continent, in confequence of the neglect of early inoculation, the natural fmall-pox at times fpreads alarm and devastation throughout ex- tenfive districts. In this ifland the ravages of the natu- ral fmall-pox are on the whole very great, yet they occa- sion little disturbance or alarm. The practice of inocu- lation among the more opulent claffes of fociety, keeps up the contagion in all our populous districts, and at the fame time by relieving thefe claffes from the apprehen- sion of the natural fmall-pox in their own families, pre- vents them from oppofing the cafual progrefs of the dif- eafe among the inferior orders, who want the knowledge and the combination neceffary to the ufe of the means of prevention among themfelves. Though therefore it is demonstrable, and has indeed been demonftrated, that the destruction of the natural, or rather the cafual fmall- pox, might be entirely avoided, yet, as it falls almoft wholly on the families of the poor, and as it has been an evil that has been long, and that is familiarly known, we submit to it through habit, as if it were inevitable.* * The obfervations on the pcffible prevention of the cafual fmall-pox., will doubtlefs fuggeff. to the medical reader, the " Sketch of a Plan1' fur that purpofe, publifhed in 1793, by my relpe&able neighbour, Dr. Hay- garth. That this plan is in itfelf practicable, and that it would be ef- fectual, I have little doubt. Unfortunately, it requires the affiftance of government (as I remarked at the time) and tbis I fear is a poweiful ob- jection. It is poffible however that fome fcheme of this kind (including I hope all contagious difeafes) may one day or another be attached to fartc comprehenfive plan for the management of the poor. 59 The alarm produced by the cafual contagion is therefore feldom fo great in our large towns, as to give a practi- tioner frequent opportunities of treating the eruptive fe- ver of the confluent fmall-pox, the only ftage of that difeafe in which medical treatment is likely to be of much avail. Where fuch an opportunity does occur to the judicious reader of thefe pages, it is hoped that the The.theory that fuggested Dr. Haygmh's plan, but which formed no effential part of it, involved him in a difcuffion on the length of time that variolous matter may be expofed to the atmofphere, and retain its infec- tious quality. On this occafion, as there was fome difference of opinion between us, he propofed feveral experiments to me, which would doubt- lefs have decided the queftion. (Seep. 4.59, 460, of'" A Sketch, Seel") It was fully my intention to have undertaken fome experiments fuch as he mentioned, and I even commenced them, but as my attention was forcibly drawn to other fubjefts, thefe experiments, which required ex- *reme accuracy, were not completed, and my engagements have never fince permitted me to recommence them. I have, however, fince that time, inoculated with matter at different periods from its heing taken from the patient, and the refult is as follows :—The length cf time which vario- lous matter expofed to the air retains its contagious quality, depends on its fuperficies. If it be fpread very thin on a piece of flat or convex glafs, it loies this quality much fooner than when it is collected in a mafs. Spread 1 Iiin upon glafs, it fometimes difappoints the inoculator at the end of • twenty days, though not generally ; and I have known it fucceed in com- municating the difeafe, even when diffufed over a large furface, at the end of feventy-three days. (See Dr. Haygartiys Sketch, p. 44.7.) But I find from the experience of others, as well as from my own, thai this is ition depends wholly on the permeability of the fkin. This doctrine, which in his lectures he extended to all other exanthemata, is in my judgment, one vf the weakelr parts of his moft valuable woik. f (1803) I was of opinion that the fame perfon might be again and again affected by fcarlatina, but experience leads me to a different conclu- fion. I now believe that fcarlatina, like fmall-pox and meazles, affects the frnie perfon once only. In the Additional Reports, the reader will fee an ample detail ,,t t<:y further experience of the nature and treatment of this cJi'Hfe. 63 power, would not be advifable, fince it mult leave the patient expofed to the future influence of that conta- gion. I have not had an opportunity of repeating Dr. Ge- rard's practice in the incipient ftage of fcarlatina, but after the efflorefcence on the furface decides the nature of the attack, I have for the laft fifteen months uniform- ly prefcribed immerfion in the tepid bath, (from 92 deg. to 96 deg.), and with Striking benefit. Whether the af- fufion of cold water is applicable to the other exanthe- mata, muft be left to future experience. In the cafes that I have related to illuftrate the effects of the cold affufion, the temperature of the water may be iudged of from the feafon of the year. In general it was from 40 deg. to 50 deg. of Fahrenheit. In the epidemic which prevailed in the 30th regiment, the wa- ter of the river was employed, as has already been men- tioned, which as the feafon was uncommonly cold, did not, though in the month of June, exceed 58 deg. or 60 degrees. I have, however, very often ufed the river water in private practice during the Summer months of the laft four years, when in general it has been from 65 deg. to 70 degrees, and the effects correfponded with thofe already defcribed. The folution of fever depends chiefly on the fudden, general, and powerful impreffion on the fenfations, and this impreffion is lefs affected by the difference in the temperature from 40 deg. to 65 deg. as far as my obfervation extends, than might on a firft confideration be imagined. Within thefe limits the ef- ficacy of this remedy, as well perhaps as its fafety, de»- pends on the fuddennefs and momentarinefs of its appli- cation. The powerful impreffion on the fenfations is much weakened when the water is poured flowly on the body, and as the refpiration is fufpended or convulfed during this application, as well as during the act of im- merfion in the cold bath, ir might in fome cafes ioovr hazard to protract it. 64 CHAP. X. Of the Affufion of Tepid Water on the Surface of the Body, in Feverifh Diforders, and of Sponging the Body with Water or Vinegar. The Affufion of Te- pid Water pralflifed by the Ancients. I APPLY the term tepid to water heated to that de- gree which is warm but not hot to the fenfations, and which in the way of affufion is from 87 deg. to 97 deg. of the fcale of Fahrenheit. According to my ex- perience, this term, when the body is immerfed, may be applied to water fome degrees colder; the reafon of which will be eafily understood by thofe who reflect, that under immerfion no evaporation from the furface of the body takes place. At firft I imagined that the tepid affufion might be beneficial in cafes where the heat of the body is below the degree neceffary to render the cold affufion fafe. I employed it therefore in thofe Sta- ges of fever where the heat did not exceed the tempera- ture of health. A little experience however convinced me that this practice required Strict attention, for I found, that in many cafes, at leaft, the heat of the living body is lowered as fpeedily by the affufion of tepid wa- ter, as by the affufion of water that is cold :—if I mif- take not, in fome cafes the heat is lowered more fpeedi- ly by the tepid water. To thofe who reafon refpecting the heating and cooling of the living body in the fame manner as refpecting inanimate matter, this obfervauon 65 will appear paradoxical; I affert it however from actual observation, and a little reflection will explain the phe- nomenon. The evaporation from the furface is more copious from the tepid affufion, and on this the cooling of the body very much depends. But this is not all; the tepid affufion is little if at all ftimulating, and does nor, like the cold affufion, roufe the fyftem to thofe ac- tions by which heat is evolved, and the effects of exter- nal cold are refitted. Where the object is to diminifh heat, that may be obtained with great certainty by the repeated ufe of the tepid affufion, fuffering the furface of the body to be expofed in the interval to the external air—and if the beams of the fun are excluded, and a Stream of wind blows over it, the heat may thus be re- duced where cold water cannot be procured ; even in the warmeft regions of the earth—on the plains of Bengal, or the fands of Arabia. I have accordingly employed the tepid affufion very generally in thofe feverifh affec- tions where the morbid actions are weakly affociated^ depending rather on the Stimulus of preternatural heat, than on contagion, miafmata, the morbid contents of the ftomach and bowels, or local inflammatory affections of this kind are a great part of the feverifh affections of children, in which the tepid affufion is a valuable reme- dy. It very generally produces a confiderable diminu- tion of heat, a diminished frequency of the pulfe and refpiration, and a tendency to repofe and fleep. I have ufed it alfo in feverifh diforders of various kinds where the lungs are oppreffed, and the refpiration labo- rious, and where of courfe the oppreffion might be dan- geroufly augmented by the fudden Stimulus of the cold affufion. It is alfo applicable to every cafe of fever in which the cold affufion is recommended, and thofe may receive much benefit from it, whofe fears or whofe feeblenefs deter them from that energetic remedy. I have not however found its effects fo permanent as thofe of the cold affufion, and I have never feen it followed by the total ceffation of regular fever, as often occurs after the cold affufion. In the hectic fever, however, 9 66 where the actions are lefs Strongly affociated than in ty nochus or typhus, the paroxyfm is fometimes completely extinguished by the affufion of tepid water* on the com- mencement of the hot ftage. 