fflm* in il If pi ARMY MEDICAL LIBRARY FOUNDED 1836 WASHINGTON, D.C. MEDICAL INQUIRIES AND OBSERVATIONS. BY BENJAMIN RUSH, M. D. PtlOFESSOR OF THE INSTITUTES AND PRACTICE OF MEDICINE, AND OF CLINICAL PRACTICE, IN THE UNIVERSITY ' '.-.-• OF PENNSYLVANIA. IN FOUR VOLUMES. VOL. II. THE SECOND EDITION, REVISED AND ENLARGED BY THE AUTHOR. PHILADELPHIA, PUBLISHED BY J. CONRAD & CO, CHESNUT-STREET, PHILADELPHIA J M. & J. CONRAD & CO. MARKET-STREET, BALTIMORE; RAPIN, CONRAD, & CO. WASHINGTON; SOMERVELL & CONRAD, PETERS- BURG; AND BONSAL, CONRAD, & CO. NORFOLK. PRINTED BY T. & G. PALMER, 116, HIGH-STREET. ..................... s^ >£^-jm£. 1805. CONTENTS OF VOLUME II. page AN inquiry into the influence of physical causes upon the moral faculty 1 Observations upon the cause and cure of pulmonary consumption 59 Observatio?is upon the symptoms and cure of dropsies 151 Inquiry into the cause and cure of the internal dropsy of the brain 191 Observations upon the nature and cure of the gout 225 Observations on the nature and cure of the hydro- phobia 299 An account of the measles, as they appeared in Phila- delphia in the spring of 1789 335 An account of the influenza, as it appeared in Phila- delphia in the years 1790 and 1791 351 An inquiry into the cause of animal life 369 i^ AN INQUIRY INTO THE INFLUENCE OF PHYSICAL CAUSES UPON THE MORAL FACULTY. CELIVERED BEFORE THE AMERICAN PHILOSOPHICAL SOCIETY, HELD AT PHILADELPHIA, ON THE 27TH OF FEBRUARY, 1786, \N VOL. II. H V ' • i AN INQUIRY, &c. me GENTLEMEN, IT was for the laudable purpose of exciting a spirit of emulation and inquiry, among the mem- bers of our body, that the founders of our society instituted an annual oration. The task of prepar- ing, and delivering this exercise, hath devolved, once more, upon me. I have submitted to it, not because I thought myself capable of fulfilling your intentions, but because I wished, by a testimony of my obedience to your requests, to atone for my long absence from the temple of science. The subject upon which I am to have the ho- nour of addressing you this evening is on the in- fluence of physical causes upon the moral faculty. 4 INFLUENCE OF PHYSICAL CAUSES By the moral faculty I mean a capacity in the human mind of distinguishing and chusing good and evil, or, in other words, virtue and vice. It is a native principle, and though it be capable of im- provement by experience and reflection, it is not derived from either of them. St. Paul and Cicero give us the most perfect account of it that is to be found in modern or ancient authors. " For when " the Gentiles (says St. Paul), which have not the " law, do by nature the things contained in the " law, these, having not the law, are a law unto " themselves; which show the works of the law " written in their hearts, their consciences also " bearing witness, and their thoughts the mean " while accusing, or else excusing another*." The words of Cicero are as follow : " Est igi- " tur hsec, judices, non scripta, sed natalex, quam " non didicimus,accepimus,legimus, verum ex na- kC tura ipsa arripuimus, hausimus, expressimus, ad " quam non docti, sed facti, non instituti, sed im- " buti sumusf." This faculty is often confounded with conscience, which is a distinct and indepen- dent capacity of the mind. This is evident from the passage quoted from the writings of St. Paul, in which conscience is said to be the witness that I * Rom. i. 14, M. + Oratio pro Milone. UPON THE MORAL FACULTY. 5 accuses or excuses us, of a breach of the law writ- ten in our hearts. The moral faculty is what the schoolmen call the " regula regulans;" the con- science is their " regula regulata;" or, to speak in more modern terms, the moral faculty performs the the office of a law-giver, while the business of con- science is to perform the duty of a judge. The moral faculty is to the conscience, what taste is to the judgment, and sensation to perception. It is quick in its operations, and, like the sensitive plant, acts without reflection, while conscience follows with deliberate steps, and measures all her actions, by the unerring square of right and wrong. The moral faculty exercises itself upon the actions of others. It approves, even in books, of the virtues of a Trajan, and disapproves of the vices of a Ma- rius, while conscience confines its operations only to its own actions. These two capacities of the mind are generally in an exact ratio to each other, but they sometimes exist in different degrees in the same person. Hence we often find conscience in its full vigour, with a diminished tone, or total absence of the moral faculty. ^^ It has long been a question among metaphysi- cians, whether the conscience be seated in the will or in the understanding. The controversy can only be settled by admitting the will to be the seat 6 INFLUENCE OF PHYSICAL CAUSES of the moral faculty, and the understanding to be the seat of the conscience. The mysterious na- ture of the union of those two moral principles with the will and understanding, is a subject foreign to the business of the present inquiry. As I consider virtue and vice to consist in action, and not in opinion, and as this action has its seat in the will, and not in the conscience, I shall confine my inquiries chiefly to the influence of physical causes upon that moral power of the mind, which is connected with volition, although many of these causes act likewise upon the conscience, as I shall show hereafter. The state of the moral faculty is visible in actions, which affect the well-being of society. The state of the conscience is invisible, and therefore removed beyond our investigation. The moral faculty has received different names from different authors. It is the " moral sense" of Dr. Hutchison; the " sympathy" of Dr. Adam Smith; the " moral instinct" of Rousseau; and " the li^pthat lighteth every man that cometh in- " to the world" of St. John. I have adopted the term of moral faculty from Dr. Beattie, because I conceive it conveys with the most perspicuity, the idea of a capacity in the mind, of chusing good and evil. UPON THE MORAL FACULTY. 7 Our books of medicine contain many records of the effects of physical causes upon the memory, the imagination, and the judgment. In some in- stances we behold their operation only on one, in others on two, and, in many cases, upon the whole of these faculties. Their derangement has received different names, according to the number or nature of the faculties that are affected. The loss of memory has been called " amnesia;" false judgment upon one subject has been called " me- lancholia;" false judgment upon all subjects has been called " mania;" and a defect of all the three intellectual faculties that have been mentioned, has received the name of " amentia." Persons who labour under the derangement, or want of these faculties of the mind, are considered, very pro- perly, as subjects of medicine; and there are many cases upon record that prove, that their diseases have yielded to the healing art. In order to illustrate the effects of physical causes upon the moral faculty, it will be neces- sary first to show their effects upon the jnemory, the imagination, and the judgment; and at the same time to point out the analogy between their operation upon the intellectual faculties of the mind, and the moral faculty. 8 INFLUENCE OF PHYSICAL CAUSES 1. Do we observe a connection between the intellectual faculties, and the degrees of .consistency and firmness of the brain in infancy and childhood? The same connection has been observed between the strength, as well as the progress of the moral faculty in children. 2. Do we observe a certain size of the brain, and a peculiar cast of features, such as the pro- minent eye, and the aquiline nose, to be connected with extraordinary portions of genius ? We ob- serve a similar connection between the figure and temperament of the body, and certain moral quali- ties. Hence we often ascribe good temper and benevolence to corpulency, and irascibility to san- guineous habits. Caesar thought himself safe in the friendship of the " sleek-headed" Anthony and Dolabella; but was afraid to trust to the profes- sions of the slender Cassius. 3. Do we observe certain degrees of the intel- lectual faculties to be hereditary in certain families? The same observation has been frequently extend- ed to moral qualities. Hence we often find certain virtues and vices as peculiar to families, through all their degrees of consanguinity, and duration, as a peculiarity of voice, complexion, or shape. UPON THE MORAL FACULTY. 9 4. Do we observe instances of a total want of memory, imagination, and judgment, either from an original defect in the stamina of the brain, or from the influence of physical causes ? The same unnatural defect is sometimes observed, and proba- bly from the same causes, of a moral faculty. The celebrated Servin, whose character is drawn by #ie Duke of Sully in his Memoirs, appears to be an instance of the total absence of the moral faculty, while the chasm, produced py this defect, seems to have been filled up by a more than common ex- tension of every other power of his mind. I beg leave to repeat the history of this prodigy of vice and knowledge. " Let the reader represent to " himself a man of a genius so lively, and of an " understanding so extensive, as rendered him " scarce ignorant of any thing that could be known; " of so vast and ready a comprehension, that he " immediately made himself master of whatever " he attempted; and of so prodigious a memory, " that he never forgot what he once learned. He " possessed all parts of philosophy, and the ma. ". thematics, particularly fortification and drawing. " Even in theology he was so well skilled, that " he was an excellent preacher, whenever he had " a mind to exert that talent, and an able dispu- " tant, for and against the reformed religion indif- " ferently. He not only understood Greek, He- VOL. II. B 10 INFLUENCE OF PHYSICAL CAUSES " brew, and all the languages which we call " learned, but also all the different jargons, or '.' modern dialects. He accented and pronounced " them so naturally, and so perfectly imitated the *' gestures and manners both, of the several nations " of Europe, and the particular provinces of *' France, that he might have been taken for a " native of all, or any of these countries : and this i( quality he applied to counterfeit all sorts of per- " sons, wherein he succeeded wonderfully. He " was, moreover, the best comedian, and the great- " est droll that perhaps ever appeared. He had a " genius for poetry, and had wrote many verses. " He played upon almost all instruments, was a " perfect master of music, and sang most agree- " ably and justly. He likewise could say mass, " for he was of a disposition to do, as well as to " know all things. His body was perfectly well " suited to his mind. He was light, nimble, and " dexterous, and fit for all exercises. He could " ride well, and in dancing, wrestling, and leap- " ing, he was admired. There are not any re. " creative games that he did not know, and he i: was skilled in almost all mechanic arts. But " now for the reverse of the medal. Here it ap- " peared, that he was treacherous, cruel, cowardly, u deceitful, a liar, a cheat, a drunkard and a.glut- ,{ton, a sharper in play, immersed in every species UPON THE MORAL FACULTY. 11 " of vice, a blasphemer, an athiest. In a word, " in him might be found all the vices that are con- " trary to nature, honour, religion, and society, the " truth of which he himself evinced with his latest " breath; for he died in the flower of his age, irv " a common brothel, perfectly corrupted by his " debaucheries, and expired widi the glass in his " hand, cursing and denying God*." It was probably a state of the human mind such as has been described, that our Saviour alluded to in the disciple, who was about to betray him, when he called him " a devil." Perhaps the es- sence of depravity, in infernal spirits, consists in their being wholly devoid of a moral faculty. In them the will has probably lost the power of chus- ingf, as well as the capacity of enjoying moral good. It is true, we read of their trembling in a belief of the existence of a God, and of their antici- pating future punishment, by asking, whether they were to be tormented before their time : but this is * Vol. III. p. 216, 217. t Milton seems to have been of this opinion'. Hence, after ascribing repentance to Satan, he makes him declare, L< Farewel remorse : all good to me is lost, " Evil, be thou my good.'"-------- Paradise Lost, Book IV., 12 INFLUENCE OF PHYSICAL CAUSES the effect of conscience, and hence arises another argument in favour of this judicial power of the mind, being distinct from the moral faculty. It would seem as if the Supreme Being had preserved the moral faculty in man from the ruins of his fall, on purpose to guide him back again to Paradise, and at the same time had constituted the conscience, both in men and fallen spirits, a kind of royalty in his moral empire, on purpose to show his property in all intelligent creatures, and their original resem- blance to himself. Perhaps the essence of moral depravity in man consists in a total, but temporary suspension of the power of conscience. Persons in this situation are emphatically said in the Scrip- tures to be " past feeling," and to have their con- sciences seared with a " hot iron;" they are like- wise said to be " twice dead," that is, the same torpor or moral insensibility, has seized both the moral faculty and the conscience. 5. Do we ever observe instances of the existence of only one of the three intellectual powers of the mind that have been named, in the absence of the other two ? We observe something of the same kind with respect to the moral faculty. I once knew a man, who discoyered no one mark of rea- son, who possessed the moral sense or faculty in so high a degree, that he spent his whole life in acts UPON THE MORAL FACULTY. IS of benevolence. He was not only inoffensive (which is not always the case with idiots), but he was kind and affectionate to every body. He had no ideas of time, but what were suggested to him by the returns of the stated periods for public wor- ship, in which he appeared to take great delight. He spent several hours of every day in devotion, in which he was so careful to be private, that he was once found in the most improbable place in the world for that purpose, viz. in an oven. 6. Do we observe the memory, the imagina- tion, and the judgment, to be affected by diseases, particularly by madness ? Where is the physician who has not seen the moral faculty affected from the same causes ! How often do we see the tem- per wholly changed by a fit of sickness! And how often do we hear persons of the most deli- cate virtue, utter speeches in the delirium of a fe- ver, that are offensive to decency or good manners! I have heard a well-attested history of a clergyman of the most exemplary moral character, who spent the last moments of a fever which deprived him both of his reason and his life, in profane cursing and swearing. I once attended a young woman in a nervous fever, who discovered, after her reco- very, a loss of her former habit of veracity. Her memory (a defect of which might be suspected of 14 INFLUENCE OF PHYSICAL CAUSES being the cause of this vice) was in every respect as perfect as it was before the attack of the fever*. The instances of immorality in maniacs, who were formerly distinguished for the opposite character, are so numerous, and well known, that it will not be necessary to select any cases, to establish the truth of the proposition contained under this head. 7. Do we observe any of the three intellectual faculties that have been named, enlarged by dis- eases ? Patients, in the delirium of a fever, often discover extraordinary flights of imagination, and madmen often astonish us with their wonderful acts of memory. The same enlargement, some- times, appears in the operations of the moral fa- culty. I have more than once heard the most sub- lime discourses of morality in the cell of an hospi- tal, and who has not seen instances of patients in acute diseases, discovering degrees of benevolence and integrity, that were not natural to them in the ordinary course of their livesf ? * I have selected this case from many others, which have come under my notice, in which the moral faculty appeared to be impaired by diseases, particularly by the typhus of Dr. Cullen, and by those species of palsy which affect the brain. t Xenophon makes Cyrus declare, in his last moments, " That the soul of man, at the hour of death, appears moat " divine, and then forese?s something of future events." UPON THE MORAL FACULTY. 