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Surgeon  General's  Office

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            A SKETCH
               OF THE

MEDICAL TOPOGRAPHY
                OF
   LEXINGTON AND ITS VICINITY:
              BEING AN
      INAUGURAL DISSERTATION,
             SUBMITTED TO
          THE EXAMINATION OF THE
REV. JOHN ANDREWS, D. D. PROVOST
            (pro tempore),
                THE
    TRUSTEES, AND MEDICAL FACULTY
               OF THE
      UNIVERSITY OF PEJYJYSYLVjVYIJ,
        ON THE 21ST DAY OF APRIL, 1806,
               FOR THE
DEGREE OF DOCTOR OF MEDICINE.

            -----!----  /   ,-:,v,';
       BY BENJAMIN W. DUDLEY, tUfrQ $
         OF LEXINGTON, KENTUCKY,
 MEMBER OF THE LEXINGTON AND PHILADELPHIA MEDICAL
              SOCIETIES.
PHILADELPHIA,
/ x &- "*
PRINTED BY THOMAS AND GEORGE PALMER,
        116, HIGH-STREET.

           1806. 
* 
TO
        DOCTOR JAMES FISHBACH,

              OF LEXINGTON, KENTUCKY.

DEAR SIR,
       A PUPIL is no doubt most indebted to his first preceptors
in medicine.  Having commenced  under the care of yourself and
Dr. F. Ridgely, when I wa§ entirely ignorant of the nature of my
object, it was the pleasure of each to inspire me with industry and
confidence,  to remove my difficulties, and to elucidate many obscu-
rities in medicine, all of which had  a tendency to enhance my medi-
cal acquisitions.  Those considerations alone are sufficient to create
the purest sense of regard.  May you long continue the exercise of
those talents, which, with ordinary  attention, cannot but exhibit ge-
nius  and judgment. As a testimony of friendship, please to receive
this imperfect essay from
                        Your most obedient friend and pupil,
                                           THE AUTHOR. 
 
TO
    BENJAMIN  SMITH BARTON, M. D.


DEAR SIR,
       THE ingenious and useful manner you have pursued in your
lectures, has not only convinced those gentlemen who have had the
pleasure of  attending them of their great utility, but it has created
a desire in many of us to be present, and share in the advantages of
future seasons.

  Your unparalleled industry in the arrangement and delivery of
useful matter is the means of contracting the warmest regard of all
your pupils ; but, independent of this, sir, I am obligated to you for
the particular  attention bestowed on me since my first visit to the
city.
  Please, sir, accept this my first and imperfect production, as a tes-
timony of the high sense I entertain of superior talents;  and,  with
the greatest  respect for your good qualifications as a gentleman, I
have the honour to be
                             Your most obliged,
                                 And very humble servant,
                                          THE AUTHOR. 
 
A SKETCH
                    OF THE


MEDICAL  TOPOGRAPHY,  &c.
       THE Ohio River, which serves as the great outlet to the
productions of the western country, forms the boundary of the state
of Kentucky to the north and west, the Virginia line bounds it on
the east, and the  state of Tennessee on the south.
  The soil of Kentucky, and particularly of Lexington and its vici-
nity, is so well  described by geographical authors on this subject,
that it appears almost superfluous to enter into a minute detail.  It
may, however, be observed, that the state throughout is remarkable
for  the universality of limestone.   Different districts put on very
different  appearances in respect to soil: some parts are of a sandy
nature, some of a poor and light description, while other parts are
of a dark, rich, and most luxuriant kind.
  It will be sufficient to observe, that, very generally, the soil is so
favourable to the  growth of all those vegetables which exist under
the influence of the climate, and which do not require peculiar local
circumstances for their growth and perfection, that one of the greatest
evils accruing to the agriculturist is the growth of foreign vegetables
in his tillage fields.