1 n the hectic paroxyfm, the heat feldom rifes more than two degrees above the tem- perature of health in the trunk of the body, and three or four degrees on the extremities. By moistening the palms of the hands and the folcs of the feet with vine- gar, its effects may be moderated, for it is from thefen- fation of heat in the extremities, that the Stimulus to the fyftem ib chiefly derived; and this practice ought not to be neglected, if the tepid affufion is not employed gene- rally. In all cafes of fever indeed where the burning heat of the palms of the hands and foles of the feet is prefent, this method of cooling them fhould be reforted to; it is uniformly fafe and refrefhing. I have not em- ployed the cold affufion in the hectic paroxyfm. This difeafe generally adheres to a debile fyftem; the body parts with its heat in it eafily; and the lungs being always affected in the pulmonary hectic, the hidden application of cold to the furface might produce unpleafant, and per- haps dangerous effects on the refpiration. Neither have I tried it in peripneumony, or meazles.f When the affufion of water, cold or tepid, is not em- ployed in fever, benefit may be derived, as has already been mentioned, though in an inferior degree, by fpon- ging or wetting the body with cold or warm vinegar or water. This application is however to be regulated like the others, by the actual ftate of the patient's heat, and of his fenfations. According to rny experience, it is not only lels effectual, but in many cafes lefs fafe; for the fyftem will often bear a fudden, a general, and a ftimulating ap- * See this fact mentioned in the Zoonomia, vol. ii. p. 296, where a re- lation is inferted by Dr. Darwin, of the author's (Dr. C's.) own cafe of hereditary confumption. f (1803) The reader will find fome account of its being accidently ufed in a few cafes of meazles, in the Additional Report/. 6y plication of cold, when it fhrinks from its flow and fuc- .:efiive application*. I have alfo ufed the affufion of cool water as a remedy in febrile difeafes, but more frequently in paralyfis, and in other difeafes of debility By the term cool, I indi- cate the temperature from 87 deg. to 75 deg. It ope- * I have purpofely avoided entering on the general operation of cold, in hopes ot being better prepared for the fubjeft at fome future opportu- nity. In the mean time I have continued the ufe of fu. h terms as are moft intelligible, and moft confonant to the true doctrines as far as I per- ceive them. To fpeak of cold in any form acling as a ftimulus, feems however 10 fome learned friends, not merely an error, but an abfolute con- tradiction in terms. Heat, they affirm to be the univerfal ftimulus, and cold being meiely the privation of heat, muft in their opinion, always have 1 fedative operation. As well, it is faid, may darknefs, which is the pri- vation ot light, ftimulate the eye, as cold, which is the privation of heat, ftimulate the general fyftem. This obfervation, wh-ch has more importance with me from the quarter whence it comes, than from any intrinfic weight it poflefL-.s, leads me into one or two general remarks. That cold can never aa as a ftimulus, was a favourite dogma of the late Dr. Brown. It was a neceffary confequence of his general doctrines of life. As he admitted only of two claffes of d feafes—-difeafes of increafed and diminifhed excitement; fo he reduced all remedies to two correfpond- mg claffes—fuch as diminifh, and fuch as increale this excitement. That cold m extreme degrees is a powerful and effectual fedative is incontro- vertible ; he therefore held that it is fedative in every degree, without be- ing at the trouble to point out the line of temperature below which the te.m cold is applicable. It was the chafer of Dr. Brown to follow his hypothefis into all its confequences, contemning all fa&s that refted on the teftimony of others, and neglecting more than perhaps any man of his talents ever did, to bring his opinions to the left of experiment His theory was in his hands the bed ot Procruftes. On the operation of cold he was fingularly erroneous. He afferts that cold can never be of fervice in the fevers of the torrid zone; {Elements of Med. vol. i. p. 23.) and the reafon he gives is, that in thofe difeafes there is indirect debility to which cold muft not be applied. He declares that it never can be of fervice but in fthenic (inflammatory) difeafes, vol. i. p. 103) that for thefe it is the grand remedy ; (p. 196) that its operation is the fame in meazles catarrh and all other inflammatory difeafes, as in fmall-pox; and that " it is iuftic.ent to cure them all !" Thefe aflertions are not merely erroneous they are dangerous in a high degree. Whatever opinion may be entertained of Dr. Brown's fundamental principle—that all the phenomena of life are to be explained by aiTumimr (hat tne living pi inc.pie (the excitability) is accumulated and exoerded in the mverfe ratio of the ftimulation, it will not now be difputed, that he was acquainted with only one mode of aaion of the living principle that which Dr. Da.win has defcribed under the name of irritation- and hat he was wholly regardlefs of the influence of fenfation, volition,' and affo 68 rates as a gentle Stimulant, and may be ufed as a milder form of the cold affufion. Like the cold affufion its application Should be fudden and momentary, when the object is to increafe the tone of the fyftem, or to diffolve a morbid catenation; where it is employed to moderate inordinate heat, it may be ufed more flowly, provided it elation, fince his time fo fully illuftrated in Zoonomia, and which on every hypofhefis muft be allowed to have fuch vaft influence on the motion of life. It ws(s to his difiegarding the action of cold on the fenfations that the error of Dr. Brown is more immediately to be traced. It is not fo eafy to explain why Dr. Darwin, who underftood the laws of fenfation fo well, fhould alfo have difregarded the influence of cold on the fenfe of feeling. He feems to confider the application of cold as merely fubtracting the ftimulus of heat, and thus to be altogether nega- tive ; {Zoonomia, vol. ii. p. 757.) without adverting to that moft powerful fenfation, by which great and fudden changes from a higher to a lower temperature are attended, through which the energies of life are roufed into action, and the fedative influence of cold for a time counteracted. Whatever theory we adopt in regard to the origin of caloric in the living; body, it feems to me to be in a great meafure owing to the influence of the changes of the external temperature or. the fenfations, that the unifor- mity cf the heat of the animal is preferved ; and this view of the fubject is, as far a I can fee, confident with the general doctrines of Dr. Darwin. The lumuf-ting action of cold, though fhort in duration, is powerful in degree. In the torpor of convulfion, when weaker ftimuli are unper- ceived, the affufion of cold water on the naked body will often excite the dormant fenfibility, and introduce a new action throughout the nervous fyftom. ii. the apoplectic ftate brought on by the fumes of charcoal, this remedy is of all others moft efficacious ; when dogs are fuffocated in the va- pour ot the Grotfo del Cam, it is well known that they are recovered by plunging them in the adjoining lake. And in other animals, when the laft motions of life are apparently over, the fame application will fometimes, as I have obferved, renew the contraction of thofe fibres that feemed before fixed in death.?-"Tliis obfervation I hope to illuftrate at fome future op- portunity. Can darknefs ftimulate the eye ? No—Darkness produces no fenfation. Can cold be rendered ftimulating? Surely—After w+iat has been obferved no one will deny it : unlefs indeed it fhould be faid, that it is not the cold that ftimulates, but the fenfation which the cold produces j a point that it would be a wafte of time to difpute. It is the ftimulant power of coid that renders it fo difficult to employ it in inflammatory difeafes. (See note St the end of chap, xv.) (1803) The above note was written in anfwer to fome obfervations in a letter from Dr. Darwin.—He exprefl'ed an intention of noticing it in the next ed/itipn, pf his Zoonomia, but nothing of the kind is 'c be found there, 69 does not interrupt the catenation on which refpiration depends.