15 8. Do we ever observe a partial insanity, or false perception on one subject, while the judgment is sound and correct, upon all others ? We perceive, in some instances, a similar defect in the moral fa- culty. There are persons who are moral in the highest degree, as to certain duties, who neverthe- less live under the influence of some one vice. I knew an instance of a woman, who was exemplary in her obedience to every command of the moral law, except one. She could not refrain from steal- ing. What made this vice the more remarkable was, that she was in easy circumstances, and not addicted to extravagance in any thing. Such was her propensity to this vice, that when she could lay her hands upon nothing more valuable, she would often, at the table of a friend, fill her pock- ets secretly with bread. As a proof that her judg- ment was not affected by this defect in her moral faculty, she would both confess and lament her crime, when detected in it. 9. Do we observe the imagination in many in- stances to be affected with apprehensions of dan- gers that have no existence ? In like manner we observe the moral faculty to discover a sensibility to vice, that is by no means proportioned to its de- grees of depravity. How often do we see persons labouring under this morbid sensibility of the mo- 16 INFLUENCE OF PHYSICAL CAUSES ral faculty, refuse to give a direct answer to a plain question, that related perhaps only to the weather, or to the hour of the day, lest they should wound the peace of their minds by telling a falsehood! 10. Do dreams affect the memory, the imagina- tion, and the judgment ?♦ Dreams are nothing but incoherent ideas, occasioned by partial or imperfect jsleep. There is a variety in the suspension of the faculties and operations of the mind in this state of the system. In some cases the imagination only is deranged in dreams, in others the memory is affec- ted, and in others the judgment. But there are cases, in which the change that is produced in the state of the brain, by means of sleep, affects the moral faculty likewise; hence we sometimes dream of doing and saying things when asleep, which we shudder at, as soon as we awake. This supposed defection from virtue, exists frequently in dreams where the memory and judgment are scarcely im- paired. It cannot therefore be ascribed to an ab- sence of the exercises of those two powers of the mind. 11. Do we read, in the accounts of travellers, of men, who, in respect of intellectual capacity and enjoyments, are but a few degrees above brutes ? We read likewise of a similar degradation of our UPON THE MORAL FACULTY. 17 species, in respect to moral capacity and feeling. Here it will be necessary to remark, that the low degrees of moral perception, that have been disco- vered in certain African and Russian tribes of men, no more invalidate our proposition of the universal and essential existence of a moral faculty in the human mind, than the low state of their intellects prove, that reason is not natural to man. Their perceptions of good and evil are in an exact pro- portion to their intellectual faculties. But I will go further, and admit with Mr. Locke*, that some savage nations are totally devoid of the moral fa- culty, yet it will by ho means follow, that this was the original constitution of their minds. The appetite for certain aliments is uniform among all mankind. Where is the nation and the individual, in their primitive state of health, to whom bread is not agreeable ? But if we should find savages, or individuals, whose stomachs have been so disor- dered by intemperance, as to refuse this simple and wholesome article of diet, shall we assert that this was the original constitution of their appetites? By no means. As well might we assert, because sa- vages destroy their beauty by painting and cutting their faces, that the principles of taste do not exist * Essay concerning the Human Understanding, book I. rhap. 3. VOL. 11. C 18 INFLUENCE OF PHYSICAL CAUSES naturally in the human mind. It is with virtue as with fire. It exists in the mind, as fire does in certain bodies, in a latent or quiescent state. As collision renders the one sensible, so education renders the other visible. It would be as absurd to maintain, because olives become agreeable to many people from habit, that we have no natural appetites for any other kind of food, as to assert that any part of the human species exist without a moral principle, because in some of them, it has wanted causes to excite it into action, or has been perverted by example. There are appetites that are wholly artificial. There are tastes so entirely vitiated, as to perceive beauty in deformity. There are torpid and unnatural passions. Why, under certain unfavourable circumstances, may there not exist also a moral faculty, in a state of sleep, or sub- ject to mistakes ? The only apology I shall make, for presuming to differ from that justly-celebrated oracle*, who first unfolded to us a map of the intellectual world, shall be, that the eagle eye of genius often darts its views beyond the notice of facts, which are ac- commodated to the slender organs of perception of men, who possess no other talent than that of observation. * Mr. Locke. UPON THE MORAL FACULTY. 19 It is not surprising, that Mr. Locke has con- founded this moral principle with reason, or that Lord Shaftsbury has confounded it with taste, since all three of these faculties agree in the objects of their approbation, notwithstanding they exist in the mind independently of each other. The fa- vourable influence which the progress of science and taste has had upon the morals, can be ascribed to nothing else, but to the perfect union that sub- sists in nature between the dictates of reason, of taste, and of the moral faculty. Why has the spi- rit of humanity made such rapid progress for some years past in the courts of Europe ? It is because kings and their ministers have been taught to rea- son upon philosophical subjects. Why have inde- cency and profanity been banished from the stage in London and Paris? It is because immorality is an offence against the highly cultivated taste of the French and English nations. It must afford great pleasure to the lovers of virtue, to behold the depth and extent of this mo- ral principle in the human mind. Happily for the human race, the intimations of duty and the road to happiness are not left to the slow operations or doubtful inductions of reason, nor to the precarious decisions of taste. Hence we often find the moral faculty in a state of vigour, in persons in whom SO INFLUENCE OF PHYSICAL CAUSES reason and taste exist in a weak, or in an unculti- vated state. It is worthy of notice, likewise, that while second thoughts are best in matters of judg- ment, first thoughts are always to be preferred in matters that relate to morality. Second thoughts, in these cases, are generally parlies between duty and corrupted inclinations. Hence Rousseau has justly said, that " a well regulated moral instinct is " the surest guide to happiness." It must afford equal pleasure to the lovers of virtue to behold, that our moral conduct and hap- piness are not committed to the determination of a single legislative power. The conscience, like a wise and faithful legislative council, performs the office of a check upon the moral faculty, and thus prevents the fatal consequences of immoral actions. An objection, I foresee, will arise to the doc- trine of the influence of physical causes upon the moral faculty, from its being supposed to favour the opinion of the materiality of the soul. But I do not see that this doctrine obliges us to decide upon the question of the nature of the soul, any more than the facts which prove the influence of physical causes upon the memory, the imagination, or the judgment. I shall, however, remark upon this subject, that the writers in favour of the im- ( UPON THE MORAL FACULTY. 21 mortality of the soul have done that truth great injury, by connecting it necessarily with its imma- teriality. The immortality of the soul depends upon the will of the Deity, and not upon the sup- posed properties of spirit. Matter is in its own nature as immortal as spirit. It is resolvable by heat and mixture into a variety of forms; but it requires the same Almighty hand to annihilate it, that it did to create it. I know of no arguments to prove the immortality of the soul, but such as are derived from the Christian revelation*. It would be as reasonable to assert, that die bason of the ocean is immortal, from the greatness of its capa- city to hold water; or that we are to live for ever in this world, because we are afraid of dying, as to maintain the immortality of the soul, from die greatness of its capacity for knowledge and happi- ness, or from its dread of annihilation. I remarked, in the beginning of this discourse, that persons who are deprived of the just exercise of memory, imagination, or judgment, were proper subjects of medicine; and that there are many cases upon record which prove, that the diseases from the derangement of these faculties, have yield- ed to the healing art. * " Life and immortality are brought to light only through " the gospel." 2 Tim. i. 10. 22 INFLUENCE OF PHYSICAL CAUSES It is perhaps only because the diseases of the moral faculty have not been traced to a connection with physical causes, that medical writers have ne- glected to give them a place in their systems of no- sology, and that so few attempts have been hitherto made, to lessen or remove them by physical as well as rational and moral remedies. I shall not attempt to derive any support to my opinions, from the analogy of the influence of phy- sical causes upon the temper and conduct of brute animals. The facts which I shall produce in favour of the action of these causes upon morals in the human species, will, I hope, render unnecessary the arguments that might be drawn from that quar- ter. I am aware, that in venturing upon this subject, I step upon untrodden ground. I feel as iEneas did, when he was about to enter the gates of Aver- nus, but without a sybil to instruct me in the mys- teries that are before me. I foresee, that men who have been educated in the mechanical habits of adopting popular or established opinions will revolt at the doctrine I am about to deliver, while men of sense and genius will hear my propositions with candour, and if they do not adopt them, will com- UPON THE MORAL FACULTY. 23 ttiend that boldness of inquiry, that prompted me to broach them. I shall begin with an attempt to supply the de- fects of nosological writers, by naming the partial or weakened action of the moral faculty, microno- mi a. The total absence of this faculty, I shall call anomia. By the law, referred to in these new genera of vesania?, I mean the law of nature writ- ten in the human heart, and which I formerly quot- ed from the writings of St. Paul. In treating of the effects of physical causes upon thermoral faculty, it might help to extend our ideas upon this subject, to reduce virtues and vices to certain species, and to point out the effects of par- ticular species of virtue and vice ; but this would lead us into a field too extensive for the limits of the present inquiry. I shall only hint at a few cases, and have no doubt but the ingenuity of my auditors will supply my silence, by applying the rest. It is immaterial, whether the physical causes that are to be enumerated, act upon the moral faculty through the medium of the senses, the passions, the memory, or the imagination. Their influence is equally certain, whether they act as remote, pre- disposing, or occasional causes. 24 INFLUENCE of PHYSICAL CAUSES 1. The effects of climate upon the moral faculty claim our first attention. Not only indivi- duals, but nations, derive a considerable part of their moral, as well as intellectual character, from the different portions they enjoy of the rays of the sun. Irascibility, levity, timidity, and indolence, tempered with occasional emotions of benevolence, are the moral qualities of the inhabitants of warm climates, while selfishness, tempered with sincerity and integritv, form the moral character of the inha- bitants of cold countries. The state of the weather, and the seasons of the year also, have a visible ef- fect upon moral sensibility. The month of No- vember, in Great Britain, rendered gloomy by con- stant fogs and rains, has been thought to favour the perpetration of the worst species of murder, while the vernal sun, in middle latitudes, has been as ge- nerally remarked for producing gentleness and be- nevolence. 2. The effects of diet upon the moral faculty are more certain, tiiough less attended to, than the effects of climate. " Fulness of bread," we are told, was one of the predisposing causes of the vices of the cities of the plain. The fasts so often inculcated among the Jews, were intended to les- sen the incentives to vice; for pride, cruelty, and sensuality, are as much the natural consequences UPON THE MORAL FACULTY. 25 of luxury, as apoplexies and palsies. But the quality as well as the quantity of aliment, has an influence upon morals; hence we find the moral diseases that have been mentioned, are most fre- quently the offspring of animal food. The pro- phet Isaiah seems to have been sensible of this, when he ascribes such salutary effects to a tempe- rate and vegetable diet. " Butter and honey shall " he eat," says he, " that he may know to refuse " the evil, and to chuse the good." But we have many facts which prove the efficacy of a vegetable diet upon the passions. Dr. Arbuthnot assures us, that he cured several patients of irascible tem- pers, by nothing but a prescription of this simple and temperate regimen. 3. The effects of certain drinks upon the moral faculty are not less observable, than upon the intellectual powers of the mind. Fermented liquors, of a good quality, and taken in a mode- rate quantity, are favourable to the virtues of can- dour, benevolence, and generosity; but when they are taken in excess, or when they are of a bad quality, and taken even in a moderate quantity, they seldom fail of rousing every latent spark of vice into action. The last of these facts is so noto- rious, that when a man is observed to be ill-na- tured or quarrelsome in Portugal, after drinking, VOL. II. D 26 INFLUENCE OF PHYSICAL CAUSES it is common in that countly to say, that " he ha9 " drunken bad wine." While occasional fits of in- toxication produce ill-temper in many people, ha- bitual drunkenness (which is generally produced by distilled spirits) never fails to eradicate veracity and integrity from the human mind. Perhaps this may be the reason why the Spaniards, in an- cient times, never admitted a man's evidence in a court of justice, who had been convicted of drunk- enness. Water is the universal sedative of tur- bulent passions; it not only promotes a general equanimity of temper, but it composes anger. I have heard several well-attested cases, of a draught of cold water having suddenly composed this vio- lent passion, after the usual remedies of reason had been applied to no purpose. 4. Extreme hunger produces the most un- friendly effects upon moral sensibility. It is imma- terial, whether it act by inducing a relaxation of the solids, or an acrimony of the fluids, or by the combined operations of both those physical causes. The Indians in this country whet their appetites for that savage species of war, which is peculiar to them, by the stimulus of hunger; hence, we are told, they always return meagre and emaciated from their military excursions. In civilized life we often behold this sensation to overbalance UPON THE MORAL FACULTY. 27 the restraints of moral feeling; and perhaps this may be the reason why poverty, which is the most frequent parent of hunger, disposes so generally to theft; for the character of hunger is taken from that vice : it belongs to it " to break through stone " avails." So much does this sensation predomi- nate over reason and moral feeling, that Cardinal de Retz suggests to politicians, never to risk a motion in a popular assembly, however wise or just it may be, immediately before dinner. That temper must be uncommonly guarded, which is not disturbed by long abstinence from food. One of the worthiest men I ever knew, who made his breakfast his principal meal, was peevish and disa- greeable to his friends and family, from the time he left his bed, till he sat down to his morning re- past, after which, cheerfulness sparkled in his countenance, and he became the delight of all around him. 5. I hinted formerly, in proving the analogy between the effects of diseases upon the intel- lects, and upon the moral faculty, that he latter was frequently impaired by madness. I beg leave to add further upon tlrs head, that not only mad- ness, but the hysteria and hypocondriasis, as well as all those states of the body, whether idiopathic or symptomatic, which are accompanied with pre~ 28 INFLUENCE OF PHYSICAL CAUSES ternatural irritability, sensibility, torpor, stupor, or mobility of the nervous system, dispose to vice, either of the body or of the mind. It is in vain to attack these vices with lectures upon morality. They are only to be cured by medicine, particu- larly by exercise, the cold badi, and by a cold or warm atmosphere. The young woman, whose case I mentioned formerly, that lost her habit of veracity by a nervous fever, recovered this virtue, as soon as her system recovered its natural tone, from the cold weather which happily succeeded her fever*. * There is a morbid state of excitability in the body during the convalescence from fever, which is intimately connected with an undue propensity to venereal pleasures. I have met with several instances of it. The marriage of the cele- brated Mr. Howard to a woman who was twice as old as himself, and very sickly, has been ascribed, by his biogra- pher, Dr. Aiken, to gratitude for her great attention to him in a fit of sickness. I am disposed to ascribe it to a sudden paroxysm of another passion, which, as a religious man, he could not gratify in any other, than in a lawful way. I have heard of two young clergymen who married the women who had nursed them in fits of sickness. In both cases there was great inequality in their years, and condition in life. Their motive was, probably, the same as that which I have attributed to Mr. Howard. Dr. Patrick Russel takes notice of an uncommon degree of venereal excitability which fol- lowed attacks of the plague at Messina, in 1743, in all ranks UPON THE MORAL FACULTY. 