  The great variety of vegetable productions of this part of Ame-
ru;^ acquire a degree  of perfection and magnitude, which are un- 
                                8
 known on the eastern side of the mountains; but whether it gives
 birth to many new species is yet undetermined.  From all the ob-
 servations I have been able to make,  I believe  the remark of Mr.
 Ellicott is just, relative to the identity  of the vegetable  kingdom on
 the east and west sides of the Allegany mountains.   Some species,
 however, as the Aesculus flava, or Buck-eye, the Gymnocladus cana-
 densis, or Coffee-tree, and a species of Sophora, an important dye
 article, appear to flourish more particularly  in this state.  To the
 first of those vegetables the citizens appear to have  but little attach-
 ment.  Its fruit  falls early in the season, and, in consequence of its
 excessive use as  food by the  cattle, they are subject to a paraplegia,
 and frequently death.  Those who have doubts relative to the powers
 of the Aesculus in producing this affection among cattle,  must give
 their assent to it when they  are assured, that the same  effects have
 arisen from its use  in a girl, who took a large quantity, with the
 hope of its curing  an obstinate intermittent.   This affection was
 soon relieved by the free use of drastic purgatives.
   Many valuable medicines can be  obtained in different parts of the
 state, such as the Podophyllum peltatum, or May-apple, the Spiraea
 trifoliata, or Indian-physic, the Datura stramonium, or Jamestown-
 weed, the Liriodendren tulipifera, or Poplar, the Cornus florida, or
 Dogwood, the Prunus virginiana, or Wild-cherry, the Juglans cine-
 rea, or Butternut-walnut, and various species  of Quercus, or Oak.
   As the soil of this country is not favourable to the growth of all
 vegetables, we  are deprived of many of those  delicious fruits, which
 grow in great plenty in situations more remarkable for the barren-
 ness of the soil.
   The  town of  Lexington, situated  near the middle of Fayette
county, sixty-four miles from Ohio  River, and half encircled by the
 Kentucky River, at the distance of ten, fifteen, and twenty miles, is
erected within one mile of the most elevated  piece of ground of all
the adjacent country.  As the rivers Missisippi  and  St.  Laurence
have almost a  common source, and pursue rectangular directions,
Lexington and  its vicinity give birth to four different streams of wa-
ter, which pursue almost opposite courses.  Lexington has a nor-
therly position of 38° 20', and the longitude west of London is »5 
                              9
10', or of Philadelphia about 9°.   The town runs in a north-west
direction three quarters of a mile, and is about half a mile broad.
  Lexington includes a small stream of water, running  in Water-
street, into which all the water of pumps, wells, and springs, with
the offal matters of the town, empty themselves, either directly, or
through the medium of sewers for that purpose. Lexington, which
could only boast of a few houses and one solitary carriage in the
year 1791, is now composed of near five hundred houses,  a very
great part of which have been erected of elegant brick,  within the
last ten years.  The streets are laid out to form  squares, which are
not so large as those of Philadelphia.  Luxury and gaiety have kept
pace with the rapid growth of the town and the increase of population.
The public buildings consist of a university, a court-house, a bank,
a market-house, and four churches.  Within the  last two or three
years, the citizens have made handsome progress in paving the
streets with excellent limestone.  The soil of the  town, excepting
the changes produced by manure, is in no respect different from that
of the adjacent country.  In common with all other rich lands, the
mud of the lanes and streets renders walking very disagreeable in
wet weather ; but the great porosity of the earth, together with so-
lar influence, and an elevated situation, very soon dissipate excessive
moisture.
   In describing the waters  of Lexington, I am sure I shall not be
extravagant  in the assertion, that few situations are better supplied
with this great necessary of life.   There is some small variation in
the sensible  qualities  of the different springs and pump water, but
the difference is so inconsiderable, that all are capable of answering
every domestic purpose.   The water  from an  excellent source is,
conveyed to  some parts of the town by pipes, but having been placed
near the surface of the earth, the water is influenced by the sun, and
rendered too warm to  drink.