* The practice of giving cold water as a drink in fe- vers, was common among the ancients, and immerfion in cold water they occafionally employed ; but the affu- fion of it on the furface of the body feems to have been wholly unknown. Ablution of the furface with cold water in feverifh difeafes, has been traced under different modifications among the practices'of the rude nations of Afia and of Africa by modern travellers, particularly by Sir John Chardin, and Mr. Bruce; but it was firft brought into notice in Europe during an epidemic fever which prevailed at Breflaw, in SileSia, in 1737, as appears from the differtation of J. G. de Hahn, under the title of Epi- demia, verna qua Wratiftaviam, anno 1737, affixit; to be found in the Appendix to the AUa Germanica, vol. x.j- While the laws by which the affufion of cold * I borrow this term (catenation) from Dr. Darwin.—It is employed to exprefs a number of actions linked together, nearly in the fenfe of affo- ciation : the fympathies, as they are ufually called, are included under this term, and many affociated actions to which the word fympathy has not been applied, as the connexion between the heart and the lungs, the fto- mach and the heart, &c. (See Zoonomia, vol. i. feet, xvii.) t De Hahn fays that he is the better able to defcribe this difeafe, as he himfelfwas feized with it; and was cured by " peregrina ilia multis vifa medendi methodus." He begins with an account of the caufes of the epi- demic—That firft mentioned is the ftate of the weather. In the month of May 1786, after a very promifing fpring, the weather became wet and cold, and the fall of rain was fo confiderable during June, July, and part of Auguft, as to lay a great part of Silefia Under water. The wind blew chiefly from the north-weft.—The harveft was almoft entirely deftroyed. In confequence a famine prevailed throughout the province, of which the au- thor gives a dreadful account, and this he mentions as the fecond caufe. The third caufe was the vitiated air. The unburied carcafles of perfons llain in battle were fuffered to putrefy in the atmofphere, and the ftagna- tion of the waters in the low grounds filled it with marfh effluvia. Even the cattle fuffered feverely from this ftate of the air, and from the want of pure water to drink. The epidemic began in the enfuing fpring. He givts a number of cafes. The firft is that of a farmer in the neighbour- hood of the city, of forty years of age. " Comites febris erant fubitus virium laplus, capitis & prsecordiorum dolor gravis, fluxio alvi, pervioi. lium, inquies, delirium. Quae infuperabilia morbi fymptomata excipiebat die undecima his ipiis infuperabilior obitus." The fecond cafe he men- lions occurred in the city. It is that of a delicate woman of thirty years 7° water ought to be regulated were not understood, the ufe of the remedy muft have been extremely hazardous, and the fatal confequences of its improper application, of age, previoufly afflicted by fevere misfortunes. The fymptoms were as follows. " Subito elanguida febriebat. Dolor capitis ilhco atrox. Sitis, & fecundo die, importuni menfes. Exin voinitus bilis, alvufque biliofa. Sputa vifcida. Syncopticus rigor. Ardor partium internus. Linguae quafi candenti ferro compreffae, ficca glabi ities & reftrictio. Vox arentibus faucibus nulla. Angina fine t.imoie peffima. Repetebant in- terdum tenacis pituitpe vomitus alvique fluxio. Os fine medela ficcum. Iactatio. Stipinus torpor. Mors inter tonvulfiones gemibunda " The author proceeds to detail four other cafes fimilar to the above, which alfo terminated fatally. Two females who caught the infection, efcaped in confequence of critical eruptions. At length the alarm became general. The attention of the magiftratts was roufed, and from a ftrict inquiry it was found, that more than double the ufual number of deaths had occurred at Bieflaw in that year. All the ufual methods of practice were ot no avail. Whether bleeding was em- ployed or abftained from, the difeafe was equally mortal. In this diftrefs Dr. De Hahn determined to try the effects of tae external ufe of cold water. The firft cafe in which it was employed, occurred in the month of April ; it is related as follows. " Mercator xxxii annus i atus, floridus natura, mox febriens, capitifque dolore 8c naufea affectus. Pennittentibus id viii- bus, altera die mittebamus fanguinem, qui inflammatorius. Vefpere vomebat aeger, tertia die maculofus. Maculae monllis aemulae, incon- ftnntss. Mndor. Mox piaecordiorum ntoleiabihs dolor & delirium. Quafi ex temulentia vacillaas extra iectum vagabatur ae^er. Oculoaltera dilatato, altero connivente, titroque gramiofo & caligenofo ; lingua laevi, nrida, candente; fputo refniofo; utina biliofa."—The ufual remedies failing, on the eighth day they had recourfe to ablution. " Turn ad ex- ternas illas humectations confugiebamus, indefeffa opeia fpongi'S omnem corporis ambitum demulcentes. Id confequebamur, ut fenfim fputa reii- nofa fierent magis mobilia; ut flaccida et fufca fades confpiceretur magis tuigidula; utfelicius procederet blandus mador ; ut refip.fceieret, hactenus vel loquax nimium, vel taciturnus ex delirio aeger." The author then re- lates a cafe of a fimilar nature, in which, the ablutions being rejected, the patient ded. Next follows the cafe of a lady, a relation of his own, forty- three years of age, whofe fymptoms appeared of the moft dangerous nature. In this cafe the attack was fudden. " in er domefticas occupationes quafi conquaflata concidebat. Facies prime momento Hippocratica; artubus gla- cie perfufis. & tremnlis. Horror repetitu^ ad quemvis aei is atiactum. Vomi- tus poft quaevis ingefta. Abdominis turgor. Videbatur mihi advolanti non rnorbo corripi aegra, fed fiderata mori, vixque amplius cum morte colluc- Jari. Pharmaco, ob vomitus, non erat locus 5 neque vense fectioni, ob algida & emarcida membra. Die 2da, jugi abluitione artuum glacies diffluebat inter gemibundos angores. Sitis tandem invitabit potum. Ca- lorem excipiebat aeftus. Clyfma folvebat partes abdominis internas. Quar- ta. die, magis fibi confcia aegra caput quafi a percuflione dolere conquere- batur. * * * Oftava demum die, certa rediturae fanitatis fpes, duorum tandem menfium confirmata." The author next relates the cafe of a man of fixty-four, whom he at- tended, with two other phyfician95 and on whom the affufion of cold water, 71 we can eafily believe to have prevented its gaining any ground on the continent, or its having been adopted in Britain. Thefe laws are now, 1 hope, afcertained by or ablution of any kind, does not feem to have been tried. This perfon died on the ioth day, and oui author himfelf was immediately after feized with the difeafe, having probably caught it from this patient. He was in hi6 44-th year. " Die nno, Perfenferam inter vix fuperabiles labores, infeftum aiiquamdiu nucha? dolorem. Hie ifto mane folito ferventior, febiem epidtmicam invitabat abfque piaevio hoiroris fenfu. Saevus die dolor ex nucha ortum ducens—totum tunc ambiebat caput. * * * Fei - vebat caput, frigentibus peilibus, fpafmo ad abdomen rigidis. Auges- cente de momento in momentum dolore, horror aderat ad quemvis aeris uttactum. Languor mox ab initio extiemus. Nox ipquieta & fudans. 7.do, Ocnli grav ffime dolentes * * * 3M0, Parca mane remiflio doloi urn, mox intenfioium; febie, prsevio tempore, aucta. Nox cJamofo nuchas & capitis cruciatu atrox. 4-to, Poft hanc dies nocte pejor. Pedum gla- cies nondum egelata." Thefe fymptoms increafed daily. On thefeventh day theie was great fubfultus tendinum, and the whole body was covered with petechiae. In ihtfe circumttances recourfe was had to ablution with cold water. •* Ab hac dieabluitio frigida tiniverfalis in ufum vocata cum antea particularis tantum obtiniffet. 8vo, Pulfus tremulus obfervatur. Gemitus a doloium ferocia perennis. 