29 6. Idleness is the parent of every vice. It is mentioned in the Old Testament as another of the predisposing causes of the vices of the cities of the plain. Labour, of all kinds, favours and facili- tates the practice of virtue. The country life is happy, chiefly because its laborious employments are favourable to virtue, and unfriendly to vice. It is a common practice, I have been told, for the planters, in the southern states, to consign a house slave, who has become vicious from idleness, to the drudgery of the field, in order to reform him. The bridewells and workhouses of all civilized countries prove, that labour is not only a very se- vere, but the most benevolent of all punishments, inasmuch as it is one of the most suitable means of reformation. Mr. Howard tells us, in his His- tory of Prisons, that in Holland it is a common saying, " Make men work, and you will make " them honest." And over the rasp and spin- house at Groeningen, this sentiment is expressed (he tells us) by a happy motto : " Vitiorum semina—otium—labore exhauriendum." The effects of steady labour in early life, in creating of people. Marriages, he says, were more frequent after it than usual, and virgins were, in some instances, violated, who died of that disease, by persons who had just recovered from it. 30 INFLUENCE OF PHYSICAL CAUSES virtuous habits, is still more remarkable. The late Anthony Benezet, of this city, whose benevolence was the centinel of the virtue, as well as of the happiness of his country, made it a constant rule, in binding out poor children, to avoid putting them into wealthy families, but always preferred mas- ters for them who worked themselves, and who obliged these children to work in their presence. If the habits of virtue, contracted by means of this apprenticeship to labour, are purely mechani- cal, their effects are, nevertheless, the same upon the' happiness of society, as if they flowed from principle. The mind, moreover, when preserved by these means from weeds, becomes a more mel- low soil afterwards, for moral and rational im- provement. 7. The effects of excessive sleep are inti- mately connected with the effects of idleness upon the moral faculty : hence we find that moderate, and even scanty portions of sleep, in every part of the world, have been found to be friendly, not only to health and long life, but in many instances to morality. The practice of the monks, who of- ten sleep upon a floor, and who generally rise with the sun, for the sake of mortifying their sensual appetites, is certainly founded in wisdom, and has often produced the most salutary moral effects. UPON THE MORAL FACULTY. 31 8. The effects of bodily pain upon the moral, are not less remarkable than upon the intellectual powers of the mind. The late Dr. Gregory, of the university of Edinburgh, used to tell his pupils, that he always found his perceptions quicker in a fit of the gout, than at any other time. The pangs which attend the dissolution of the body, are often accompanied with conceptions and expressions up- on the most ordinary subjects, that discover an uncommon elevation of the intellectual powers. The effects of bodily pain are exactly the same in rousing and directing the moral "faculty. Bodily pain, we find, was one of the remedies employed in the Old Testament, for extirpating vice, and promoting virtue : and Mr. Howard tells us, that he saw it employed successfully as a means of re- formation, in one of the prisons which he visited. If pain has a physical tendency to cure vice, I sub- mit it to the consideration of parents and legislators, whether moderate degrees of corporal punishments, inflicted for a great length of time, would not be more medicinal in their effects, than the violent degrees of them, which are of short duration. 9. Too much cannot be said in favour of .cleanliness, asa physical means of promoting virtue. The writings of Moses have been called by military men, the best " orderly book" in the 32 influence of physical causes world. In every part of them we find cleanliness inculcated with as much zeal, as if it was part of the moral, instead of the Levitical law. Now, it is well known, that the principal design of every pre- cept and rite of the ceremonial parts of the Jew- ish religion, was to prevent vice, and to promote virtue. All writers upon the leprosy, take notice of its connection with a certain vice. To this dis- ease gross animal food, particularly swine's flesh, and a dirty skin, have been thought to be predis- posing causes : hence the reason, probably, why pork was forbidden, and why ablutions of the body and limbs were so frequently inculcated by the Jewish law. Sir John Pringle's remarks, in his Oration upon Captain Cook's voyage, deli- vered before the Royal Society, in London, are very pertinent to this part of our subject. " Clean- " liness (says he) is conducive to health, but it is " not so obvious, that it also tends to good order and " other virtues. Such (meaning the ship's crew) " as were made more cleanly, became more sober, " more orderly, and more attentive to duty." The benefit to be derived by parents and school- masters frcm attending to these facts, is too obvi- ous to be mentioned. 10. I hope I shall be excused in placing soli- tude among the physical causes which influence UPON THE MORAL FACULTY. 32 the moral faculty, when I add, that I confine its effects to persons who are irreclaimable by rational or moral remedies. Mr. Howard informs us, that the chaplain of the prison at Leige, in Germany, assured him, " that the most refractory and turbu- " lent spirits became tractable and submissive, by " being closely confined for four or five days." In bodies that are predisposed to vice, the stimulus of cheerful, but much more of profane society and conversation, upon the animal spirits, becomes an exciting cause, and, like the stroke of the flint upon the steel, renders the sparks of vice both active and visible. By removing men out of the reach of this exciting cause, they are often reformed, especially if they are confined long enough to produce a suf- ficient chasm in their habits of vice. Where the benefit of reflection and instruction from books can be added to solitude and confinement, their good effects are still more certain. To this philosophers and poets in every age have assented, by describing the life of a hermit as a life of passive virtue. 11. Connected with solitude, as a mechanical means of promoting virtue, silence deserves to be mentioned in this place. The late Dr. Fother- gill, in his plan of education for that benevolent institution at Ackworth, which was the last care of his useful life, says every thing that can be said vol. n. E 34 INFLUENCE of physical causes in favour of this necessary discipline, in the follow- ing words: " To habituate children from their " early infancy, to silence and attention, is of the " greatest advantage to them, not only as a prepa- " rative to their advancement in religious life, but " as the groundwork of a well cultivated under- " standing. To have the active minds of children " put under a kind of restraint; to be accustomed " to turn their attention from external objects, " and habituated to a degree of abstracted quiet, " is a'matter of great consequence, and lasting be- " nefit to them. Although it cannot be supposed, " that young and active minds are always engaged " in silence as they ought to be, yet to be accus- " tomed thus to quietness, is no small point gained " towards fixing a habit of patience, and recollec- " tion, which seldom forsakes those who have " been properly instructed in this entrance of the " school of wisdom, during the residue of their " days." For the purpose of acquiring this branch of edu- cation, children cannot associate too early, nor too often with their parents, or with their superiors in age, rank, and wisdom. 12. The effects of music upon the moral faculty,* have been felt and recorded in every country. UPON THE MORAL FACULTY. £5 Hence we arc able to discover the virtues and vi- ces of different nations, by their tunes, as certainly as by their laws. The effects of music, when sim- ply mechanical, upon the passions, are powerful and extensive. But it remains yet to determine the degrees of moral ecstacy, that may be produc- ed by an attack upon the ear, the reason, and the moral principle, at the same time, by the combined powers of music and eloquence. 13. The eloquence of the pulpit is nearly allied to music in its effects upon the moral faculty. It is true, there can be no permanent change in the temper, and moral conduct of a man, that is not derived from the understanding and the will; but we must remember, that these two powers of the mind are most assailable, when they are attacked through the avenue of the passions; and these, we know, when agitated by the powers of eloquence, exert a mechanical action upon every power of the soul. Hence we find in every age and country, where Christianity has been propagated, the most accomplished orators have generally been the most successful reformers of mankind. There must be a defect of eloquence in a preacher, who, with the resources for oratory, which are contained in the **01d and New Testaments, does not produce in every man who hears him, at least a temporary 36 influence of physical causes love of virtue. I grant that the eloquence of the pulpit alone cannot change men into christians, but it certainly possesses the power of changing brutes into men. Could the eloquence of the stage be properly directed, it is impossible to conceive the extent of its mechanical effects upon morals. The language and imagery of a Shakespeare, upon mo- ral and religious subjects, poured upon the passions and the senses, in all the beauty and variety of dra- matic representation; who could resist, or des- cribe their effects ? 14. Odours of various kinds have been observ- ed to act in the most sensible manner upon the mo- ral faculty. Brydone tells us, upon the authority of a celebrated philosopher in Italy, that the pecu- liar wickedness of the people who live in the neigh- bourhood of JEtna and Vesuvius, is occasioned chiefly by the smell of the sulphur and of the hot exhalations which are constantly discharged from those volcanos. Agreeable odours seldom fail to inspire serenity, and to compose the angry spirits. Hence the pleasure, and one of the advantages of a flower garden. The smoke of tobacco is likewise of a composing nature, and tends not only to pro- duce what is called a train in perception, but to hush the agitated passions into silence and order. UPON THE MORAL FACULTY. 37 Hence the practice of connecting the pipe or segar, and the botde together, in public company. 15. It will be sufficient only to mention light and darkness, to suggest facts in favour of the influence of each of them upon moral sensibility. How often do the peevish complaints of the nighty in sickness, give way to the composing rays of the light of the morning ? Othello cannot murder Desdemona by candle-light, and who has not felt the effects of a blazing fire upon the gende pas- sions ? 16. It is to be lamented, diat no experiments have as yet been made, to determine the effects of all the different species of air s, which chemistry has lately discovered, upon the moral faculty. I have authority from actual experiments, only to declare, that dephlogisticated air, when taken in- to the lungs, produces cheerfulness, gentieness, and serenity of mind. 17. What shall we say of the effects of medi- cines upon the moral faculty? That many sub- stances in the materia medica act upon the in- tellects, is well known to physicians. Why should it be thought impossible for medicines to act in like manner upon the moral faculty ? May not the 38 influence of physical causes earth contain, in its bowels, or upon its surface, an- tidotes? But I will.not blend facts with conjec- tures. Clouds and darkness still hang upon this part of my subject. Let it not be suspected, from any thing that I ^have delivered, that I suppose the influence of phy- sical causes upon the moral faculty, renders the agency of divine influence unnecessary to our mo- ral happiness. I only maintain, that the opera- tions of the divine government are carried on in the moral, as in the natural world, by the instru- mentality of second causes. I have only trodden in the footsteps of the inspired writers; for most of the physical causes I have enumerated, are con- nected with moral precepts, or have been used as the means of reformation from vice, in the Old and New Testaments. To the cases that have been mentioned, I shall only add, that Nebuchad- nezzar was cured of his pride, by means of soli- tude and a vegetable diet. Saul was cured of his evil spirit, by means of David's harp, and St. Paul expressly says, " I keep my body under, and bring " it into subjection, lest that by any means, when " I have preached to others, I myself should be a " cast-away." But I will go one step further, and add in favour of divine influence upon* the moral principle, that in those extraordinary cases, where UPON the moral faculty. 39 bad men are suddenly reformed, without the in- strumentality of physical, moral, or rational causes, I believe that the organization of those parts of the body, in which the faculties of the mind are seated, undergoes a physical change*; and hence the ex- pression of a " new creature," which is made use of in the Scriptures to denote this change, is pro- per in a literal, as well as a figurative sense. < It is probably the beginning of that perfect renovation of the human body, which is predicted by St. Paul in the following words : " For our conversation " is in heaven, from whence v/e look for the Savi- " our, who shall change our vile bodies, that they " may be fashioned according to his own glorious " body." I shall not pause to defend myself against the charge of enthusiasm in this place ; for the age is at length arrived, so devoutiy wished for by Dr. Cheyne, in which men will not be deterred in their researches after truth, by the terror of odi- ous or unpopular names. * St. Paul was suddenly transformed from a persecutor in- to a man of a gentle and amiable spirit. The manner in which this change was effected upon his mind, he tells us in the following words: " Neither circumcision availeth " any thing, nor uncircumcision, but a new creature. From " henceforth let no man trouble me; for I bear in my body, " the marks of our Lord Jesus." Galatians, vi. 15, 17. 40 INFLUENCE OF PHYSICAL CAUSES I cannot help remarking under this head, that if the conditions of those parts of the human body which are connected with the human soul, influence morals, the same reason may be given for a virtu- ous education, that has been admitted for teaching music and the pronunciation of foreign languages, in the early and yielding state of those organs which |brm{ the voice and speech. Such is the effect of a moral education, that we often see its fruits in advanced stages of life, after the religious princi- ples which were connected with it, have been re- nounced ; just as we perceive the same care in a surgeon in his attendance upon patients, after the sympathy which first produced this care, has ceas- ed to operate upon his mind. The boasted mora- lity of the deists, is, I believe, in most cases, the offspring of habits, produced originally by the prin- ciples and precepts of Christianity. Hence appeals the wisdom of Solomon's advice, " Train up a " child in the way he should go, and when he is " old he will not," I had almost said, he cannot " depart from it." Thus have I enumerated the principal causes which act mechanically upon morals. If from the combined action of physical powers that are oppo- sed to each other, the moral faculty should become stationary, or if the virtue or vice produced by UPON THE MORAL FACULTY. 