   There is a very considerable difference in the temperature of the
different waters, and this leads to a useful practical inference respect-
ing their use  in the warmer seasons  of the year. Saline, sulphur, and
chalybeate waters are common in different  parts of the state, but
none such  have been discovered in Lexington.
                               B 
                              10.
  I am sorry that I have not been able to furnish myself with any baro-
metrical observations taken at Lexington ; but as I know of no circum-
stance whatever which would tend to regularity in atmospheric pres-
sure in Lexington more than in any other situation on the continent,
and as we are liable to as great and immediate changes of weather
as any other situation, I am led to conclude, that the variation in the
barometer would be equally great.  Placed in a situation so .remote
from the focus of philosophy, and labouring under the disadvantages
of an infant country, our opportunities for philosophic observations
have been oh a very limited scale; but we  hope, from the ambition
of those in the pursuit of science, that we shall soon be in posses-
sion of observations which will serve us on many future occasions.
  The rapid increase of the population of Lexington is no less re-
markable than its first settlement was perilous.  A few years since,
the  population consisted only of about seventeen or eighteen hundred
souls, while the present  number of inhabitants must  exceed  four
thousand.  This rapid increase is no doubt to be attributed in a great
degree to migration ; at the same time, the innocent nature of the
climate is such, that there are but few infants which, with ordinary
attention, cannot be brought to years of maturity.
  The constitutions of the citizens are much modified by their" par-
ticular modes of life.  The seven different  temperaments  of the-
professor of the institutes can, with peculiar propriety, be applied
to the citizens of Lexington and its vicinity;  but, to speak more de-
finitely, there are few constitutions more robust and energetic, and
few expose themselves more to the changes of the weather.   The
delicate female, the lawyer, the merchant,  and the mechanic, all
give their constitutions a very material modification, in consequence
of their different pursuits in life; and this is always followed by di-
versified states of morbid excitement, arising from the same cause.
  The females  suffer a  loss of appetite and health, from want of
regular and properly accommodated exercise, and from improper
diet, from taking too much or too little aliment, from the use of strong
tea  and  coffee, and of too much animal food.   Few of them take
sufficient exercise to retain health, in the warm seasons of the  year,
in consequence of which, a lady not unfrequently dates her indispo- 
                             11
sition from the exercise of a particular party, or from the<dampness
and disagreeable nature of the evening.   The sedentary life pursued
by many of them is, no doubt, one great cause of hysteria, in all its
different grades, from an unpleasant state of the mind to a general
convulsion.
,  The  observation which  fell from the clinical chair, " that cold
proves the greatest enemy to which mankind  are exposed,"  is but
too frequently verified in the western country.   The citizen of Lex-
ington,  and the adjacent farmer, having been accustomed to receive
no serious injuries to their constitutions by such negligence,  in the
earlier part of their lives,  they frequently discontinue it only after
they have sustained so great a loss of health, as to be almost useless
in their families, and even  a burthen to society.
  The farmer, who is sensible of the salutary and innocent nature
of his climate, seldom exercises those  precautions which are  requi-
site, under the sudden changes of the weather, to retain  his health;
by which means he contracts those diseases only, which are the
consequence of sudden transitions from a comfortable room into the
cold and disagreeable air.  In the summer season, when he has no
vegetable putrefaction and stagnant water to produce disease, he
frequently subjects himself to the most disagreeable consequences,
by the excessive use of cold spring water, both internally and  exter-
nally, by drawing  off his clothes, and receiving the cool breezes in
some delightful shade, and sometimes by making so free use  of spi-
rits as to derange the animal functions, which frequently terminates
in disease.