91110, Vomitus grumum cruoris cmoliebatur. roino, Obtinebat tunc return ab aliquo mentis deliro ftu- poie incuria. nmu, Sudor, armiftitium aliquot horarum producens, opportuno cortici9 ufui locum concedebat, cum jam exitialis languorquse- vis peffima minaretur. Loquela difficdis & balbutiens. Angina apthofa. Str dor dentium. nmo, Rifus fardonicus. Spafmi cynici. * * * Id interim confequebamuicoiticis ufu, ut qimtidiana exacerbatio tardtus, & die deem.a quarta, qua? tota comatofa fuerat, fub nuctem demum ingru- erit. Sed gravitate tarditatem compenlabat, violenti frigore totum corpus quaiiente. M*x algidus aderat fudor, deficiente loquela ; demifl'a citra vo- luntatis miperium urina." Fiom this apparently defperate ftate, De Hahn, however, recovered, and chiefly, as he apprehends, by the ablu- tions of cold water, which were employed even in this advanced ftage of the fever. Almoft from the beginning of the fever he indulged freely, according to the pl::n he had followed with others, in liquids, confuting chiefly of water, rendered grateful and cooling by the addition of lemon juice, nitre, &c. and every night he took a moderate dofe of opium, from which he found the greateft benefit. From all heating alexipharmics he entirely abftained, having the greateft repugnance to them. On the fe- venth day, the general ablutions with cold water were begun. The me- thod employed feems to have been that of fponging the fuiface, and this appears to have been continued for fome time together. The effects are delciibed as follows. " Sancteque teftor, nunquam non refici ad breva temporis momentum languentes marcidae cutis fibras me perfenfifle. Suc- cedebat, repurgatis hac ope poris, pefpiratio liberior, ac fudor modeftusj videbanturque cutis obturacula promptius fpongia remota, quam phar- maci interni virtute. Rtcreabat piaeteiea hiantia & purum aerem litientia cutis ora, liberior aens acceflus." This account of the effects of the practice, correfponds with our experience at prefent. Dr. De H hn found the advantage ui a plentiful fupply of frefh air, at that time little under- 72 ample experience, and practitioners will, I truft, find themfelves directed in fafety in the future ufe of this powerful remedy. flood throughout Germany or Europe, and.hefecured it by keeping his win- dows open. He changed his bed-clothes and linen frequently j and he oc- cupied one bed during the day, and another during the night, a practice which moderated the heat, and often produced great refrefhment. This practice deierves indeed to be followed whenever it can be done with conve* nience. Experience convinces me that it always produces much comfort under feverifh heat and initation, and that it often procures tranquil fleep. Where a change of bed cannot be obtained, the method of Dr. Franklin, of expofmg the body to frefh air, and ventilating the bed-clothes, ought to be reforted to. De Hahn took the bark on the nth day, and found it very grateful to his ftomach, and agreeable to his fenfations. That day he took five drachms of the powder. On the 12th, he took four drachms j on the 13th, three only ; and on the 14th, only one ; his relifh for it ha- ving gone off. The baik feemed to moderate his fymptoms, which returned with violence on leaving it off, and on the 15th day he found himfelf on the point of death. At this very time however he perfifted in the cold ablutions^ and to them he afcribes his recovery. " Juges iliac abluitiones, quibus hucufque recreatus fueram, ea ipfo die, qua mori videbar, non negiigebantur; licet enim totus algidus algido fudore perfunderer, non fecus ac liquefactae glaciei immerfus, frigidatamen abluebarj maritofer- vitura. chariflima conjuge lethales madores ocius deluente." From this time the fymptoms became lefs violent, but his recovery was flow and dif- ficult. On the 18th day he was ftill delirious, and fyncope came on when he attempted to get out of bed. His appetite, however, began to return, he had copious fweats and fell into profound fleep. On awaking he felt a great averfion to noife, and every thing appeared new and extraordinary. On the 36th day cholera came on, but was fubdued. On the 48th theie was a defquamation of the fkin, and a falling off of the nails. He con- cludes this account of his own cafe in the following words, " Moibi tandem reliquiae menftrua equitatione feliciter fubactae." De Hahn was attended by his father, alfo a phyfician, under whofe direction the ablutions were performed, and by whom the greater part of the fymptoms muft have been recorded. In confequence of this fuccefs cold ablutions were employed with others, and many were faved by them in circumttances apparently the moft defperate. It is evident from this abftract, that De Hahn was not regulated in his ufe of external ablution with cold water, by rules fimilar to thofe which I have ventured to lay down from feveral years experience. Inftead of pouring the water over the naked body, he applied fponges foaked in cold water to every part of the furface in fucceffion, and feems to have continued the application for fome time together; in my judgment the leaft effica- cious, as well as the moft hazardous manner of ufing the remedy. He does not feem in general to have ufed the ablutions till the eighth or ninth day of fever, and till the cafes were growing defperate from the failure of other means. At this advanced ftage, the ablutions, as might be expected, feem to have been of very inferior efficacy. Yet in the iingle cafe, in which 73 The affufion of tepid water in febrile difeafes was not unknown to the ancients, though feldom employed by them.* It is, I apprehend, new in modern practice, and will be found an important addition to the lift of our remedies. The effects differ considerably from immer- fion in the tepid bath, as will be more fully explained in fpeaking of that remedy. Though the affufion of from the impoffibility of the patient's fwallowing medicines, ablutions were ufed on the fecond day of the fever, the recovery was fpeedy ; it ap- peared certain on the eighth day; and this might have encouraged an earlier trial of the fame practice in other inftances. But what appears to me moft furprifing, is, that he does not feem to have been regulated in the ufe of this remedy, either by the actual heat of the patient or his fenfations of heat. In his own cafe he exprefsly declares, that the cold ablutions were ufed on the 15th day of the fever, when he was fhivering with cold, and covered with cold fweat; circumttances under which I fhould pro- nounce it to be in the moft extreme degree dangerous. Whether my re- ftrictions as to the ufe of the cold affufion, and the application of cold in general to the body, be too fevere, future obfervations muft decide; but from a general review of the incautious practice of De Hahn, I am not furprifed that his boafted remedy, is, fo far as I can learn, no longer in ufe, either in Silefia or in any part of Germany. Befides ablution, clyfters of water were found ufeful in this epidemic, and water was ufed copioufly as a drink. Eruptions of a fuppofed critical nature frequently appeared. This fever carried off three thoufand perfons in Breflaw and its vicinity. The means of making this abftract have been furnifhed me by a friend at Edinburgh, who copied for me the greater part of the memoir of Dr. De Hahn, from the 10th vol. of the A8a Germanica, in the College Library ; in my firft edition called Ada Not. Cur. after Dr. Cullen. (1803.) In my laft edition this note was printed very inaccurately, owing to an accidental circumftance—the quotations from De Hahn are now I hope given with fufficient correctnefs, though I have not had an opportunity of infpecting the printed work. The abftract of this differta- tion in Sauvages is imperfect and incorrect, not being taken from the original work of De Hahn, but from the Review of it in the Journal de Medicine for 1757. See Nofologia Method: Tom. i. p. 334, 4/0 edition. • Some traces of its ufe in fever are to be found in Celfus. " Quidam " ex antiquioribus medicis, Cleophantus, in hoc genere morborum, " (tertian intermittents) multo ante acceffionem caput aegri multa ca- " lida, aqua perfundebat, deinde vinum dabat. Quod quamvis pleraque " ejus viri praecepta fecutus eft Afclepiades, recte tamen praeteriit, eft '« enim anceps," Celfus, lib. iii. cap. xiv. This ufe of the tepid or warm affufion is altogether different from what I propofe, and was not only, as Celfus fuppoles, a doubtful, but probably an injurious practice. For by chilling the body, it would difpofe it to the acceffion of the paroxyfm. The ufe of the tepid affufion ns now propofed, may fairly be confidcrcd as a new practice. • 10 74 tepid water was little in ufe as a remedy, it waj» familiarly practifed as a part of their daily regimen, by the Greeks and Afiatics, in the earlier periods of their hiftory. That the Greeks in later times, and after them the Romans, immerfed themfelves in the baths to which they were fo much devoted, is certain; but in the heroic age of Greece, the affufion of tepid water feems to have been the mode in which this luxury was enjoyed. Abundant proofs of this are to be found in Homer, particularly in the Odyffey, that admirable record of an- cient manners. Venus, after her public difgrace, is de- fcribed as flying to the groves of Paphos, were fhe is laved by the Graces, and the improvement derived to her beauty is recorded in a ftrain of poetry worthy of the fubject. (Odys. lib. viii. /. 362 to 367). Ulyffes is repre- sented as laved by attendant nymphs in the court of A1- cinous, and in the ifland of Circe the whole procefs of heat- ing the water, and pouring it over the naked hero, is par- ticularly defcribed.* On this occafion alfo, nymphs ad- miniftered to him, who after the ablution anointed him all over with oil j a fervice well calculated in every refpecl to increafe the pleafure, and to diminish the rifque of the tepid affufion. The Romans under their Emperors, carried the fyftem of bathing to a height of luxury and expenfe which it never reached in Greece or Afia, as the ruins of their magnifi- cent Balnea prove to this day ; and the affufion of warm water was one of the methods by which they diverfified this favorite gratification.f * Odys. lib. x. /. 358, &c. compare this with the bathing of Telemachus in lib. xvii. /. 