41 them, should form a neutral quality, composed of both of them, I hope it will not call in question the truth of our general propositions. I have only mentioned the effects of physical causes in a simple state*. It might help to enlarge our ideas upon this subject, to take notice of the influence of the dif- ferent stages of society, of agriculture and com- merce, of soil and situation, of the different degrees of cultivation of taste, and of the intellectual pow- ers, of the different forms of government, and last- ly, of the diflerent professions and occupations of mankind, upon the moral faculty; but as these act indirectly only, and by the intervention of causes that are unconnected with matter, I conceive they are foreign to the business of the present inquiry. If they should vary the action of the simple physi- cal causes in any degree, I hope it will not call in question the truth of our general propositions, any more than the compound action of physical powers, that are opposed to each other. There remain but a few more causes which are of a compound na- * The doctrine of the influence of physical causes on mo rals is happily calculated to beget charity towards the fail- ings of our fellow-creatures. Our duty to practise this vir- tue is enforced by motives drawn from science, as well as from the precepts of Christianity. VOL. II. F 42 INFLUENCE OF PHYSICAL CAUSES ture, but they are so nearly related to those which are purely mechanical, that I shall beg leave to trespass upon your patience, by giving them a place in my oration. The effects of imitation, habit, and association ►upon morals, would furnish ample matter for in- vestigation. Considering how much the shape, texture, and conditions of the human body, influ- ence morals, I submit it to the consideration of the ingenious, whether, in our endeavours to imitate moral examples, some advantage may not be de- rived, from our copying the features and external manners of the originals. What makes the suc- cess of this experiment probable is, that we gene- rally find men, whose faces resemble each other, have the same manners and dispositions. I infer the possibility of success in an attempt to imitate originals in a manner that has been mentioned, from the facility with which domestics acquire a resemblance to their masters and mistresses, not only in manners, but in countenance, in those cases where they are tied to them by respect and affec- tion. Husbands and wives also, where they pos- sess the same species of face, under circumstances of mutual attachment, often acquire a resemblance to each other. UPON THE MORAL FACULTY. 43 From the general detestation in which hypocrisy is held, both by good and bad men, the mechani- cal effects of habit upon virtue have not been suf- ficiendy explored. There are, I am persuaded, ^nany instances where virtues have been assumed by accident, or necessity, which have become real from habit, and afterwards derived their nourish-.. ment from the heart. Hence the propriety of Hamlet's advice to his mother: " Assume a virtue, if you have it not. " That monster, Custom, who all sense doth eat " Of habits evil, is angel yet in this, " That to the use of actions fair and good k' He likewise gives a frock or livery, " That aptly is put on. Refrain to-night, " And that shall lend a kind of easiness " To the next abstinence; the next more ea«y: " For use can almost change the stamp of nature, " And master even the devil, or throw him out, « With wondrous potency." The influence of association upon morals, opens an ample field for inquiry. It is from this principle, that we explain the reformation from theft and drunkenness in servants, which we some- times see produced by a draught of spirits, in which tartar emetic had been secretly dissolved. The recollection of the pain and sickness excited by the emetic, naturally associates itself with the spi- 44 INFLUENCE OF PHYSICAL CAUSES rits, so as to render them both equally the objects of aversion. It is by calling in this principle only, that we can account for the conduct of Moses, in grinding the golden calf into a powder, and afterwards dissolving it (probably by means of hepar sulphuris) in water, and compelling the , children of Israel to drink of it, as a punishment for their idolatry. This mixture is bitter and nau- seating in the highest degree. An inclination to idolatry, therefore, could not be felt without be- ing associated with the remembrance of this disa- greeable mixture, and of course being rejected, with equal abhorrence. The benefit of corporal punishments, when they are of a short duration, depends in part upon their being connected, by time and place, with the crimes for which they are inflicted. Quick as the thunder follows the lightning, if it were possible, should punishments follow the crimes, and the advantage of association would be more certain, if the spot where they were committed, were made the theatre of their expiation. It is from the effects of this association, probably, that the change of place and company, produced by exile and transportation, has so often reclaimed bad men, after moral, rational, and physical means of reformation had been used to no purpose. UPON THE MORAL FACULTY. 45 As sensibility is the avenue to the moral fa- culty, every thing which tends to diminish it tends also to injure morals. The Romans owed much of their corruption to the sights of the contests of their gladiators, and of criminals, with wild beasts. For these reasons, executions should never be pub- lic. Indeed, I believe there are no public punish- ments of any kind, that do not harden die hearts of spectators, and thereby lessen the natural horror which all crimes at first excite in the human mind. Cruelty to brute animals is another means of destroying moral sensibility. The ferocity of sa- vages has been ascribed in part to their peculiar mode of subsistence. Mr. Hogarth points out, in his ingenious prints, the connection between cru- elty to brute animals in youth, and murder in man- hood. The emperor Domitian prepared his mind, by the amusement of killing flies, for all those bloody crimes which afterwards disgraced his reign. I am so perfectly satisfied of the truth of a connection between morals and humanity to brutes, that I shall find it difficult to restrain my idolatry for that legislature, that shall first establish a system of laws, to defend them from outrage and oppression. 46 INFLUENCE OF PHYSICAL CAUSES In order to preserve the vigour of the moral faculty, it is of the utmost consequence to keep young people as ignorant as possible of those crimes that are generally thought most disgraceful to hu- man nature. Suicide, I believe, is often propa- gated by means of newspapers. For this reason, I should be glad to see the proceedings of our courts kept from the public eye, when they expose or punish monstrous vices. The last mechanical method of promoting mo- rality that I shall mention, is to keep sensibility alive, by a familiarity with scenes of distress from poverty and disease. Compassion never awakens in the human bosom, without being accompanied by a train of sister virtues. Hence the wise man justly remarks, that " By the sadness of the coun- " tenance, the heart is made better." A late French writer, in his predictioii of events that are to happen in the year 4000, says, " That " mankind in that aera shall be so far improved by " religion and government, that the sick and the " dying shall no longer be thrown, together with " the dead, into splendid houses, but shall be re- " lieved and protected in a connection with their " families and society." For the honour of huma- UPON THE MORAL FACULTY. 47 nity, an institution*, destined for that distant pe- riod, has lately been founded in this city, that shall perpetuate the year 1786 in the history of Penn- sylvania. Here the feeling heart, the tearful eye, and the charitable hand, may always be connected together, and the flame of sympathy, instead of being extinguished in taxes, or expiring in a soli- tary blaze by a single contribution, may be kept alive, by constant exercise. There is a necessary connection between animal sympathy, and good morals. The priest and the Levite, in the New Testament, would probably have relieved the poor man who fell among thieves, had accident brought them near enough to his wounds. The unfortunate Mrs. Bellamy was rescued from the dreadful pur- pose of drowning herself, by nothing but the dis- tress of a child, rending the air with its cries for bread. It is probably owing, in some measure, to the connection between good morals and sympathy that the fair sex, in every age and country, have been more distinguished for virtue, than men; for how seldom do we hear of a woman, devoid of humanity ? Lastly, attraction, composition, and DE- COMPOSITION, belong to the passions as well as * ,A public dispensary. 48 INFLUENCE OF PHYSICAL CAUSES to matter. Vices of the same species attract each other with the most force: hence the bad conse- quences of crowding young men, whose propensi- ties are generally the same, under one roof, in our modern plans of education. The effects of com- position and decomposition upon vices, appear in the meanness of the school-boy being often cured by the prodigality of a military life, and by the pre- cipitation of avarice, which is often produced by ambition and love. If physical causes influence morals in the man- ner we have described, may they not also influence religious principles and opinions? I answer in the affirmative; and I have authority, from the records of physic, as well as from my own obser- vations, to declare, that religious melancholy and madness, in all their variety of species, yield with more facility to medicine, than simply to-polemical discourses, or to casuistical advice. But this sub- ject is foreign to the business of the present in- quiry. From a review of our subject, we are led to contemplate with admiration, the curious structure of the human mind. How distinct are the num- ber, and yet how united! How subordinate, and yet how co-equal are all its faculties! How worr- UPON the moral faculty. 49 derful is the action of the mind upon the body! of the body upon the mind! and of the Divine Spirit upon both! What a mystery is the mind of man to itself!----O ! Nature !----or, to speak more properly, O! thou God of Nature ! in vain do we attempt to scan thy immensity, or to comprehend thy various modes of existence, when a single particle of light, issued from thyself, and kindled into intelligence in the bosom of man, thus dazzles and confounds our understandings! The extent of the moral powers and habits in man is unknown. It is not improbable, but the human mind contains principles of virtue, which have never yet been excited into action. We be- hold with suq^rise the versatility of the human body in the exploits of tumblers and rope-dancers. Even the agility of a wild beast has been demon- strated in a girl of France, and an amphibious na- ture has been discovered in the human species, in a young man in Spain. We listen with astonish- ment to the accounts of the memories of Mithri- dates, Cyrus, and Servin. We feel a veneration bordering upon divine homage, in contemplating the stupenduous understandings of lord Verulam and sir Isaac Newton; and our eyes grow dim, in attempting to pursue Shakespeare and Milton in their immeasurable flights of imagination. And if vol. II. c 50 influence of PHYSICAL CAUSES the history of mankind does not furnish similar in- stances of the versatility and perfection of our spe- cies in virtue, it is because the moral faculty has been the subject of less culture and fewer experi- ments than die body, and the intellectual faculties of the mind. From what has been said, the rea» son of this is obvious. Hitherto the cultivation of the moral faculty has been the business of pa- rents, schoolmasters, and divines*. But if the principles, we have laid down, be just, the im» provement and extension of this principle should be equally the business of the legislator, the na- tural philosopher, and the physician; and a phy- sical regimen should as necessarily accompany a moral precept, as directions with respect to the air, exercise, and diet, generally accompany pre- scriptions for the consumption, and the gout. To encourage us to undertake experiments for the * The people commonly called Quakers and the Metho- dists, make use of the greatest number of physical remedies in their religious and moral discipline, of any sects of Chris- tians; and hence we find them every where distinguished for their good morals. There are several excellent fl/tysical institutions in other churches; and if they do not produce the same moral effects that we observe from physical insti- tutions among those two modern sects, it must be ascribed to their being more neglected by the members of those churches. UPON THE MORAL FACULTY. 51 improvement of morals, let us recollect the suc- cess of philosophy in lessening the number, and mitigating the violence of incurable diseases. The intermitting fever, which proved fatal to two of the monarchs of Britain, is now under absolute subjection to medicine. Continual fevers are much less fatal than formerly. The small-pox is disarmed of its mortality by inoculation, and even the tetanus and the cancer have lately received a check in their ravages upon mankind. But medi- cine has done more. It has penetrated the deep and gloomy abyss of death, and acquired fresh ho- nours in his cold embraces. Witness the many hundred people who have lately been brought back to life by the successful efforts of the humane so- cieties, which are now established in many parts of Europe, and in some parts of America. Should the same industry and ingenuity, which have pro- duced these triumphs of medicine over diseases and death, be applied to the moral science, it is highly probable, diat most of those baneful vices, which deform the human breast, and convulse the nations of the earth, might be banished from the world. I am not so sanguine as to suppose, that it is possible for man to acquire so much perfection from science, religion, liberty, and good govern- ment, as to cease to be mortal; but I am fully persuaded, that from the combined action of causes,. 52 INFLUENCE OF PHYSICAL CAUSES which operate at once upon the reason, the moral faculty, the passions, the senses, the brain, the nerves, the blood, and the heart, it is possible to produce such a change in his moral character, as shall raise him to a resemblance of angels ; nay, more, to the likeness of God himself. The state of Pennsylvania still deplores the loss of a man, in whom not only reason and revelation, but many of the physical causes that have been enumerated, concurred to produce such attainments in moral excellency, as have seldom appeared in a human being. This amiable citizen considered his fellow- creature, man, as God's extract, from his own works ; and whether this image of himself was cut out from ebony or copper; whether he spoke his own, or a foreign language ; or whether he wor- shipped his Maker with ceremonies, or without them, he still considered him as a brother, and equally the object of his benevolence. Poets and historians, who are to live hereafter, to you I com- mit his panegyric ; and when you hear of a law for abolishing slavery in each of the American states, such as was passed in Pennsylvania, in the year 1780 ; when you hear of the kings and queens of Europe, publishing edicts for abolishing the trade in human souls; and, lastly, when you hear of schools and churches, with all the arts of civilized life, being established among die nations of Africa, UPON THE MORAL FACULTY. 53 then remember and record, that this revolution in favour of human happiness, was the effect of the labours, the publications, the private letters, and the prayers of Anthony Benezet*. I return from this digression, to address my- self in a particular manner to you, venerable * This worthy man was descended from an ancient and honourable family that flourished in the court of Louis XIV. With liberal prospects in life he early devoted him- self to teaching an English school; in which, for industry, capacity, and attention to the morals and principles of the youth committed to his care, he was without an equal. He published many excellent tracts against the African trade, against war, and the use of spiritous liquors, and one in fa- vour of civilizing and Christianizing the Indians. He wrote to the queen of Great Britain, and the queen of Portugal, to use their influence in their respective courts to abolish the African trade. He also wrote an affectionate letter to the king of Prussia, to dissuade him from making war. The history of his life affords a remarkable instance how much it is possible for an individual to accomplish in the world; and that the most humble stations do not preclude good men from the most extensive usefulness. He be- queathed his estate (after the death of his widow) to the support of a school for the education of negro children, which he had founded and taught for several years before he died. He departed this life in May, 1784, in the 71st year of his age, in the meridian of his usefulness, universally lamented by persons of all ranks and denominations. 54 INFLUENCE OF PHYSICAL CAUSES sages and fellow citizens in the republic of letters. The influence of philosophy, we have been told,' has already been felt in courts. To increase, and complete this influence, there is nothing more necessary, than for the numerous literary societies in Europe and America, to add the science of morals to their experiments and inquiries. The godlike scheme of Henry IV, of France, and of the illustrious queen Elizabeth, of England, for establishing a perpetual peace in Eu- rope, may be accomplished without a system of jurisprudence, by a confederation of learned men, and learned societies. It is in their power, by mul- tiplying the objects of human reason, to bring the monarchs and rulers of the world -under their sub- jection, and thereby to extirpate war, slavery, and capital punishments, from the list of human evils. Let it not be suspected that I detract, by this de- claration, from the honour of the Christian religion. It is true, Christianity was propagated without the aid of human learning; but this was one of those miracles, which was necessaiy to establish it, and which, by repetition, would cease to be a miracle. They misrepresent the Christian religion, who sup- pose it to be wholly an internal revelation, and ad- dressed only to the moral faculties of the mind. The truths of Christianity afford the greatest scope for the human understanding, and they will become UPON THE MORAL FACULTY. 