  By unwarranted industry, in exposing themselves too early in the
morning and too late at night,  no  citizens, under circumstances
equally  favourable,  are  more subject to disease than the farmers
near Lexington; and, ignorant or negligent of the proper precau-
tions, they only make application after the disease has made  consi-
derable  inroad on their constitutions.   But although I charge them
with ignorance as it respects medicine (which must be the case even
vith the learned professional characters who  have not made  it a
atudy), yet it is.but justice to observe,  that  they are  more fond of
obtaining useful information, and exercise their  own reason on sub- 
                              12
jects of every description, than many of their brethren in situations
more favourable to mental improvement in the United States.
  The practice of dram drinking, which crept into society soon after
the extensive erection of distilleries in Kentucky, proves a fruitful
source of disease;  and its patrons, who cannot afford to make use
of liquors of a  superior and more innocent nature,  consume large
quantities of peach brandy and whiskey, which are manufactured at
home.  Spirit,  like opium, when taken in proper time and quantity,
constitutes one  of the first articles of the materia medica; but, like
opium with  the Turks, it is too frequently converted  to  those
purposes, which prove a degradation to mankind, and convert them
into beings but  little superior to the beasts of the forest.
  Those, who are  the least conversant with medical science,  will
easily ascertain the diseases which are the consequence of excessive
spirituous potation; but what is still more pleasant to be known is,
that the best remedy for these diseases seems to be gaining ground
in many places, where it could have been but little  expected:  this
is, abstinence from the cause.
   The blacks in this, as well as in every other country, are the most
subject to those diseases which are the consequence of exposure to the
weather, of an insufficiency in clothing, and of scanty and improper
aliment.  Even if they become the property of some humane mas-
ter, who takes  all the necessary precautions to avoid either of the
causes above-mentioned  in producing disease, the human mind, in
a state of subserviency, cannot, or does not, bring its faculties into
play, so as either to exhibit them as descendants from the same source
with the whites, or to make  the  necessary provision for their own
comfort in life. Being deprived of the advantages of their own la-
bour, and looking to their masters for  support, they almost look to
them for health and life also; rambling, after night, from place to
place, for the prospects either of amusement or advantage, and open-
ing their bosoms to the prey of causes, which, should they not pro-
duce immediate disease, will  eflect such a derangement in some of
the functions,  as to bring on fatal affections.   Many of them, and
 sometimes a great part  of a family, become the subjects of a con-
 sumption, which, from its frequent  occurrence, and its variation, in 
                               13
 appearance from the disease as it appears in the whites, has con-
 tracted their name.  In treating of the diseases of Lexington  and
 its vicinity, I shall again notice this negro consumption.
   I  have now examined some of the most prominent circumstances
 relative to the constitutions of the citizens ; but it is certain that the
 manrter by which the country was settled has a tendency to assimi-
 late to each other the constitutions and diseases of those who  suf-
 fered the hardships of the Indian wars; and, for the last ten  years,
 the  migration  from different parts of the world has produced so
 great variety in the citizens,  that it would appear prominently erro-
 neous to specify their constitutions.
   In order that we may come at a just knowledge of the incident
 diseases of Lexington and its vicinity, it is necessary that we should
 take notice of circumstances of a more foreign nature, inasmuch as
 they have an influence on this part of the country; and, in doing this,
 I believe  it will be the natural inference, that the favourable circum-
 stances for health are more prominent in Lexington than in almost
 any other habitable situation.
   The  excellent tract of land on which  Lexington is situated ex-
 tends to a very considerable distance in different directions, forming
 the  first,  most  interesting, and most important body of good* land
 which is known in the western country.   This fertile and level part
 of the country is furnished with innumerable streams of greater or
 less  size,  which pursue different directions.   From the great depo-
 sition of rain, which sometimes occurs in the spring season,  these
 waters become so numerous and extensive, as not only to answer all
 domestic  purposes, but they frequently inundate the farms of the
 country, and prove considerably inconvenient to the agriculturist;
 while the only toestiges of their  remains  in the latter summer and
 fall season are the damages sustained by the farmer, and the effects
 of a  rapid and momentary current on its own bed.  No sooner does
the cause of those'inundations cease to operate, than the streams
begin to'faulter  in their boldness: the nature of the soil is such a6
to absorb large quantities of water ;  the  numerous caverns serve the
office of receptacles; the elevated siiuuilc:: of th. vountry favours a 
                              14
quick descent of water into rivers; and solar influence is considera-
ble in evaporating water which runs on so dark a soil.