85, &c. f See Hieronymi Mercurialis de Arte Gymnaft : lib. i. pt 44 and 45. CHAP. XI. Of the Internal Ufe of Cold Water in Fever. BEFORE I conclude the account of my experience of the ufe of cold water in fever, it will be necef- fary for me to fay fomething of its effects when fwal- lowed, on the ftomach, and through it on the fyftem at large. Among the ancients the internal ufe of cold water in ardent fevers is recommended by Hippocrates, Galen, Celfus, and moft of the celebrated phyficians whofe works have come down to us: among the mo- derns, that extraordinary man, Cardanus, wrote a dif- fertation in its favour, and to pafs over a multitude of inferior names, Hoffman, though with fome restrictions, recommends it, not in fever only, but in various other difeafes.* In our own country it was propofed as an al- moft univerfal remedy by Smith, and a treatife has been written on it under the title of Febrifugum Magnuup by Dr. Hancock. In Spain and in Italy the ufe of cold water in fevers, obtained in the beginning of this cen- tury, a greater and more general reputaticn than in any of the other countries in Europe, and at one time, feems to have fuperfeded all other diet, as well as medicine. This treatment was celebrated under the title of' Diaeia- Aquea, and an account of it may be found in the 36th volume of the Philofophical Tranfactions, by Dr. Cv~ * Ucffmnnni Opera, vol. i. p. 479- 76 rillus, a profeffor at Naples, to which the reader is re- ferred. Befides the internal ufe of cold water, he men- tions the advantage of laying powdered ice or fnow on the bodies of the fick. Neverthelefs, the propriety of giving cold water in fevers has been difputed by men of high character, and particularly by the celebrated Boerhaave. His doctrine, that a lentor in the blood is the caufe of fever, led him to infift on the ufe of warm drink, and the danger of cold; and his commentator Van Swieten, though he allows cold drink in fome inftances, yet in general ar- gues againft it.* Thefe learned theorists prevailed in their day over the voice of nature, and the precepts of Hippocrates and Hoffman.—In the writings of Pringle, Cleghorn, and Lind, we find little or nothing on the fubject, though they wrote exprefsly on fevers j Dr. Cullen mentions cold drink, but gives no opinion on the propriety of its being ufed, and certainly did not re- commend it in practice. He was even doubtful of the extent to which cold air might be admitted.f On the whole it may be afferted, that the ufe of cold drink in fever is contrary to modern practice, and that where it is occafionally given, it is adminiftered with caution, and rather permitted than enjoined. It is not however to the doctrine and precepts of Boerhaave alone, that the difufe of cold drink in fevers is to be imputed. The propriety of giving it freely has been at all times controverted, not on the ground of theory only, but from experience of the dangerous, and fometimes fuddenly fatal effects of large draughts of cold liquids, various inftances of which have been recorded from the earlieft periods of medical hiftory. While therefore fome phyficians have prohibited the ufe of cold * See Boerbaawii Aphorifm. Sect. 743, with the commentary of Van Sivieten. f See his Firft Lines—cure of fever. 11 drink in fevers altogether, thofe who have recom- mended it from experience of its falutary effects, have introduced various cautions as to its exhibition, founded on certain theories, generally fallacious, on the manner in which its deleterious influence is produced. To de- tail the various opinions that have prevailed on this curi- ous and important point, would be to add another chap- ter to the ample records of human errors. That the danger arifing from cold drink depended on the great difference between the temperature of the liquid and of the body, and that it is therefore to be prohibited when the heat of the body is very great, is an opinion very generally received by the moderns: and among the ancients, though their doctrines were lefs erroneous, yet while the means of afcertaining the real heat of the living body, and the changes it undergoes, were un- known, it cannot be expected that they Should have ar- rived at the truth on this important fubject. The effects of cold water as a drink in fevers, I was naturally led to examine by my experience of its effects as an external application. I have made this examina- tion with the thermometer in my hand, and with all the attention in my power; and the following refults, which will fave the reader the fatigue of reading the particu- lars of various cafes and experiments, feem to me to contain all the information neceffary to direct our prac- tice. i. Cold water is not to be ufed as a drink in the cold ftage of the paroxyfm of fever, however urgent the thirft. Taken at fuch times, it increafes the chillinefs and torpor of the furface and extremities, and produces a fenfe of coldnefs in the ftomach, augments the op- preffion on the prsecordia, and renders the pulfe more frequent and more feeble. Its effects in all thefe ref- pects are fimilar to the affufion of cold water on the fkin in the fame ftage of the paroxyfm, as defcribed in pages 20 and 43, though inferior in degree. If the thirft is 73 gratified in the cold ftage of the paroxyfm, it ought to be with warm liquids. 2. When the hot ftage is fairly formed, and the fur- face is dry and burning, cold water may be drunk with the utmoft freedom. Frequent draughts of cold liquids at this period, are highly grateful j they generally di- minish the heat of the furface feveral degrees, and they leffen the frequency of the pulfe. When they are at- tended with thefe falutary effects, fenfible perfpiration and fleep commonly follow.—Thefe effects are fimilar to thofe produced by the affufion of cold water on the furface, as already defcribed, but inferior in degree alfo. Though various cafes are on record of the paroxyfm of fever being diffolved by cold water, drunk in this ftage of the difeafe, my experience does not furnifh me with any inftance of this kind.* Indeed fince I became ac- quainted with the extraordinary efficacy of the affufion of cold water on the furface, I have not trufted the fo- lution of the paroxyfm to its internal ufe. I have how- ever employed cold drink when neceffary as an auxiliary. Throughout the hot ftage of the paroxyfm cold water may be fnfely drunk, and more freely in proportion as the heat is farther advanced above the natural ftandard. It may even be drunk in the beginning of the fweating ftage, though more fparingly. Its cautious ufe at this time will promote the flow of the fenfible perfpiration, which after it has commenced, feems often to be retard- ed by a frefh increafe of animal heat. A draught of cold water taken under fuch circumstances will often re- duce the heat to the ftandard at which perfpiration flows * See Alpinus. Med. Meth. lib. ii. cap. 3. After reciting the effects of cold drink in diminifhing heat and thirft, and exciting profufe perfo- rations and large difcharges of urine, he concludes, Mirabile eft, quomodo tale praefedium, has febres expugnat; nam execretionibus, quas aqua fuf- citat, haefebres finiunter. According to the fame author, this practice was followed by the Egyptians, See lib. ii. cap. 15. The pernicious effects of cold drink during profufe perfpiration? wr>s known to the ancients.—See Celfus, lib. i. cap. ■z. 79 more freely, and thus bring the paroxvfm to a fpeedier ;ffue. 3. But after the fenfible perfpiration has become ge- neral and profufe, the ufe of cold drink is Strictly to be forbidden. At this time I have perceived in more than one inftance, an inconfiderate draught of cold water, produce a hidden chillinefs both on the furface and at the ftomach, with great fenfe of debility, and much op- preffion and irregularity of refpiration. At fuch times, on applying the thermometer to the furface, the heat lias been found fuddenly and greatly reduced. The proper remedy is to apply a bladder filled with wa- ter, heated from no deg. to 120 degrees, to the fcrobi- culus cordis, and to administer fmall and frequent dofes of tincture of opium, as recommended by Dr. Rufh. By thefe means the heat is fpeedily reftored. This effect of cold water ufed as a drink during pro- fufe perfpiration, is precifely analagous to the affufion of it at fuch times on the furface of the body, a practice known to be of the utmoft danger, and enumerated by Hoffman among the caufes of hidden death. Inveniun- iur in ampliffimo regno nature plura qua brevi tempore nocent ac perimunt, ut aqua frigida corpori fudore diffiu- enti immoderatius fuperingefla. Vol. i. p. 194. The pernicious effects of cold water applied internal- ly and externally during profufe perfpiration, depend on the fame caufes, namely, that perfpiration itfelf is a cooling procefs, under which when profufe, the heat of the body, whatever its actual ftate may be, is finking j that under fuch circumftances, we find as a matter of fact, that it parts with its remaining heat more eafily; and on the hidden application of cold, that this heat finks to a degree which difturbs, and fometimes wholly interrupts the actions on which life immediately de- pends. 