55 intelligible to us, only in proportion as the human genius is stretched, by means of philosophy, to its utmost dimensions, Errors may be opposed to errors; but truths, upon all subjects, mutually support each other. And perhaps one reason why some parts of the Christian revelation are still in- volved in obscurity, may be occasioned by our imperfect knowledge of the phenomena and laws of nature. The truths of philosophy and Christianity dwell alike in the mind of the Deity, and reason and religion are equally the offspring of his good- ness. They must, therefore, stand and fall toge- ther. By reason, in the present instance, I mean the power of judging of trudi, as well as the power of comprehending it. Happy aera! when the di- vine and the philosopher shall embrace each other, and unite their labours for the reformation and hap- piness of mankind! Illustrious counsellors and senators of Pennsylvania* ! I anticipate your candid recep- tion of this feeble effort to increase the quantity of virtue in our republic. It is not my business to * The president, and supreme executive council, and the members of the general assembly of Pennsylvania, attended the delivery of the oration, in the hall of the university, by invitation from the Philosophical Society. 56 influence of physical causes remind you of the immense resources for great- ness, which nature and Providence have bestowed upon our state. Every advantage which France has derived from being placed in the centre of Europe, and which Britain has derived from her mixture of nations, Pennsylvania has opened to her. But my business, at present, is to suggest the means of promoting the happiness, not the great- ness, of the state. For this purpose, it is abso- lutely necessary that our government, which unites into one, all the minds of the state, should possess, in an eminent degree, not only the understanding, the passions, and the will, but, above all, the moral faculty and the conscience of an individual. No- thing can be politically right, that is morally wrong; and no necessity can ever sanctify a law, that is contrary to equity. Virtue is the soul of a republic. To promote this, laws for the sup- pression of vice and immorality will be as ineffec- tual, as the increase and enlargement of jails. There is but one method of preventing crimes, and of rendering a republican form of government durable, and that is, by disseminating the seeds of virtue and knowledge through every part of the state, by means of proper modes and places of edu- cation, and this can be done effectually only by the interference and aid of the legislature. I am so deeply impressed with the truth of this opinion, UPON THE MORAL FACULTY. 57 that were this evening to be the last of my life, I would not only say to the asylum of my ancestors, and my beloved native country, with the patriot of Venice, " Esto perpetua," but I would add, as the last proof of my affection for her, my parting advice to the guardians of her liberties, " To esta- " bush and support public schools, in every " part of the state." VOL. II. H AN INQUIRY INTO THE CAUSES AND CURE PULMONARY CONSUMPTION I AN INQUIRY, &c. IN an essay, entided " Thoughts on the " Pulmonary Consumption*," I attempted to show th&t this disease was the effect of causes which induced general debility, and .that the only hope of discovering a cure for it should be directed to such remedies as act upon the whole system. In the following inquiry, I shall endeavour to establish the truth of each of those opinions, by a detail of facts and reasonings, at which I only hinted in my former essay. The method I have chosen for this purpose, is to deliver, and afterwards to support, a few general propositions. * Vol. I. p. 199. 62 ON pulmonary consumption. I shall begin by remarking, I. That the pulmonary consumption is induced by predisposing debility. This I infer, 1st, From the remote and exciting causes which produce it. The remote causes are pneumony, catarrh, haemoptysis, rheumatism, gout, asthma, scrophula, chronic diseases of the sto- mach, liver, and kidneys, nervous and intermitting fevers, measles, repelled humours from the surface of the body, the venereal disease, obstructed men- ses, sudden growth about the age of puberty, grief, and all other debilitating passions of the mind; hypochondriasis, improper lactation, excessive eva- cuation of all kinds, more especially by stool*, cold and damp air, a cough, external violence act- ing upon the bodyf ; and finally, every thing that * Sir George Baker relates, in the second volume of the Medical Transactions, that Dr. Blanchard had informed him, that he had seen the consumption brought on ten per- sons out of ninety, by excessive purging used to prepare the body for the small-pox. I have seen a case of consumption in a youth of 17, from the spitting produced by the intem- perate use of segars. t Dr. Lind says, that out of 360 patients whom he at- tended between July 1st, 1758, and July 1st, 1760, in con- sumptions, the disease was brought on one fourth of them ON PULMONARY CONSUMPTION. 63 tends, directly or indirectly, to diminish the strength of the system. The most frequent exciting cause of consump- tion is the alternate application of heat and cold to the whole external surface of the body; but all the remote causes which have been enumerated, ope- rate as exciting causes of consumption, when they act on previous debility. Original- injuries of the lungs seldom excite this disease, except they first induce a debility of the whole system, by a trou- blesome and obstinate cough. 2. From the debilitating occupations and habits of persons who are most liable to this disease. These are studious men, and mechanics who lead sedentary lives in confined places; also women, and all persons of irritable habits, whether of body or mind. i 3. From the period in which riersons are most liable to be affected by this disease. This is ge- nerally between the 18th and 36th year of life, a period in which the system is liable, in a peculiar manner, to most diseases which induce it, and in by falls, bruises, and strains, received a year or two before the disease made its appearance. 64 ON PULMONARY CONSUMPTION. which there is a greater expenditure of strength, than in any other stage of life, by the excessive exercises of the body and mind, in the pursuits of business or pleasure. I have conformed to authors, in fixing the period of consumptions between the 18th and 36th year of life,- but it is well known that it sometimes ap- pears in children, and frequendy in persons beyond the 40th, or even 60th year of life. II. The pulmonary consumption is a primary disease of the whole system. This I infer, 1. From the causes which produce it, acting upon the whole system. 2. From the symptoms of general debility which always precede the affection of the lungs. These symptoms are a qujck pulse, especially towards evening; a heat and burning in the palms of the hands; faintness, head-ach, sickness at stomach, and an occasional diarrhoea. I have frequently ob- served each of these symptoms for several months before I have heard of a single complaint in the breast. ON PULMONARY CONSUMPTION. 65 3. From the pulmonary consumption alternating with other diseases which obviously belong to the whole system. I shall briefly-mention these dis- eases. The rheumatism. I have seen many cases in which this disease and the consumption have alternately, in different seasons or years, affected the system. In the winter of 1792, three clinical patients in the Pennsylvania hospital exemplified by their complaints the truth of this observation. They were relieved several times of a cough by rheumatic pains in their limbs, which seemed for a while to promise a cure to their pulmonic com- plaints. The gout has often been observed to alternate with the pulmonary consumption, especially in per- sons in the decline of life. Dr. Sydenham describes a short cough continuing through the whole win- ter, as a symptom of gouty habits. A gendeman from Virginia died under my care in the spring of 1788, in the 45th year of his age, with all the symptoms of pulmonary consumption, which had frequendy alternated with pains and a swelling in his feet. VOL. IT. 7 66 ON PULMONARY CONSUMPTION. • The pulmonary consumption has been observed to alternate with madness. Of this I have seen two instances, in both of which the cough and expectoration were wholly suspended during the continuance of the derangement of the mind. Dr. Mead mentions a melancholy case of the same kind in a young lady, and similar cases are to be met with in other authors. In all of them the disease proved fatal. In one of the cases which came un- der my notice, the symptoms of consumption re- turned before the death of the patient. I have likewise witnessed two cases in which the return of reason after madness, was suddenly suc- ceeded by a fatal pulmonary consumption. Per- haps the false hopes, and even the cheerfulness which so universally occur in this disease, may be resolved into a morbid state of the mind, produced by a general derangement of the whole system. So un/*ersal are the delusion and hopes of patients, with respect to the nature and issue of this disease, that I have never met with but one man, who, up- on being asked what was the matter with him, an- swered unequivocally, " that he was in a consump- " tion." Again : Dr. Bennet mentions a case of " A " phthisical patient, who was seized with a violent ON PULMONARY CONSUMPTION. 67 " pain in the teeth for two days, and in " whom, during that time, every symptom of a " consumption, except the leanness of the body, " altogether vanished :" and he adds further, " that " a defluction on the lungs had often been relieved " by SALIVARY EVACUATIONS*." I have seen several instances in w hich the pul- monary symptoms have alternated with headacii and dyspepsia ; also with pain and noise in one ear. This affection of the ears sometimes con- tinues throughout the whole disease, without any remission of the pulmonary symptoms. I have seen one case of a discharge of matter from the left ear, without being accompanied by either pain or noise. In all our books of medicine are to be found cases of consumption alternating with eruptions on the skin. And who has not seen the pulmonary symptoms alternately relieved and reproduced by the appear- ance or cessation of a diarrhoea, or pains in the bowels? * Treatise of the Nature and Cure of Consumptions. Exercitation X. 68 ON pulmonary consumption. To these facts I shall only add, under this head, as a proof of the consumption being a disease of the whole system, that it is always more or less relieved by the change which is induced in the system by pregnancy. 4. I infer that the pulmonary consumption is a disease of the whole system from its analogy with several other diseases, which, though accompanied by local affections, are obviously produced by a morbid state of the whole system. The rheumatism, the gout, the measles, small- pox, the different species of cynanche, all furnish examples of the connection of local affections with a general disease; but the apoplexy, and the pneumony, furnish the most striking analogies of local affection, succeeding a general disease of the system in the pulmonary consumption. The most frequent predisposing cause of apo- plexy is a general debility of the system, produced by intemperance in eating and drinking. The phe- nomena of the disease are produced by an effusion of blood or serum, in consequence of a morbid dis* tension, or of a rupture of the vessels of the brain. The pulmonary consumption begins and ends in the same way, allowing only for the difference of ON PULMONARY CONSUMPTION. 69 situation and structure of the brain and lungs. After the production of predisposing debility from the action of the remote causes formerly enumerat- ed, the fluids are determined to the weakest part of the body. Hence effusions of serum or blood take place in the lungs. When serum is effused, a pituitous or purulent expectoration alone takes place; when blood is discharged, a disease is pro- duced which has been called haemoptysis. An effusion of blood in the brain, brought on by the operation of general debility, has been called by Dr. Hoffman, with equal propriety, a haemorrhage of the brain. The effusion of blood in the lungs, in consequence of the rupture of a blood-vessel, is less fatal than the same accident when it occurs in the brain, only because the blood in the former case is more easily discharged from the system. Where no rupture of a blood-vessel is produced, death is nearly as speedy and certain in the one case as in the other. Dissections show many cases of suffo*- cation and death, from the lungs being preternatu- rally filled with blood or serum. From this great analogy between the remote and proximate causes of the two diseases which have been described, I have taken the liberty to call them both by the name of apoplexy. The only symptom which does not accord with the derivation of the term, is, that in the apoplexy of the lungs, the patient does 70 ON PULMONARY CONSUMPTION. not fall down as if by an external stroke, which is most frequently die case in the apoplexy of the brain. The history of the remote and proximate causes of pneumony will furnish us with a still more re- markable analogy of the connection between a lo- cal affection, and a general disease of the system. The pneumony is produced by remote exciting causes which act on the whole system. The whole arterial system is frequently agitated by a fever in this disease before a pain is perceived in the breast or sides, and this fever generally constitutes its strength and danger. The expectoration which terminates the disease in health, is always the ef- fect of effusions produced by a general disease, and even the vomicas, which sometimes succeed a de-r'' ficiency of bleeding, always depend upon the same general cause. From this view of the analogy be- tween pneumony and pulmonary consumption, it would seem that the two diseases differed from each other only by the shorter or longer operation of the causes which induce them, and by the great- er or less violence and duration of their symptoms. The pneumony appears to be an acute consump- tion, and the consumption a chronic pneumony. From the analogy of the pulmonary consumption with the diminutive term of certain fevers, I have taken the liberty of calling itapNEUMONicuLA. ON PULMONARY CONSUMPTION. 71 5. I infer that the pulmonary consumption is a disease of the whole system, from its existence without ulcers in the lungs. Of this there are many cases recorded in books of medicine. Dr. Leigh informs us, in his Natural History of Lancashire, that the consumption was a very com- mon disease on the sea coast of that country ; but that it was not accompanied either by previous in- flammation or ulcers in the lungs. It was gene- rally attended, he says, by an unusual peevishness of temper. 6. I infer that the pulmonary consumption is a disease of the whole system, from its being reliev- ed, or cured, only by remedies which act upon the whole system. This will appear, I hope, here- after, when we cOme to treat of die cure of this disease. Let us now enquire how far the principles I have laid down will apply to the supposed causes of con- sumption. These causes have been said to be, an abscess in the lungs, haemoptysis, tubercles, wTidiout and with ulcers, catarrh, hereditary diathe- sis, contagion, and the matter of cutaneous erup- tions, or sores repelled, and thrown upon the lungs. I shall make a few observations upon each of them. 72 ON PULMONARY CONSUMPTION. 1. An abscess in the lungs is generally the con- sequence of a neglected, or half-cured pneumony. It is seldom fatal, where it is not connected with a predisposition to consumption from general debi- lity, or where general debility is not previously in. duced by the want of appetite, sleep, and exercise, which sometimes accompany that disease of the lungs. This explanation of the production of con- sumption by an abscess in the lungs, will receive further support from attending to the effects of wounds in the lungs. How seldom are they fot. lowed by pulmonary consumption; and this only because they are as seldom accompanied by pre* disposing general debility. I do not. recollect a single instance of this disease having followed a wound in the lungs, either by the bayonet, or a bullet, during our revolutionary war. The reco- veries which have succeeded such wounds, and frequently under the most unfavourable circum- stances, show how very improbable it is that a much slighter affection of the lungs should become the cause of a pulmonary consumption. A British officer, whom I met in the British eamp, a few days after the battle of Brandywine, in September, 1777, informed me that the surgeon- general of the royal army had assured him, that out of twenty-four soldiers who had been admitted ON PULMONARY CONSUMPTION. 