   The state of Kentucky is visited with as sudden transitions of the
weather, from one extreme to another, as any other on the conti-
nent.    The  uncultivated state of its northern boundary  must no
doubt influence the weather, but whether there are any other local
circumstances which can also influence the temperature is uncer-
tain.  The very dark nature of the soil would  seem to increase the
warmth of the climate; but the great evaporation from the surface
of the earth  appears to counterbalance this effect, and renders the
temperature  similar  with countries not so remarkable for a black
soil.   Some  facts tend to prove that the climate has been in some
degree revolutionized within  a  few centuries back, independent of
any influence which could have been produced by cultivation.
   The two species of elephant, the skeletons of which have been
discovered within the limits  of the  state,  together with the bones
of some other animals, prove that this country was originally inha-
bited by animals which at present do not belong to our continent,
unless they have passed into those western regions which are as yet
unknown..
   Before  entering on  the diseases of Kentucky generally, and of
Lexington and its vicinity particularly, it may not be improper to
consider the  nature of many causes which act in the production of
disease.  Animal and vegetable putrefaction are so much  talked of
as the causes productive of sickly countries, that we scarce direct our
attention to any other  source for an explanation.  We may,  with
propriety, confine our  attention  to those causes, together with in-
temperance,  in the explanation of ninety diseases of the  hundred,.
which occur in the western country.   All those diseases which are
the consequence of the influence of the sun in decomposing vegeta-
ble and  animal substances, make their appearance in the latter part
of the summer season, when the heat of the sun is greatest, when
running waters  have collected  in natural basons on the surface of
the earth, and when vegetables  are favourably  situated for  putrefac-
tion. 
                              15
  I am induced, from several circumstances, to conclude, that Ken-
tucky is not so liable to those malignant  forms of autumnal disease
as the adjacent state, Ohio.  Kentucky has a less number of large
currents of water, its subterranean caverns are more numerous, its
soil is not of that marshy and moist description,  it has fewer ponds
of water, and  it  is more remarkable for the regular appearance of
limestone.
  It is justly observed by the professor of  the institutes, that there
is a particular point in the progress of cultivation, which peculiarly
disposes to the prevalence of intermittents, where  moist lands are
the subject of cultivation.  He verifies his  position by calling to aid
that portion of land included in the junction of the rivers Schuylkill
and  Delaware.   In its original  uncultivated state,  Dr. Rush ob-
serves, that intermittents were then scarcely known; that when the
British were stationed in Philadelphia, in the time of the American
revolution, they destroyed great part of the timber, and exposed this
land to solar influence, soon after  which intermittents were preva-
lent, and continued annually, until, by cultivation, its moisture was
dissipated.   This has  been so frequently verified  in the  western
country, and the reason is so obvious, as to preclude the necessity
of an explanation.  The pleasant and elevated situation  of  Lexing-
ton  will  operate as an eternal  barrier against  disease from this
cause, while  lower situations of the state will be troubled  with  its
frequent recurrence.
  I have  now said as much as I thought necessary,  in order to ren-
der the account of the diseases of Lexington and its vicinity as sim-
ple as  I could.  The nature of the climate is such, that it is imprac-
ticable to establish any rule relative to the appearance of any form
of disease, as belonging to particular seasons of the year.  There is
no disease, whether pleurisy or typhus fever, which does not make
its appearance occasionally in every month of the year. In Janu-
ary,  1805, the only disease in Lexington and its vicinity was typhus,
in its worst forms.  It  is certain that particular months favour the
prevalence of some diseases more than others; but a particular rule
would be  so  very exceptionable,  that it would be improper to say 
                               16
that a pleurisy is the  disease of spring, and an intermittent the dis-
ease of fall months.