8o Thus then we may fafely adopt the fame general rules for the ufe of cold water in fever as a drink, that have already been laid down for its external application. It may be ufed as a drink, in fevers, at any time, when there is no fenfe of chillinefs prefent, when the heat of the furface is fteadily above what is natural, and when there is no general or profufe fenfible perfpiration* Though we have arrived at thefe conclusions, the effects of cold water ufed as a drink have not been in- ferred from its external application, but made the Sub- ject of feparate inquiry. Yet, that in the one cafe, and in the other, they Should be fimilar in kind, though different in degree, will be expected by every one ac- quainted with the laws of the animal economy, and par- ticularly with the fympathy that fubfifts between the ftomach and the furface. I have only to add, that in our common contagious fever, when I have ufed the affufion of cold water, I have feldom found it neceffary to employ it largely as a drink, and my experience of its effects when drunk in large quantities, has been chiefly confined to thofe cafes, where the fears or prejudices of the patients, or their friends, have prevented our having recourfe to the more powerful method of affufion. For; however burning the thirft may be, it is fpeedily abated, and even remo- ved, with very little drink, and often without any, by the fuccefsful ufe of the affufion on the furface. Though the affufion in general fufhees in our contagious fever, yet where cold water is employed in the dreadful fever of Philadelphia and the Weft Indies, it is probable, that its internal and external ufe Should be combined; a point that muft be determined by the actual heat of the patients, meafured by the thermometer, and by their fenfation of heat; circumftances of which it is to be regretted that we have as yet no accurate information. * See page 29. 8i CHAP. XII. Of the Difeafe that arifes from drinking Cold Liquids > or ufing the Cold Bath, after fevere Exercife. IT is here natural to inquire how far the fatal effects pro- ceeding from drinking cold water, not in fever, but in cafes where the fyftem has been extremely heated by bodily exertions, (of which the records of medicine af- ford fo many inftances), are to be explained on the prin- ciples already laid down. If they are explicable on thefe principles, we ought to be able to fhew, that they have occured in fituations where the fyftem, after having been much heated and enfeebled by fevere exertions, is lofing its preternatural heat from profufe fweating, and in general alfo from the ceffation of the exertions by which this heat was originally produced. Here two powerful caufes combine to cool the body, and if under their operation, a hidden application of cold is made either to the ftomach or the furface, the living power will, we know, refift it faintly, and the fatal confe- quences be accounted for; i. In my own experience this hidden death has oc- curred once only, and that many years ago. It was in the cafe of a young man who had been engaged a long time in a moft fevere match at fives. After it was over, he fat down on he ground, panting for breath, and co- vered with profufe perfpiration. In this ftate he called 11 82 to a fervant to bring him a pitcher of cold water juft drawn from a pump in fight. He held it in his hand for fome minutes, but put it to his head as foon as he had recovered his breath, and drank a large quantity at once. He laid his hand on his ftomach, and bent for- wards j his countenance became pale, his breath labo- rious, and in a few minutes he expired. Various me- thods were employed to reftore him, but in vain. 2. The following cafe refembles very exactly that juft given. Blafius, Senenfis, familiaris nofter et con- difcipulus, dum longiufculo tempore fub ardentiffimo fole pila lufu incaluiffet, nee fudore adhuc aut fatigatione remiflis, in fubterraneum locum ubi vinaria erat cellula. defcendiffet, frigidiffimi vini calicem haufit; quo epoto, ftatim defecit. Benevent. cap. 17. De abditis. 3. Elegans £f? optima ftatura juvenis Romanus, cum pild luderet, et fudore refperfus, ac totus madidus, & fatigatus ad puteum, fro fiti arcendd veniffet, exhauftd frigidd recens per caldarium extratld, illico in terram cecidit £sf ebiit. 4. Alteram novimus ex iis, qui in campo negotiantur. qui quum non minus corporis totius adapertis poris madi- dus domum reverteretur, cyathum frigidioris aqua ebibit, et mortuus fult. Anat. Lufit. curat, med. cent. 2. cu- rat. 62. 5. Forreftus relates, that in the year 1544, Valerius Cordus, a young man of great learning and talents, went during the heat of the dog-days, to collect plants among the Florentine mountains. Exhausted with fa- tigue and thirft, he incautioufly drank of a cold fpring which iffued out of one of the hills, and was immedi- ately Seized with a fever, of which he died -, but the fymptoms of which he has not recorded. P. Foreftus, lib.:. Scholio ad obs, 13. 83 6. Scaliger relates the cafe of a reaper, who, Stoop- ing down to drink at a fountain after fevere labour, in- stantly expired. Scaliger de Subt. ad Cardan, exer. 13. 7. In Heifter's obfervations, a cafe is related of a young man, who, about the Chriftmas feafon, had been playing and dancing at a Mill with fome young women, and had eaten greedily of fome hot buttered cake. Af- ter this, being extremely thirfty, he took a large draught of fome cold water mixed with fnow. An inflamma- tion in the ftomach followed, terminating in mortifica- tion, of which he died. Heifter's Med. &c. Obferva- tions tranftated by Wifeman, p. 17. 8. Villanum quendam nobis familiarem novimus, qui meffis tempore, anno 1597, exhauftus viribus, et totus fitibundus prce nimio foils ardore, domum rediens, cum in magna quantitate, adfitim explendam, gelidam (aquam) bibiffet, exanimatus mox juxta puteum cedidit, ac intra tres horas animam expiravit. Georgius Graffeccius in Theatro Anatomico. Thefe relations are chiefly taken from the collection of Schenck—they might be greatly enlarged, and I have collected a number of fimilar cafes ; which it were a te- dious and an ufelefs-tafk to detail. In all of the cafes which I have confulted, as well as in thofe I have related, three circumftances are either expreffed or may be clearly inferred—1, The body had been previoufly heated be- yond the temperature of health, by exercife carried to fatigue. 2, To this violent exertion a ftate of reft had Succeeded. 3, A profufe perfpiration had taken place. So far our reafoning is fupported; but as thefe points are of the utmoft confequence in explaining the opera- tion of cold on the human body, and as direct experi- ments are attended with extreme hazard, the reader will excufe me if I attempt to illustrate them by fuch evi- dence as hiftory may incidentally afford. 84 i. In Quintus Curtius, (lib.vu. cap. 5.J an account is given of the march of the army of Alexander the Great in purfuit of Beffus, through the country of the Sogdiani, which is reprefented as deftitute of water, Ste- rile, and covered with fcorching fands. The intolera- ble heat, fatigue, and thirft of the foldiers, in their march through this burning defert, are defcribed with all the florid eloquence of the historian. At length, fainting under their toils, they reached the banks of the river Oxus, where by indulging large draughts of the Stream, Alexander loft a greater number of his troops than in any of his battles. Sed qui intemperantius hau- ferant inter clufo fpiritu extin£li funt -, multoque major horum numerus fuit, quam ullo amiferal pralio* 1. A fimilar Story is related by Appian—Appianus Alexandrinus de bellis civilibus, lib. v. tradidit Cornifi,-? cianos milites a Pompeianis pugna fatigatos &" aftuantes fontanam aquam avide bibentei, ex iis pturimos emortuos. Marcel. Donat. lib. iv. cap. 6. Hift. med. mirah. * The whole particulars of this march as defcribed by Quintus Curtius, are very intereftmg. The defert, which contained not a drop of water, was four hundred Stadia aciofs—(per quadringenta ftadia ne modicus qui- dem humor exfiftit) that is, upwards of forty-fix Englifh miles. They began their journey in the nighr, directing their courfe by the ftarf, and for fome time their march was tolerable, being refrefhed by the dews of the night, and ihe coolnefs of the dawn; but when the fun rofe, the heat became troublefonie, and as the day proceeded, moft opprefflve; it was equally painful to ftuid ftill or proceed. Afur a day c f dreadful fatigue, the vanguard of the army, and Alexander himfelf, reached the Oxus to- wards evening; and fuch as were themfelve- refrefhed, were employed in carrying watu back to the fainting troops behind. As they arrived in fucceffion on the banks of the river, it may eafily he fuppofed that they drank without moderation, and hence the deftruction that enfued. It was on this occafion that Alexander difplayed his magnanimity, in refu- fing the cup of water brought to him as he advanced, becaufe it was not fufficent both for him and his companions ; and th.it he gave a proof of his genius, by ordering fires to be kindled on the high banks of the Oxus, not merely to direct his way-worn foldiers through the daiknefs, but to animate ther fa ntii g exertions by a profptct of the end of their toils. Fiutaich alludes to this ftory, but does not relate it fully. I fear it is not to be found in Arnan. A fimilar diftiofs is rrfentioned by him (lib. vi. p. 425) to have occurred in Alexander's march through the defei ts of the country of the Gedrofi, who inhabited the fbuthern part of the Perfi;:r empire, on the fhores of the Indian ocean. 