73 into the hospitals, during the campaign of 1776, with wounds in their lungs, twenty-three of them had recovered. Even primary diseases of the lungs often exist with peculiar violence, or con- tinue for many years w ithout inducing a consump- tion. I have never known but one instance of the whooping-cough ending in consumption, and all our books of medicine contain records of the asthma continuing for twenty and thirty years without terminating in that disease. The reason in both cases, must be ascribed to those two ori- ginal diseases of the lungs not being accompanied by general debility. One fact more will serve to throw still further light upon the subject. Millers are much afflicted with a cough from floating par- ticles of flour constantly irritating their lungs, and yet they are not more subject to consumptions than other labouring people. Hence " a miller's " cough" is proverbial in some places, to denote a cough of long continuance without danger. 2. The haemoptysis is either a local disease, or it is the effect of general debility of the whole sys- tem. When it is local, or when it is the effecfrof causes which induce a temporary or acute debility only in the system, it is seldom followed by con- sumption. The accidental discharge of blood from the lungs, from injuries, and from an obstruction vol. n. k 74 ON PULMONARY CONSUMPTION. of the menses in women is of this kind. Many persons are affected by this species of haemorrhage once or twice in their lives, without suffering any inconvenience from it afterwards. I have met with several cases in which it has occurred for many years every time the body was ,exposed to any of the causes which induce sudden debility, and yet no consumption has followed it. The late king of Prussia informed Dr. Zimmerman that he had been frequently attacked by it during his seven years war, and yet he lived, notwithstanding, above twenty years afterwards without any pulmonary complaints. It h only in persons who labour under chronic debility, that a haemoptysis is necessarily followed by consumption. 3. I yield to the popular mode of expression when I speak of a consumption being produced by tubercles. But I maintain that they are the effects of general debility communicated to the bronchial vessels which cause them to secrete a preternatural quantity of mucus. This mucus is sometimes poured into the trachea from whence it is discharg- ecFby hawking, more especially in the morning; for it is secreted more copiously during the languid hours of sleep than in the day time. But this mucus is frequently secreted into the substance of the lungs, where it produces those tumours we ON PULMONARY CONSUMPTION. 75 call tubercles. When this occurs, there is either no cough* or a very dry one. That tubercles are formed in this way, I infer from the dissections and experiments of Dr. Starkf, who tells us, that he found them to consist of inorganic matter; that he was unable to discover any connection between them and the pulmonary vessels, by means of the microscope or injections; and that they first opened into the trachea through the bronchial vessels. It is remarkable that the colour and consistence of the matter of which they are composed, is nearly the same as the matter which is discharged through the trachea, in the moist cough which occurs from a relaxation of the bronchial vessels, and which has been called by Dr. Beddoes a bronchial gleeti I am aware that these tumours in the lungs have been ascribed to scrophula. But the frequent oc- currence of consumptions in persons in whom no scrophulous taint existed, is sufficient to refute this opinion. I have frequently directed m)^ inquiries after this disease in consumptive patients, and have met with very few cases which were produced by it. It is probable that it may frequently be a jwP * See Med. Com. Vol. II. t Clinical and Anatomical Observations, p. 26, 27. See also Morgagni, letter xxii. 21. ?6 ON PULMONAJtY CONSUMPTION. disposing cause of consumption in Great Britain, but I am sure it is not in the United States. Baron HutnbOldt informed me, that the sOrophula is un- known in Mexico, and yet consumptions, he said, are very common in that part of Spanish America. That tubercles are the effects, and not the cause of pulmonary consumption, is further evident from similar tumours being suddenly formed oh the in- testines by the dysentery, and on the omentum by a yellow fever. Cases of the former are to be met w ith in the dissections of Sir John Pringle, and one of the latter is mentioned by Dr. Mackittrick, in his inaugural dissertation upon the yellow fever, published in Edinburgh in the year 1766*. 4. The catarrh is of two kinds, acute and chro- nic, both of which are connected with general de- bility, but this debility is most obvious in the chronic catarrh: hence we find it increased by every thing which acts upon the whole system, such as cold and damp wreather, fatigue, and, above all, by old age, and relieved or cured by exercise, ajKl every thing else which invigorates the whole system. This species of catarrh often continues for twenty or thirty years without inducing pulmo- nary consumption, in persons who pursue active ' occupations. * Pages 7, 8. ON PULMONARY CONSUMPTION. 77 5. In the hereditary consumption there is either a hereditary debility of the whole system, or a hereditary mal-conformation of the breast. In the latter case, the consumption is the effect of weak- ness communicated to the whole system, by the long continuance of difficult respiration, or of such injuries being done to the lungs as are incompati- ble writh health and life. It is remarkable, that the consumptive diathesis is more frequently de- rived from paternal, than maternal ancestors. ■6. Physicians, the most distinguished charac- ters, have agreed, that the pulmonary consumption may be communicated by contagion. Under the influence Of this belief, Morgagni informs us, that Valsalva, who was predisposed to the consumption, constantly avoided being present at the dissection of the lungs of persons who had died of that dis- ease. In some parts of Spain and Portugal, its contagious nature is so generally believed, that cases of it are reported to the magistrates of those countries, and the clothes of persons who die of it are burned by their orders. The doctrine of nearly all diseases spreading by contagion, required But a short and simple act of the mind, and favoured the indolence and timidity which characterized the old school of medicine. I adopted this opinion, with respect to the consumption, in the early part of my 78 ON PULMONARY CONSUMPTION. life; but I have lately been led to call its truth in question, especially in the unqualified manner in which it has been taught. In most of the cases in which the disease has been said to be propagated by contagion, its limits are always confined to the members of a single family. Upon examination, I have found them to depend upon some one or more of the following causes : 1. Mal-conformation of the breast, in all the branches of the diseased family. It is not neces- sary that this organic predisposition should be here- ditary. 2. Upon the debility which is incurred by nurs- ing, and the grief which follows the loss of rela- tions who die of it. 3. Upon some local cause undermining the con- stitutions of a whole family. This may be exhala- tions from a foul cellar, a privy, or a neighbouring mill-pond, but of so feeble a nature as to produce debility only, with an acute fever, and thus to ren- der the consumption a kind of family epidemic. I wras consulted, in the month of August, 1793, by a Mr. Gale, of Maryland, in a pulmonary com- plaint. He informed me, that he had lost several brothers and sisters with the consumption, and ON PULMONARY CONSUMPTION. 79 that none of his ancestors had died of it. The deceased persons, five in number, had lived in a place that had been subject to the intermitting fever. 4. Upon some peculiar arid unwholesome arti- cle of diet, which exerts slowly debilitating effects upon all the branches of a family. 5. Upon a fearful and debilitating apprehension entertained by the surviving members of a family, in which one or two have died of consumption, that they shall perish by the same disease. The effects of all the passions, and especially of fear, acted upon by a lively imagination, in inducing determinations to particular parts of the body, and subsequent disease, are so numerous, as to leave no doubt of the operation of this cause, in pro- ducing a number of successive deaths in the same family, from pulmonary consumption. t In favour of its depending upon one or more of the above causes, I shall add two remarks. 1. There is often an interval of from two to ten years, between the sickness and deaths which oc- cur in families from consumptions, and this we know never takes place in any disease which is admitted to be contagious. $0 ON PULMONARY CONSUMPTION. % The consumption is not singular in affecting several branches of a family. I was lately con- sulted by a young physician from Maryland, who informed me, that two of his brothers, in common with himself, were afflicted with epilepsy. Mad- ness, scrophula, and a disposition to haemorrhage, often affect, in succession, several branches of the same family ; and who will say that any one of the above diseases is propagated by contagion ? The practice of the Spaniards and Portuguese, in burning the clothes of persons who die of con- sumptions, no more proves the disease to be con- tagious, than the same acts sanctioned by the ad- vice or orders of public bodies in the United States, establish the contagious nature of the yellow fever. They are, in both countries, marks of the superstition of medicine. In suggesting these facts, and the inferences which have been drawn from them, I do not mean to deny the possibility of the acrid and foetid va- pour, which is discharged by breathing from an ulcer or abscess in the lungs, nor of the hectic sweats, v/hen rendered putrid by stagnating in sheets, or blankets, communicating this disease to persons who are Jong exposed to them, by sleep- ing with coiioumpuve patients; but that such cases ON PULMONARY CONSUMPTION. 81 rarely occur I infer, from the persons affected often living at a distance from each other, or when they live under the same roof, having no intercourse with the sick. This was the case with the black slaves, who were supposed to have taken the dis- ease from the white branches of a family in Con- necticut, and which was mentioned, upon the authority of Dr. Beardsley, in a former edition of this inquiry. Admitting the above morbid mat- ters now and then to act as a remote cause of con- sumption, it does not militate against the theory I have aimed to establish, for if it follow the analogy of common miasmata and contagions, it must act by first debilitating the whole system. The ap- proach of the jail and bilious fevers is often indi- cated by general languor. The influenza and the measles are always accompanied by general debi- lity, but the small-pox furnishes an analogy to the case in question more directly in point. The con- tagion of this disease, whether received by the medium of the air or the skin, never fails of pro- ducing weakness in the whole system, before it discovers itself in affections of those parts of the body on wrhich the contagion produced its first operation. 7. I grant that cutaneous humours, and the mat- ter of old sores, when repelled, or suddenly healed, VOL. n. fc 82 ON PULMONARY CONSUMPTION. have in some cases fallen upon the lungs, and pro- duced consumption. But I believe, in every case where this has happened, the consumption was preceded by general debility, or that it was not in- duced, until the whole system had been previously^ debilitated by a tedious and distressing cough. If the reasonings founded upon the facts which have been mentioned be just, then it follows, III. That the abscess, cough, tubercles, ulcers, and purulent or bloody discharges which occur in the pulmonary consumption, are the effects, and not the causes of the disease ; and, that all attempts to cure it, by inquiring after tubercles and ulcers, or mto the quality of the discharges from the lungs, are as fruitless as an attempt would be to discover the causes or cure of dropsies, by an examination of the qualities of collections of water, or to find out the causes and cure of fevers, by the quantity or quality of the discharges which take place in those diseases from the kidneys and skin. It is to be lamented, that it is not in pulmonary consumption only, that the effects of a disease have been mistaken for its cause. Water in the brain, a membrane in die trachea, and a preternatural secretion of bile, have been accused of producing hydrocephalus in- terims, cynanche trachealis, and bilious fever, ON PULMONARY CONSUMPTION. 83 whereas we now know they are the effects of those diseases only, in the successive order in which each of them has been mentioned. It is high time to harness the steeds which drag the car of medicine before, instead of behind it. The earth, in our science, has stood still long enough. Let us at last believe, it revolves round its sun. I admit that die cough, tubercles, and ulcers, after they are formed, increase the danger of a consumption, by becoming new causes of stimulus to the system, but in this they are upon a footing with the water, the membrane, and the bile that have been alluded to, which, though they constitute no part of the dis- eases diat produce them, frequendy induce symp- toms, and a termination of them, wholly unconnect- ed with the original disease. The tendency of general debility to produce a disease of the lungs appears in many cases, as well as in the pulmonary consumption. Dr. Lind tells us, that the last stage of the jail fever was often marked by a cough. I have seldom been disap- pointed in looking for a cough and a copious ex- cretion of mucus and phlegm after the 14th or 15th days of the slow nervous fbver. Two cases of hy- pocondriasis under my care, ended in fatal diseases of the lungs. The debility of old age is generally accompanied by a troublesome cough, and the de- 84 ON PULMONARY CONSUMPTION. bility which precedes death, generally discovers its last symptoms in the lungs. Hence most people die with what are called the rattles. They arc produced by a sudden and copious effusion of mu- cus in the bronchial vessels of the lungs. Sometimes the whole force of the consumptive fever falls upon the trachea instead of the lungs, producing in it defluxion, a hawking of blood, and occasionally a considerable discharge of blood, which are often followed by ulcers, and a spitting of pus. I have called it a tracheal, instead of a pulmonary consumption. Many people, pass through a long life with a mucous defluxion upon the trachea, and enjoy in other respects tolerable health. In such persons the disease is of a local nature. It is only when it is accompanied with debility of the whole system, that it ends in a consumption. Mr. John Harrison, of the Northern Liberties, died of this dis- ease under my care, in the year 1801, in conse- quence of the discharge of pus from an ulcer which followed a haemorrhage from the trachea being sud- denly suppressed. I have seen another case of the same kind in a lady in this city, in the year 1797. Dr. Spence, of Dumfries, in Virginia, in a letter which I received from him in June, 1805, describes a case then under his care, of this form of consump- tion. He calls it, very properly, " phthisis trache- ON PULMONARY CONSUMPTION. 85 alis." I have met with two cases of death from this disease, in which there were tubercles in the tra- chea. The patients breathed with great difficulty, and spoke only in a whisper. One of them died from suffocation. In the other, the tubercle bursted a few days before his death, and discharged a large quantity of foetid matter. Should it be asked, why does general debility terminate by a disease in the lungs and trachea, ra- ther than in any other part of the body ? I answer, that it seems to be a law of the system, that gene- ral debility should always produce some local dis- ease. This local disease sometimes manifests itself in dyspepsia, as in the general debility which fol- lows grief; sometimes it discovers itself in a diarr- hoea, as in the general debility which succeeds to fear. Again it appears in the brain, as in the general debility which succeeds intemperance, and the con- stant or violent exercise of the understanding, or of stimulating passions; but it more frequently ap- pears in the lungs, as the consequence of general debility. It would seem as if the debility in the cases of consumption is seated chiefly in the blood- vessels, while that debility which terminates in dis- eases of the stomach and bowels, is confined chiefly to the nerves, and that the local affections of the brain arise from a debility, invading alike the ner- 86 ON PULMONARY CONSUMPTION. vous and arterial systems. What makes it more probable that the arterial system is materially affect- ed in the consumption is, that the disease most fre- quendy occurs in those periods of life, and in those habits in which a peculiar state of irritability or ex- citability is supposed to be present in the arterial system ; also in those climates in which there are the most frequent vicissitudes in the temperature of the weadier. It has- been observed, that the de- bility in the inhabitants of the West-Indies, whe- ther produced by the heat of the climate or the ex- cessive pursuits ef business or pleasure, generally terminates in dropsy, or in some disease of the ali- mentary canal. I have said, that it seemed to be a law of the sys- tem, that general debility should always produce some local affection. But to this law there are sometimes exceptions : the atrophy appears to be a consumption without an affection of the lungs. This disease is frequently mentioned by the writers of the 16th and 17th centuries by the name of tabes. I have seen several instances of it in adults, but more in children, and a greater number in the chil- dren of black than of w hite parents. The hectic fever, and even the night sweats, were as obvious in several of these cases, as in diose consumptions ON PULMONARY CONSUMPTION. 