   The diseases, generally speaking, throughout the state, appear
to carry with them no  peculiarities, which are not common  with
other states of the union ; and, as a minute description of the diseas-
es of Lexington would be uninteresting,  in so far as they are com-
mon with the diseases of the continent, I shall merely consider them
generally.  The ten forms of autumnal fever arising from  vegeta-
ble and animal putrefaction, the different states of pulmonary fever,
from a catarrh to a consumption, diabetes, hepatitis, enteretis, gas-
tritis, dropsies, rheumatism, venereal, &c  are the diseases  most
common in Kentucky.   It may incur the displeasure  of some of
the citizens, to observe yellow fever arranged among the diseases
of particular  situations in the  state; but  the tempest  should soon
cease, when they are  assured, that  it is nothing more than a high
grade of bilious fever,  and that it is more serious both in its attack
and consequences, and requires the more prompt attention to medi-
cine and diet.
   A great part of the diseases of the western country are frequent-
ly concentrated in particular situations.   The town of Frankfort is
an unfortunate instance of the kind  ; instead of being the fine mea-
dow of an adjacent farmer, it is the seat  of government  for the
state.   It is impossible  in the nature of things for this place to en-
joy health, so lopg as the bottom  remains favourable for the pro-
duction of, and the high hills continue to confine, its putrid  exhala-
tions.   The  worst states of autumnal  fever have prevailed, and
proved fatal to many  of the inhabitants for the last few years.  I
feel much at a loss in confining myself to the diseases of Lexing-
ton and its vicinity, as I believe it is practicable, whether we ar-
range them according to the  nosological doctrine of Cullen, or the
more modern unity of our own professor, to exhibit as many various
states of morbid excitement,  as in any  town, village, or country
situation, the history of which has been recorded.
  , The diseases of the country have undergone considerable change
since the commencement of agriculture.  Pleurisies are much less 
                              17
common and less violent in their attacks, than they were while the
citizens, from the infancy of the  country, were obliged to live the
lives in some degree of the original inhabitants,   Rheumatic affee-
tions of the acute and chronic kind are less  frequent than they ori-
ginally were, and the suppurated liver is scarcely known until  we
approach some of the larger waters or stagnating ponds. The small
quantity  of still  water near Lexington  precludes a  possibility  of
intermittents becoming prevalent, except immediately on the south
side of some few mill-ponds. The few cases of scrophula which oc-
cur, seem, many of them, to be of Virginia extract; but from some
predisposition,  together  with  the improper  management of negro
children, its occurrence as an indigenous disease cannot be doubt-
ed.  Hitherto it has been but seldom cured, from our ignorance of
its nature ; but from the  progress of our great professors of materia
medica, and the practice of medicine towards the true nature of me-
dicines, and the cure of diseases, we may now anticipate some de-
gree of success.  We must either prescribe some medicine, which
acts specifically on the glandular and lymphatic systems, as mercury,
8cc.  or we  must restore the  harmony of the different  systems of
vessels by tonics, if too little action prevails,  or by evacuants, if the
patient can  bear this mode of treatment.
   It has  been suggested to me, by  an intimate friend and  corres-
pondent, that there is an ophthalmia peculiar to the state of Ken-
tucky ;  he supposes the affection to  be the  consequence of the  use
of iime stone water, and that transient visitors to this country only
are the subjects of  the disease.  My ingenious friend  may be in
possession of facts, which to him may render the idea conclusive ;
but, judging from  what I have read and heard delivered on this
subject, by  the different professors of the institution, I am disposed,
if not to reject  the  idea  altogether,  at least to suspend an  opinion,
which requires time and probably minute  chemical  knowledge to
determine.   Ophthalmia, in all its grades, is one of  the most com-
mon forms of disease in countries exposed to vegetable and animal
putrefaction; and as this  state has stagnant waters, standing in great
plenty in  different  parts, may not the most natural solution of this
disagreeable affection be  the same with that of intermittent fevers?