85 2* A difafter of the fame kind is recorded to have occurred to the Christian army in the holy wars. Gu- lielmus Tyrius, lib. iii. c 16. fcribit, Chriftianum ag- men Pifidtam ingreffum, regionem arentem & inaquofam, tandem invento fluvio, avide bibiffe-, quad quidem, qui largtus aquam frigidam ingurgit aver unt, fitis difcrimen evadentes, mortem in aquarum opulentid reperere. Thefe historical relations fupport very fully the doc- trine 1 have already laid down. The cautious reafoner may not, on a hafty consideration, be inclined to reft with much confidence on this fort of evidence; but on reflection he will fee that it is entitled to confiderable authority; becaufethe facts are in their nature not liable to be mistaken, and becaufe they are not likely to be mifre- prefented. It is alfo entitled to much weight, becaufe it is not given by thefe historians in fupport of any par- ticular doctrine; and becaufe the experiment having been made on fuch numbers of perfons at once, it ac- quires an authority hardly to be afcribed to folitary ca- fes, however accurately detailed. Thefe confiderations induce me to lay much more ftrefs on evidence of this kind, than on the precepts refpecting the effects of cold drink to be found in medical authors, ancient or mo- dern. Neverthelefs I have looked into the greater part of the ancients on this point, (for among the moderns there is not much on the fubject), and have found nothing, that fully confidered, invalidates the con- clusions I have laid down. Of the ancient phyficians, the moft copious on the ufe of water, in all its forms, is Galen. He not only ufed cold drink, but immerfion in the cold bath, in burning fevers, with extraordinary fuccefs. His rela- tions appear to me, in general tedious and obfcure, but not deftitute of truth; and the wearinefs of perufing him, is occasionally relieved by the pleafure of refcuing a fact that was buried under maffes of falfe theorv. 86 The reader who would confult him on this Subject may ufe the references below.* In the firft volume of Medical Inquiries and Obfer- vations, publifhed by Dr. Rufh of Philadelphia, 1789, an account is given of the u Diforder occafioned by " drinking cold water in warm weather," which fre- quently occurs there, " Three circumftances," he ob- ferves, " generally concur to produce difeafe or death " from drinking cold water. 1, The patient is ex- tc tremely warm. 2, The water is extremely cold. And ff 3, A large quantity of it is fuddenly taken into the " body. The danger from drinking cold water is al- " ways in proportion to the degrees of combination " which occur in the three circumftances that have been " mentioned." p. 151. Dr. Rufh goes on to ftate the fymptoms of this difeafe, which are, I apprehend, gi- ven with accuracy. His method of cure my experience neither authorifes me to confirm nor oppofe. " I know " but one certain remedy for this difeafe, and that is " liquid laudanum. The dofes of it, as in other cafes of fC fpafm, fhould be proportioned to the violence of the " difeafe. From a tea-fpoonful, to near a table-fpoon- " ful, has been given in fome inftances before relief has c? been obtained. Where the powers of life appear to " be fuddenly fufpended, the fame remedies Should be " ufed which have been fo fuccefsfully employed in re- " covering perfons fuppofed to be dead from drowning." To this I would add the application of a bladder filled with water, heated to 110 deg. or 115 deg. of Fahren- renheit, to the pit of the ftomach, from which I have feen powerful effects in restoring the vital heat. But while I do not diffent from Dr. Ruth's practice, I cannot fubfcribe to his notion of the caufes of this difeafe, or to the method of prevention founded on this notion. * Vol. i. 23. B. Vol. ii. 78. C. Vol. vii. 70. A. and forwards throughout the volume. I quote from the Latin edition in folio, publifh- ed at Venice, 1656. «7 Dr. Rufh feems to entertain the popular opinion on this fubject: the body is extremely warm, the water ex- tremely cold, and a large quantity is introduced fuddenly. He apprehends the danger to arife from the great differ- ence between the temperature of the body, and of the water taken in. As a means of prevention he therefore propofes to fuch as cannot be reftrained from drinking cold water when preternaturally heated—i, To grafp the veffel out of which they are about to drink for a minute or longer with both hands, that a portion of heat may be abstracted from the body and imparted to the cold liquor. 2, If they are not furnished with a veffel to drink out of, but obliged to drink at a pump or a fpring, always to wafh their hands and face previoufly to drinking, with a little of the cold water. " By re- ceiving," fays he, " the fhock of the water firft on thofe ,c parts of the body, a portion of its heat is conveyed " away, and the vital parts are defended from the action " of the cold." The fact however is in my mind perfectly eftablifhed, that there is no fituation in which the application of cold to the body, whether to the furface or the ftomach, is fo fafe, or in general fo falutary, as when the heat of the body from whatever caufe, is preternaturally great, pro- vided that the body is not already in a ftate in which it is rapidly parting with this heat, and no difeafe has taken place in the general fenfibility, or in the Structure of any of the parts; and that where the body is preter- naturally heated, the degree to which cold water may be drunk, may be always decided by the fteadinefs of" the fenfation of heat, and the tenacity with which the pre- ternatural heat is actually retained. Thus, in continued fevers it may be drunk to a greater extent, than in the hot Stage of intermittents, becaufe the heat is more firmly retained ; the profufe perfpiration not being at hand, by which the febrile heat of intermittents is carried off. The ancients who gave cold drink largely in continued fe- 88 vers, were doubtful of its ufe in intermittents.* It may however be given (as I have already ftated) with great fafety in intermittents, provided it be taken in the time that intervenes after the hot ftage of the paroxyfm is fairly eftablifhed, and before the fweat that follows it, has be- come general and profufe. As however it is only in that interval that it can be given in intermittents with ad- vantage or fafety, we can eafily understand, that the ill effects arifing from its being accidently drunk in the cold, or the fweating ftage of the paroxyfm, (in both of which the thirft often demands liquids), may have pro- duced the doubts which fome have expreffed in regard to its ufe in intermittents, and the interdiction which in fuch cafes others have pronounced againft it. We may explain alfo from the fame confiderations, why in the accounts that have been handed down to us of injurious effects from the ufe of cold drink in fevers, the greater part of the cafes have been intermittents. The inftances however that are recorded of the fatal effects of large draughts of cold liquids, have more fre- quently occurred after fevere exercife and fatigue, than even in intermittent fever. The caufe of this is obvious— the heat preternaturally accumulated by exercife, is held with lefs tenacity than even the heat in intermittents. It is diffipated by the perforations that exercife occafions, and is fpeedily loft, when to profufe perfpiration is added a ftate of reft. It is then that a large draught of cold liquid is efpecially dangerous. But while the preter- natural heat is fuftained by continued exertion, cold li- quids may be taken in moderate quantities without pro- ducing 2ny injurious effects. They may even, I appre- hend, be drunk copioufty without producing fuddenly the fatal effects already defcribed—but in copious * See Sennertus, lib. ii. cap. ix. p. 54. Itaque Graeci auctores jubent in ftatu, cum febris acuta, fitis, inquietudo, cordis & arteriarum pulfatio eft vehementiffima, segerque avidiffime earn expetit, aquam frigidam co- piofe exhibere.— * * * * In intermittentibus febribus vero aquae frijidae potus nunquam conren't, 89 draughts, they are found oppreffive to the ftomach during exercife, and excite languor, naufea, and fome^ times vomiting, as I have had occafion to obferve. In the narrative already mentioned of the march of Alex- ander's army through the defert country of the Sogdiani, it is related by the historian, that a few of the foldiers, by the advice of the natives, had provided themfelves with water, of which under their burning thirft they drank immoderately. The confequence was, that they became heavy, feeble, an.l unable to fupport their arms, and this ftate of oppreflion was Succeeded by fevere vo- miting. Graves deinde avide haufto humore, non fuf- tinere arma ; non ingredi pot er ant; et feliciores vide ban- tur, quos aqua defecerat, quam ipfiftne modo infufam vo~ mitu cogerentur egerere. £>j Curtius, lib. vii. cap. 5. The water thus wafted, or worfe than wafted, might have been ufed to advantage in wetting, from time to time, Lhe garment next the Skin. Thus the oppreffion of its weight on the ftomach would have been prevented, and the furface of the body being kept cool by conftant evaporation, the heat of the fyftem would have been moderated, and the thirft alleviated.