87 where general debility had discovered itself in an affection of the lungs. I come now to make a few observations upon the cure of consumption; and here I hope it will appear, that the theory which I have delivered ad- mits of an early and very important application to practice. If the consumption be preceded by general de- bility, it becomes us to attempt the cure of it be- fore it produce the acdve symptoms of cough, bloody or purulent discharges from the lungs, and inflammatory or hectic fever. The symptoms which mark its first stage, are too seldom observ- ed ; or if observed, they are too often treated with equal neglect by patients and physicians. I shall briefly enumerate these symptoms. They are a slight fever increased by the least exercise ; a burn- ing and dryness in the palms of the hands, more especially towards evening; rheumy eyes upon waking from sleep; an increase of urine; a dry- ness of the skin, more especially of the feet in the morning*; an occasional flushing in one, and some- * The three last-mentioned symptoms are taken notice of by Dr. Bennet, in his Treatise upon the Nature and Cure of the Consumption, as precursors of the disease. Dr. Boer- haave used to tell his pupils that they had never deceived him. 88 Oif PULMONARY CONSUMPTION. times in both cheeks; a hoarseness* ; a slight or acute pain in the breast; a fixed pain in one side, or shooting pains in both sides ; head-ach ; occa- sional sick and fainty fits; a deficiency of appetite, and a general indisposition to exercise or motion of every kind. It would be easy for me to mention cases in which every symptom that has been enumerated has occurred within my own observation. I wish them to be committed to memory by young prac- titioners ; and if they derive the same advantages from attending to them, which I have done, I am sure they will not regret the trouble they have taken for that purpose. It is probable, while a morbid state of the lungs is supposed to be the proximate cause of this disease, they will not de- rive much reputation or emolument from curing it in its forming stage; but let them remember, that in all attempts to discover the causes and cures of diseases, which have been deemed incurable, a physician will do nothing effectual until he acquire a perfect indifference to his own interest and fame. * I have seen the hoarseness in one case the first symptom of approaching consumption. In this symptom it preserves the analogy of pneumony, which often comes on with a hoarseness, and sometimes with paraphonia. ON PULMONARY CONSUMPTION. 89 The remedies for consumption, in this stage of the disease, are simple and certain. They consist in a desertion of all the remote and exciting causes of the disorder, particularly sedentary employ- ments, damp or cold situations, and whatever tends to weaken the system. When the disease has not yielded to this desertion of its remote and exciting causes, I have recommended the cold bath, steel, and bark with great advantage. However impro- per, or even dangerous, these remedies may be after the disease assumes an inflammatory or hectic type, and produces an affection of the lungs, they are perfectly safe and extremely useful in the state of the system which has been described. The use of die bark will readily be admitted by all those practitioners who believe the pulmonary consump- tion" to depend upon a scrophulous diathesis. Should even the lungs be affected by scrophulous tumours, it is no objection to the use of the bark, for there is no reason why it should not be as use- ful in scrophulous tumours of the lungs, as of the glands of the throat, provided it be given before those tumours have produced inflammation; and in this case, no prudent practitioner will ever pre- scribe it in scrophula, when seated even in the ex- ternal parts of the body. To these remedies should be added a diet moderately stimulating, and gentle exercise. I shall hereafter mention trie dif- VOL. II. M 90 ON PULMONARY CONSUMPTION. ferent species of exercise, and the manner in which each of them should be used, so as to derive the utmost advantage from them. I can say nothing of the use of salt water or sea air in this stage of » the consumption, from my own experience. I have heard them commended by a physician of Rhode- Island ; and if they be used before the disease has discovered itself in pulmonary affections, I can easily conceive they may do service. If the simple remedies which have been men- tioned have been neglected, in the first stage of the disease, it generally terminates, in different periods of time, in pulmonary affections, which show them- selves under one of the three following forms : 1. A fever, accompanied by a cough, a hard pulse, and a discharge of blood, or mucous matter from the lungs. 2. A fever of the hectic kind, accompanied by chilly fits, and night sweats, and a pulse full, quick, and occasionally hard. The discharges from the lungs, in this state of the disease, are fre- quently purulent. 3. A fever with a weak frequent pulse, a trou- blesome cough, and copious purulent discharges ON PULMONARY CONSUMPTION. 91 from the lungs, a hoarse and weak voice, and chilly fits and night sweats alternating with a diarrhoea. From this short history of the symptoms of pul- monary consumption there are occasional devia- tions. I have seen four cases, in which the pulse was natural, or slower than natural, to the last day of life. Mrs. Rebecca Smith, the lovely and ac- complished wife of Mr. Robert Smith, of this city, passed through the whole course of this disease, in the year 1802, without a single chilly fit. Two other cases have come under my notice, in which there Was not only an absence of chills, but of fever and night sweats. A similar case is recorded in the Memoirs of the Medical Society of London; and lastly, I have seen two cases which terminated fatally, in which there was neither cough nor fever for several months. One of them was in Miss Mary Loxley, the daughter of the late Mr. Benja- min Loxley, in the year 1785. She, had com- plained of a pain in her right side, and had frequent chills with a fever of the hectic kind. They all gave way to frequent and gentle bleedings. In the summer of 1786, she was seized with the same complaints, and as she had great objections to bleeding, she consulted a physician who gratified her, by attempting to cure her by recommending exercise and country air. In the autumn she re- 92 ON PULMONARY CONSUMPTION. turned to the city, much worse than when she left it. I was again sent for, and found her confined to her bed with a pain in her right side, but with- out the least cough or fever. Her pulse was pre- ternaturally slow. She could lie only on her left side. She sometimes complained of acute flying pains in her head, bowels, and limbs. About a month before her death, which was on the 3d of May, 1787, her pulse became quick, and she had a litde becking cough, but without any discharge from her lungs. Upon my first visit to her in the preceding autumn, I told her friends that I believed she. had an abscess in her lunars. The w7ant of fever and cough afterwards, however, gave me rea- son to suspect that I had been mistaken. The morning after her death, I received a message from her father, informing me that it«had been among the last requests of hi^ daughter, that the cause of her death should be. ascertained, by my opening her body. I complied with this request, and, in company with Dr. Hall, examined her thorax. We found the left lobe of the lungs perfectly sound; the right lobe adhered to the pleura, in separating, of which, Dr. Hall plunged his hand into a large sac, which contained about half a pint of purulent matter, and which had nearly destroyed the whole substance of the right lobe of the lungs. (BN PULMONARY CONSUMPTION. 93 I have never seen a dry tongue in any of the forms or stages of this disease. The three different forms of the pulmonary affec- tion that I have mentioned, have been distinguished by die names of the first, second, and third stages of the consumption; but as they do not always succeed each other in the order in which they have been mentioned, I shall consider them as different states of the system. The first I shall call the inflammatory, the second the hectic, and the third the typhus state. I have seen the pulmonary consumption come on sometimes with all the symptoms of the second, and sometimes with most of the symptoms of the third state; and I have seen two cases in which a hard pulse, and other symptoms of inflam- matory action, appeared in the last hours of life. It is agreeable to pursue the analogy of this dis- ease with a pneumony, or an acute inflammation of the lungs. They both make their first appearance in the same seasons of the year. It is true, the pneumony most frequently attacks with inflamma- tory symptoms; but it sometimes occurs with symptoms which forbid blood-letting, and I have more than once seen it attended by symptoms which required the use of wine and bark. The 94 ON PULMONARY CONSUMPTION. % pneumony is attended at first by a dry cough, and an expectoration of streaks of blood ; the cough in the consumption, in like manner, is at first dry, and attended by a discharge of blood from the hmgs, which is more copious than in the pneu- mony, only because the lungs are more relaxed in the former than in the latter disease. There are cases of pneumony in which no cough attends. I have just now mentioned that I had seen the ab- sence of that symptom in pulmonary consumption. The pneumony terminates in different periods, according to the degrees of inflammation, or the nature of the effusions which take place in the lungs : the same observation applies to the pulmo* nary consumption. The symptoms of the different forms of pneumony frequently run into each other; so do the symjjtpHns of the three forms of consump- -tion which have been mentioned. In short, the pneumony and consumption are alike in so many particulars, that they appear to resemble shadows of die same substance. They differ only as the protracted shadow of the evening does from that of the noon-day sun. I know that it will -be objected here that the consumption is sometimes produced by scrophula, and that this creates an essential difference between ON PULMONARY CONSUMPTION. 95 it and pneumony. I formerly admitted scrophula to be one of the remote causes of the consumption; but this does not invalidate the parallel which has been given of the two diseases. The phenomena produced in the lungs are the same as to their nature, whether they be produced by the remote cause of scrophula, or by the sudden action of cold and heat upon them. No more happens in the cases of acute and chro- nic pneumony, than what happens in dysentery and rheumatism. These two last diseases are for the most part so acute, as to confine the patient to his bed or his room, yet we often meet with both ©f them in patients wrho go about their ordinary business, and, in some instances, carry their dis- eases with them for two or three years. The parallel which has been drawn between the pneumony and consumption, will enable us to un- derstand the reason why the latter disease termi- nates in such different periods of time. The less it partakes of pneumony, the longer it continues, and vice versa. What is commonly called in this country a galloping consumption, is a disease com- pounded of different degrees of consumption and pneumony. It terminates frequently in two or three months, and without many of the symptoms 96 ON PULMONARY CONSUMPTION. which usually attend the last stage of pulmonary consumption. But there are cases in which pa- tients in a consumption are suddenly snatched away by an attack of pneumony. I have met with one case only, in which, contrary to my expectation, the patient mended after an attack of an acute in- flammation of the lungs, so as to live two years afterwards. It would seem from these facts, as if nature had preferred a certain gradation in diseases, as well as in other parts of her works. There is scarcely a disease in w-hich there is not a certain number of grades, which mark the distance between health and the lowest specific deviation from it. Each of these grades has received different names, and has been considered as a distinct disease, but more accurate surveys of the animal economy have taught us, that they frequently depend upon the same original causes, and that they are only greater or less degrees of the same disease. I shall now proceed to say a few words upon the cure of the different states of pulmonary con- sumption. The remedies for this purpose are of two kinds, viz. palliative and radical. I shall first mention the palliative remedies which belong to each state, and then mention those- ON PULMONARY CONSUMPTION. 97 which are alike proper in them all. The palliative remedies for the I. Or INFLAMMATORY STATE, are 1. Blood-letting. It may seem strange to recommend this debilitating remedy in a disease brought on by debility. Were it proper in this place, I could prove that there is no disease in which bleeding is prescribed, which is not induced by predisposing debility, in common with the pul- monary consumption. I shall only remark here, that in consequence of the exciting cause acting upon the system (rendered extremely excitable by debility) such a morbid and excessive excitement is produced in the arteries, as to render a diminu- tion of the stimulus of the blood absolutely neces- sary to reduce it. I have used this remedy with great success, in every case of consumption at- tended by a hard pulse, or a pulse rendered weak by a laborious transmission of the blood through the lungs. In the months of February and March, in the year 1781, I bled a Methodist minister, who was affected by this state of consumption, fifteen times in the course of six weeks. The quantity of blood drawn at each bleeding was never less than eight ounces, and it was at all times covered with an inflammatory crust. By the addition of VOL. II. N 08 ON PULMONARY CONSUMPTION. country air, and moderate exercise, to this copious evacuation, in the ensuing spring he recovered his health so perfectly, as to discharge all the duties of his profession for many years, nor was he ever afflicted afterwards with a disease in his breast. I have, in another instance, bled a citizen of Phila- delphia eight times in two weeks, in this state of consumption, and with the happiest effects. The blood drawn at each bleeding was always sizy, and never less in quantity than ten ounces. Mr. Tra- cey of Connecticut informed me, in the spring of 1802, that he had been bled eighty-five times in six months, by order of his physician, Dr. Sheldon, in the inflammatory state of this disease. He as- cribed his recovery chiefly to this frequent use of the lancet. To these cases I might add many others of consumptive persons who have been per- fectly cured by frequent, and of many others whose lives have been prolonged by oecasional bleedings. But I am sorry to add, that I could relate many more cases of consumptive patients, who have died martyrs to their prejudices against the use of this invaluable remedy. A common objection to it is, that it has been used without success in this dis- ease. When this has been the case, I suspect that it has been used in one of the other two states of pulmonary consumption which have been men- tioned, for it has unfortunately been too fashion- ON PULMONARY CONSUMPTION. 