                               C 
                              18
   That ophthalmia is frequently produced by the same causes which
operate in producing autumnal fevers, is too well known  by us all
to be doubted;  we suppose, in consequence of previous debility of
the eyes, that on  the application  of miasmata the morbid excite-
ment is invited to (those) the weakest  parts.  This  principle, no
doubt, constitutes one of the most important supports  in medicine,
and  can  be happily applied on every occasion similar to  the pre-
sent.
   I regret, that the lime stone waters of  the state have never been
subjected to a minute chemical examination, as this would be one
step towards accounting for those  obscure phenomena.  My friend
observes, that when the foreigner is not affected with ophthalmia,
that diarrhoea is almost always the consequence.   If the above  ex-
planation I have given be admitted, this last circumstance only tends
to substantiate the opinion, as it shows, in this case, that instead of
the eyes, the bowels are most subject to debility, and consequently,
the morbid action  arising  from the  application of miasmata is con-
centrated on those parts.
   The singular nature of a consumption, which has appeared in
and near Lexington, in some families of negroes, has attracted the
notice of some of our physicians, as being as different from the disease
as it generally appears in the whites, as their modes of existence are
dissimilar.   It  appears more particularly to be a native  among the
hard faring negroes of Virginia; but its occurrence in Kentucky
is so frequent, as to solicit a minute examination.   It discovers
scarce any other premonitory signs than general debility, both arte-
rial and muscular; it is  attended with very little, and sometimes no
cough ; the bronchial and  tracheal mucus may be encreased,  but is
not always an  attendant; suppuration and expectoration of pus is
a very rare occurrence ; the patient complains of no pain,  some-
times a heaviness in the chest.  In  a state of rest, the transient vi-
sitor would suppose he had been  exercising deception)  and  will
hardly be convinced to the  contrary, unless he  is present at a pa-
roxysm of convulsive respiration,  or examines the pulse, which last
is always indicative of the  greatest debility.   No disease assumes 
                              19
more flattering appearances, for a speedy recovery of the patient,
than this frequently does ; for several days at a time, he may enjoy
a perfect remission of convulsive  breathing, may obtain a good ap-
petite, and may be rapidly recovering his strength, when, on a sud-
den, a paroxysm of dyspnoea comes on, and threatens instant suffo-
cation.
   This disease is rapid in its progress, and has always terminated
fatally to the patient.  Throughout its whole course the only regu-
lar attendant symptom  is extreme debility ;  some are tortured with
laborious  breathing, much more than others, when no perceptible
cause can be assigned ; various other symptoms, more numerous
and novel than occurs  in almost  any other disease, are frequently
complained of by the patient.
   On dissection, we find the  lungs nearly of  the  consistence of
the liver  throughout their whole extent; rarely any other morbid
appearance than that of increased solidity.  This at once leads us
to the knowledge of a disease, which by many of the  superstitious
class of people  has  been attributed to poison,  and have accordingly
sent the poor, and almost breathless consumptive patient, to some
old witch woman, to have the poison extracted  from his body.
   Does not the gradual exclusion of oxygen, by the increase in so-
lidity of the lungs, account for the gradual debility induced?  Is not
too little morbid action  present to be followed by suppuration, at the
same time it is sufficiently great to. extend the vessels, and almost
obliterate the cavities of the bronchial ramifications ? The lungs are
passive organs,  and  in a state  of health,  while the muscles of re-
spiration are performing their office with ease, they at the same time
conduce to effect other  purpose's of a very different kind, without dis-
ordering  respiration ;  but when the cavities of  some  of the bron-
chial vessels are obliterated, and many of them obstructed,  drj we
not require more prompt and invariable exertion in the respiratory
muscles ? and should the action of any of them be obstructed either
by exercise or an unnatural position of the  body, or should an un-
usual quantity of blood be carried to the lungs, an incomplete oxy-
genation of it, and, consequently,  convulsive respiration  will  be the
consequence. 