* If this account of the circumftances under which cold drink after fevere exercife proves injurious, be juft, the directions of Dr. Rufh to thofe who will drink in fuch circumftances, are founded on error. By abstracting a part of the preternatural heat of the body before drink- ing, the danger is not diminifhed, but greatly increafed. This enlightened phyfician will ex^ufc thefe obfervations, drawn from me by a confideration of the importance of * Poftillions underftand the difference between giving their horfes cold water to dnnk, during exercife, and after the exercife has ceafed. When in their power, they always water their horfes iwo or three miles before the end of their journey. My friend, Mr. Charles Aiken, aflures me, thai during his tour on foot through Wales, in company with his brother, of which Mr. Aithut Aikin has given fo interefting and ufeful an account, the) drank of em pure ftreams, as they defcended from the mountains, without relervc, Juring the fervor of the day, taking care however n^ve^ to reft after Ji inking. 12 9° the Subject, but accompanied by fentiments of Sincere efteem and refpect. If the effects of cold water ufed internally under fe- vere exercife are not entirely analogous to the effects produced by its affufion on the fkin ;—the difference will be eafily understood, by thofe who eonfider, that where a quantity of water is fwallowed, befides the in- fluence of the cold, the ftomach fuftains a load, from the weight and the bulk of the liquid, particularly op- preffive under the constant action and agitation of the voluntary mufcles, from which the furface, moiftened with water, is entirely free; and on the other hand, that the evaporation from the furface, promoted by the im- mediate accefs of the external air, muft operate more directly in cooling the body, and particularly in coun- teracting the burning rays of the fun, than water taken into the ftomach. With thefe exceptions, the operation of cold liquids on the ftomach and on the furface of the body are analogous in the cafe of preternatural heat pro- duced by bodily exertion, as in all other cafes of pre- ternatural heat. As it is fafe to drink cold water in proportion as the heat from exercife is great and Steady, fo alfo it is fafe, according to this ratio, to pour it on the furface, or to immerfe the body in the cold bath. In the earlier ftages of exercife, before profufe perfpi- ration has diffipated the heat, and fatigue debilitated the living power, nothing is more fafe, according to my ex- perience, than the cold bath. This is fo true, that I have for fome years constantly directed infirm perfons to ufe fuch a degree of exercife before immerfion, as may produce fome increafed action of the vafcular fyftem, with fome increafe of heat; and thus fecure a force of re-action under the Shock, which otherwife might not always take place. The popular opinion, that it is fafeft to go perfectly cool into the water, is founded on erroneous notions, and is fometimes productive of inju- rious confequences. Thus, perfons heated and begin • 9* ning to Sweat, often think it neceffary to wait on the edge of the bath until they are perfectly cooled ; and then, plunging into the water, feel a hidden chillinefs that is alarming and dangerous. In fuch cafes the injury is generally imputed to going into the water too warm, whereas in truth it arifes from going in too cold.* But though it be perfectly fafe to go into the cold bath in the earlier ftages of exercife, nothing is more dan- gerous than this practice after exercife has produced profufe fweating, and terminated in langourand fatigue. Becaufe, as has already been repeated more than once, in fuch circumftances, the heat is not only finking ra- pidly, but the fyftem parts more eafily with the portion that remains. This account of the operation of the cold bath, will explain fome circumftances very generally mentioned by writers on the effects of cold on the human body, and hitherto not properly accounted for. That the Roman youth, in the heat of their exercife in the Campus Mar- tius, frequently plunged into the Tyber, is a fact uni- verfally known; they found in this practice a high en- joyment, and they believed it conducive to health, and more efpecially to fleep. On the other hand, various relations may be cited of the injurious effects of an apparently fimilar practice; the moft remarkable of which is the cafe of Alexander the Great, when covered with duft and fweat, he threw himfelf into the Cydnus, and was feized with a difeafe, of which he nearly periihed; one of the belt authenticated facts in ancient hiftory. * Dr. A. Munro Drummond, in hi-s inaugural differtation, " De Ye- oribus Arceudis" the only fpecimen left of his admirable talents, fpeak- ing of the effects of the cold bath as a preventative againft the action of contagion, obferves, " Nee frigida protinus fugiendavel calida temperan- •' d.i, quamvis cutis pallida aliquantifper fiat vel leviter aliquis inhorrue- " fit. Si exercitatio antecedat qua? citra laffitudinem & fudorem eft, hare " facile evitaii poffe experiendo didici j et fere, fi nil aliud obftet, quo " ante quifque plus incaluerei q\nm aquam intraverit, cocaliJior emer- 92 In the differtation De febribus arcendis, by Dr. A. Munro Drummond, thefe fafts are brought together in the following words. Alexander, quondam diei fervidif- fimo tempore, liquorefluminis invitatus. vix dum in Cyd- num amnem dfcenderat,. cum gravi inde morbo implicitus eft. Romana juventus, poft quotidianas in Campo Mar- tio exercitationes, pulverefimul & fudore perfufa, Tyberi impune laffitudinem curfus natandi labore depofuit. Mali nimirum adfuetudine duramur in his ficut in cater is rebus omnibus. Ihes. Med. vol. iii. p. 154. Doubtlefs the influence of habit has a confiderable lhare in regulating the effects of cold on the human body ; but the circum- ftances juft mentioned, feem capable of an explanation on other principles. On the Campus Martius, the exercifes of.the Roman youth were carried on with all the vehemence of emula- tion. Swimming formed a part o thofe exercifes,* and generally terminated the foot-race. The youthful can- didates in this exercife directed their courfe towards the banks of the river, and plunged headlong into the Stream. Sometimes the contention did not terminate till they had fwam acrofs the river twice. Hence it will eafily be feen, that they were accuftomed to immerfe themfelves in water in the very fervor of their exertions, when the heat was preternaturally great; and not after the body was cooled by profufe perfpiranons, or exhaust- ed by long continued fatigue, In this Situation the prac- tice was fafe , without taking into confideration, that the perfons following it, were in the flower of life, fortified by early habits, and partly defended from the fhock of immerfion by the inunctions which feem to have been * See Horace, lib. i. ode 8. Where the poet, after queftioning Lydia why her (over neglects hi accuftomed exercifes on the Campus Martius, among other particulars afks, Cur timet flanjum Tiberim tangere ? See Vigetius, lib. i. cap. x. See alfo Heiron. Mercur. lib. iii. cap, 14, 93 generally ufed among the Romans, before the cold,* and after the hor bath ; and which were particularly em- ployed by the athteta of Greece and Rome in all their exercifes. It was the more fafe, becaufe the ftream of the yellow Tyber, being comparatively fcanty and Slow, its waters fpeedily received the influence of the fun, and acquired the temperature of the atmofphere. Where the air and the water are of the fame temperature, the rarer clement prepares the body for the contact of that which is more denfe. The circumftances under which Alexander plunged into the Cydnus, were different in many effential points. He had marched at the head of his troops to feize a pafs in Mount Taurus, neceffary to facilitate his paffage in- to Cilicia. After having fecured his object, he de- fcended from his elevated Station, through a road, diffi- cult and full of defiles, to the city of Tarfus, which was Situated at the bottom of the mountains. His whole march, which probably continued feveral days, was attended by extraordinary exertion, not from the nature of the country only, but alfo from the preffure of circumftances. In afcending the heights, he had to haften forwards, left the enemy fhould pre-occupy the • See Horace, Satyr: lib. ii. fat. i. ---------Ter uncli Tranfnanto Tiberim, fommo quibus eft opus alto. The fubject of the ancient unguents is treated of by Hieronymus Mer curialis, de arte Gymnaftica, lib. i. cap. x. The fame author (lib. iii. cap. 14. j fpeaking of fwimming, fo much in eftimation among the ancients, obferves, quo patio