                              20
  The difficulty of curing this disease is easily foreseen ;  wa must
direct our attention more particularly to the removal of its  causes.
Improper aliment,  scanty clothing,  exposure at night to cold in
ram'/iing about from place  to place,  filthiness, &c.  must  be  the
causes productive of this disease.
  The diseases of females constitute a very great part of the mala-
dies with which physicians have to contend in Kentucky.   The ma-
ny ignorant old women of the country, who pretend to a knowledge
of a particular department in surgery, and who are called  on more
from a delicacy of the patient's feelings, than from a conviction of
their qualifications to perform  the duties of a surgeon, leave  but too
many  proofs of the impropriety of their whisky stews, their other
nostrums, and their precipitate conduct in relieving the  sick;  and
so long as the female  class  of the citizens refuse to adopt the cus-
toms of populous countries  and large cities,  so long must they be
the prey of many distressing complaints, which by proper attention
might have been avoided.
  It may be proper in this place to make a distinction between those
diseases which unquestionably have their origin in the country, and
those which appear t) have been introduced from abroad.  Under
the former head,  consumptions, pleurisies, catarrhs, bilious fevers,
dysenteries, hepatitis, dropsies, rheumatisms, Sec. may with propri-
ety be arranged;  while under  the latter may be arranged small-pox,
measles, hooping-cough, influenza, syphilis, 8cc.   In the year 1783,
when the residence of the citizens was confined to the different forts
of the state, small-pox seems first to have been introduced at Louis-
ville, and from thence  to the other forts.   About ten or twelve years
ago, it was again prevalent througliout great part of  the state, and
proved fatal to many of the citizens : like many other diseases, when
trusted to the operations of nature.   We are fortunately but little
influenced by  the efforts of  nature in curing diseases at the present
day.   But although we are  generally believers in the theory of the
forced state of life,  still even  many of those who are  its warm sup-
porters are but too frequently disturbing the tombstone of the ope-
rations of nature, and dragging out some of her blind laws, which,
blended with modern theory,  only serves to reduce our ideas of life 
                              21
down to that chaotic state from which they were delivered by some
late philosopher.
  If life is a forced state, as we  believe, I see no necessity for re-
sorting to nature in the explanation or in the cure of one single dis-
ease.   The true principle will serve us, on one occasion as well as
another; if there are  any diseases which disappear without the use
of calomel, bark, ipecacuanha, or  opium, we are not to conclude that
nature performed the cure,  as it depends as much on the operation
of stimulus, as the cure of syphilis does on the operation of mercu-
ry.   The food we  consume is an  effectual medicine in  all those
diseases which it can transcend in action.   In retaining or establish-
ing any principle of a physiological nature, it  is presumable that it
is with the intent only of extending our ideas of the theory and prac-
tice of medicine.   Could the operations of nature, the vitality of the
blood,  and the stimulant powers of  cold,  be  established as truths
(which I am sure will never be  the  case), it would be natural to
conclude, that many  phenomena would  be rendered  simple and
plain ; but as we cannot  discover  the smallest connection which sub-
sists between the one and the other, I see no use in admitting  them
in obtaining an education.   Principles which appear in themselves
so doubtful, and which explain nothing, should no longer burthen
medical science.
   As I have given so minute a description of all those circumstances
which would favour the  production of disease  in Lexington and its
vicinity, both as it respects the particular  situation of the country
and the constitutions of its citizens, I think it unnecessary to protract
the subject any farther.  But I cannot conclude without discharging
a duty, so necessarily incumbent upon me as a pupil: to acknow-
ledge the very great advantages I  have experienced by attending the
lectures of six ingenious and well-qualified teachers of medicine:
and may the professors individually enjoy a share of that happiness
in life,  which they have so studiously laboured to bestow on their
fellow-citizens. 
 
M<lI. Hi sir.
   WZ.


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