99 able among physicians to prescribe the same re- medies in every stage and form of the same disease, and this I take to be the reason why the same medicines, which, in the hands of some phy- sicians, are either inert or instruments of mischief, are, in the hands of others, used with more or less success in every case in which they are prescribed. Another objection to bleeding in the inflammatory state of consumption, is derived from the apparent and even sensible weakness of the patient. The men who urge this objection, do not hesitate to take from sixty to a hundred ounces of blood from a patient in a pneumony, in the course of five or six days, without considering that the debility in the latter case is such as to confine a patient to his bed, while, in the former case, the patient's strength is such as to enable him to walk about his house, and even to attend to his ordinary business. The difference between the debility in the two diseases, consists in its being acute in the one, and chronic in the other. It is true, the preternatural or con- vulsive excitement of the arteries is somewhat greater in the pneumony, than in the inflammatory consumption ; but the plethora, on which the ne- cessity of bleeding is partly founded, is certainly greater in the inflammatory consumption than in pneumony. This is evident from women, and even nurses, discharging from four to six ounces 100 ON PULMONARY CONSUMPTION. of menstrual blood every month, while they are labouring with the most inflammatory symptoms of the disease ; nor is it to be wondered at, since the appetite is frequendy unimpaired, and the genera- tion of blood continues to be the same as in perfect health. Dr. Cullen recommends the use of bleeding in consumptions, in order to lessen the inflammation of the ulcers in the lungs, and thereby to dispose them to heal. From the testimonies of the re- lief which bleeding affords in external ulcers and tumours accompanied by inflammation, I am dis- posed to expect the same benefit from it in inflamed ulcers and tumours in the lungs : whether, there- fore, we adopt Dr. Cullen's theory of consumption, and treat it as a local disease, or assent to the one which I have delivered, repeated bleedings appear to be equally necessary and useful. I have seen two cases of inflammatory con- sumption, attended by a hajmorihage of a quart of blood from the lungs. I agreed at first with the friends of these patients in expecting a rapid termination of their disease in death, but to the joy and surprise of all connected with them, they both recovered. I ascribed their recovery wholly to the inflammatory action of their systems being ON PULMONARY CONSUMPTION. 101 suddenly reduced by a spontaneous discharge of blood. These facts, I hope, will serve to establish the usefulness of blood-letting in the inflammatory state of consumption, with those physicians who are yet disposed to trust more to the fortuitous operations of nature, than to the decisions of rea- son and experience. I have always found this remedy to be more necessary in the winter and first spring months, than at any other season. We obtain by means of repeated bleedings, such a mitigation of all the symptoms as enables the patient to use exercise with advantage as soon as the weather becomes so dry and settled, as to admit of his going abroad ever}7 day. The relief obtained by bleeding, is so certain in this state of consumption, that I often use it as a palliative remedy, where I do not expect it will perform a cure. I was lately made happy in find- ing, that I am not singular in this practice. Dr. Hamilton, of Lynn Regis, used it with success in a consumption, which was the effect of a most de- plorable scrophula, without entertaining the least hope of its performing a cure*. In those cases * Observations on Scrophulous Affections. 102 ON PULMONARY CONSUMPTION. where inflammatory action attends the last scene of the disease, there is often more relief obtained by a little bleeding than by the use of opiates, and it is always a more humane prescription, in desperate cases, than the usual remedies of vomits and blisters. I once bled a sea captain, whom I had declared to be within a few hours of his dissolution, in order to relieve him of uncommon pain, and diffi- culty in breathing. His pulse was at the same time hard. The evacuation, though it consisted of but four ounces of blood, had the wished for effect, and his death, I have reason to believe, was ren- dered more easy by it. The blood, in this case, was covered with a buffy coat. The quantity of blood drawn in every case of inflammatory consumption, should be determined by the force of the pulse, and the habits of the pa- tient. I have seldom taken more than eight, but more frequendy but six ounces at a time. It is much better to repeat the bleeding once or twice a week, than to use it less frequently, but in larger quantities. From many years experience of the efficacy of bleeding in this state of consumption, I feel my- ON PULMONARY CONSUMPTION. 103 self authorised to assert, that where a greater pro- portion of persons die of consumption when it makes its first appearance in the lungs, with symp- toms of inflammatory diathesis, than die of ordi- nary pneumonies (provided exercise be used after- wards), it must, in nine cases out often, be ascribed to the ignorance, or erroneous theories of physi- cians, or to the obstinacy or timidity of patients. In speaking thus confidently of the necessity and benefits of bleeding in the inflammatory state of consumption, I confine myself to observations made chiefly in the state of Pennsylvania. It is possible*the inhabitants of European countries and cities, may so far have passed the simple ages of inflammatory diseases, as never to exhibit those symptoms on which I have founded the indication of blood-letting. I suspect moreover that in most of the southern states of America, the inflammatory action of the arterial system is of too transient a nature to admit of the repeated bleedings in the consumption which are used with so much advan- tage in the middle and northern states. In reviewing the prejudices against this excel- lent remedy in consumptions, I have frequently wished to discover such a substitute for it as would with equal safety and certainty take down the mor- 104 ON PULMONARY CONSUMPTION/ bid excitement, and action of the arterial system. At present we know of no such remedy; and until it be discovered, it becomes us to combat the prejudices against bleeding; and to derive all the advantages from it which have been mentioned. 2. A second remedy for the inflammatory state of consumption should be sought for in a milk and vegetable diet. In those cases where the milk does not lie easy on the stomach, it should be mixed with water, or it should be taken with- out its cheesy or oily parts, as in whey, or butter- milk, or it should be taken without skimming; for there are cases in which milk will agree with the stomach in this state, and in no other. The oil of the milk probably helps to promote the so- lution of its curds in the stomach. It is seldom in the power of physicians to prescribe ass' or goat's milk in this disease; but a good substitute may be prepared for them by adding to cow's milk a little sugar, and a third or fourth part of water, or of a weak infusion of green tea. The quantity of milk taken in a day should not exceed a pint, and even less than that quantity when we wish to lessen the force of the pulse by the abstrac- tion of nourishment. The vegetables which are eaten in this state of the disease, should contain as litde stimulus as possible. Rice, in all the wavs in ON PULMONARY CONSUMPTION. 10S which it is usually prepared for aliment, should be preferred to other grains, and the less saccharine fruits to those which abound with sugar. In those cases where the stomach is disposed to dyspepsia, a little salted meat, fish, or oysters, also soft boiled eggs, may be taken with safety, mixed with vege- table aliment. Where there is no morbid affection of the stomach, I have seen the white meats eaten without increasing the inflammatory symptoms of the disease. The transition from a full diet to milk and vegetables should be gradual, and the addition of animal to vegetable aliment, should be made with the same caution. From the neglect of this direction, much error, both in theory and practice, has arisen in the treatment of consumptions. In every case it will be better for the patient to eat four or five, rather than but two or three meals in a day. A less stimulus is by this means communicated to the system, and less chyle is mixed with the blood in a given time. Of so much importance do I conceive this direction to be, that I seldom prescribe for a chronic disease of any kind without enforcing it. 3. Vomits have been much commended by Dr. Read in this disease. From their indiscrimi- nate use in every state of consumption, I believe vol. ii. o 106 ON pulmonary consumption. they have oftener done harm than good. In cases where a patient objects to bleeding, or where a physician doubts of its propriety, vomits may al- ways be substituted in its room with great advan- tage. They are said to do most service when the disease is the effect of a catarrh. 4. Nitre, in moderate doses of ten or fifteen grains, taken three or four times a day, has some- times been useful in this disease ; but it has been only when the disease has appeared with inflamma- tory symptoms. Care should be taken not to per- severe too long in the use of this remedy, as it is apt to impair the appetite. I have known one case in which it produced an obstinate dyspepsia, and a disposition to the colic; but it removed, at the same time, the symptoms of pulmonary consump- tion. 5. Cold and dry air, when combined with the exercise of walking, deserves to be mentioned as an antiphlogistic remedy. I have repeatedly prescribed it in this species of the consumption with advantage, and have often had the pleasure of find- ing a single walk of two or three miles in a clear cold day, produce nearly the same diminution of the force and frequency of the pulse, as the loss of six or eight ounces of blood. ON PULMONARY CONSUMPTION. 107 I come now to treat of the palliative remedies which are proper in the II. O* hectic state of consumption. Here we begin to behold the< disease in a new and more distressing form than in the state which has been described. There is in this state of consumption the same complication of inflammatory and typhus diathesis which occurs in the typhiod and puer- perile fevers, and of course the same difficulty in treating it successfully ; for the same remedies do good and harm, according as the former or latter diathesis prevails in the system. All that I shall say upon this state is, that the treatment of it should be accommodated to the predominance of inflammatory or typhus symp- toms, for the hectic state presents each of them alternately every week, and sometimes every day to the hand, or eye of a physician. When a hard pulse with acute pains in the side and breast occur, bleeding and other remedies for the inflammatory state must be used; but when the disease exhi- bits a predominance of typhus symptoms, the re- medies for diat state to be mentioned immedi- ately, should be prescribed in moderate doses. There are several palliative medicines which have been found useful in the hectic state, but they are *<* 108 ON PULMONARY CONSUMPTION. such as belong alike to the other two states; and therefore will be mentioned hereafter in a place as- signeato them. j I am sorry, however, to add, that where bleed- ing has not been indicated, I have seldom been able to afford much relief by medicine in this state of consumption. I have used alternately the most gentle, and the most powerful vegetable and metal- lic tonics to no purpose. Even arsenic has failed in my hands of affording the least alleviation of the hectic fever. I conceive the removal of this fever to be the great desideratum in the cure of con- sumption ; and should it be found, after all our researches, to exist only in exercise, it will be no departure from a law of nature, for I believe there are no diseases produced by equal degrees of chronic debility, in which medicines are of any more effi- cacy, than they are in the hectic fever of the pul- monary consumption. I proceed now to speak of the palliative reme- dies which are proper in the III. Or typhus state of the pulmonary con- sumption. ON PULMONARY CONSUMPTION. 109 The first of these are stimulating medi- cines. However just the complaints of Dr. Fo- thergill may be against the use of balsams in the inflammatory and mixed states of consumption, they appear to be not only safe, but useful like- wise, in mitigating the symptoms of weak morbid action in the arterial system. I have therefore fre- quently prescribed opium, the balsam of copaivae, of Peru, the oil of amber, and different prepara- tions of turpentine and tar, in moderate doses, with obvious advantage. Garlic, elixir of vitriol, the juice of dandelion, a strong tea^made of horehound, and a decoction of the inner bark of the wild cherry tree*, also bitters of all kinds, have all been found safe and useful tonics in this state of consumption. Even the Peruvian bark and the cold bath, so often and so generally condemned in consumptions, are always innocent, and frequently active remedies, where there is a total absence of inflammatory dia- thesis in this disease. The bark is said to be most useful when the consumption is the consequence of an intermitting fever, and when it occurs in old people. With these remedies should be combined 2. A cordial and stimulating diet. Milk and vegetables, so proper in the inflammatory, are * Prunus Virginiana. 110 ON pulmonary consumption. improper, when taken alone, in this state of con- sumption. I believe they often accelerate that decay of appetite and diarrhoea, which form the closing scene of the disease. I have lately seen three persons recovered from the lowest stage of this state of consumption, by the use of animal food and cordial drinks, aided by frequent doses of opium, taken during the day as well as in the night. I should hesitate in mentioning these cures, had they not been witnessed by more than a hundred students of medicine in the Pennsylvania hospital. The history of one of them is recorded in the 5th volume of the New-York Medical Repository, and of the two others in Dr. Coxe's Medical Mu- seum. Oysters, it has been said, have performed cures of consumption. If they have, it must have been only when they were eaten in that state of it which is now under consideration. They are a most savoury and wholesome article of diet, in all diseases of weak morbid action. To the cordial articles of diet belong sweet vegetable matters. Grapes, sweet apples, and the juice of die sugar maple tree, when taken in large quantities, have all cured this disease. They all appear to act by fill- ing the blood-vessels, and thereby imparting tone to the whole system. I have found the same ad- vantage from dividing the meals in this state of consumption, that I mentioned under a former ON PULMONARY CONSUMPTION. Ill head. The exhibition of food in this case, should not be left to the calls of appetite, any more than the exhibition of a medicine. Indeed food may be made to supply the place of cordial medicines, by keeping up a 'constant and gende action in the whole system. For this reason, I have frequently advised my patients never to suffer their stomachs to be empty, even for a single hour. I have some- times aimed to keep up the influence of a gentle action in the stomach upon the whole system, by- advising them to eat in the night, in order to ob- viate the increase of secretion into the lungs and of the cough in the morning, which are brought on in part by the increase of debility from the long abstraction of the stimulus of aliment during the night. However safe, and even useful, the cordial me- dicines and diet that have been mentioned may appear, yet I am sorry to add, that we seldom see any other advantages from them than a mitigation of distressing symptoms, except when they have been followed by suitable and long continued ex- ercise. Even under this favourable circumstance, they are often ineffectual; for there frequendy oc- curs, in this state of consumption, such a destruc* tion of the substance and functions of the lungs, as to preclude the possibility of a recovery by the use 112 ON PULMONARY CONSUMPTION. of any of the remedies which have been discovered. Perhaps, where this is not the case, their want of efficacy may be occasioned by their being given before the pulse is completely reduced to a typhus state. The weaker the pulse, the greater is the probability of benefit being derived from the use of cordial diet and medicines. I have said formerly, that the three states of consumption do not observe any regular course in succeeding each other. They are not only com- plicated in some instances, but they often appear and disappear half a dozen times in the course of the disease, according to the influence of the wea- ther, dress, diet, and the passions upon the system. The great secret, therefore, of treating this disease consists in accommodating all the remedies that have been mentioned to the predominance of any of the tiiree different states of the system, as mani- fested cliiefly by the pulse. It is in consequence of having observed the evils which have resulted from the ignorance or neglect of this practice, that I have sometimes wished that it were possible to abolish the seducing nomenclature of diseases alto- gether, in order thereby to oblige physicians to conform exactly to the fluctuating state of the sys- tem in all their prescriptions; for it is not more certain, that, in all cultivated languages, every idea ON PULMONARY CONSUMPTION. US has its appropriate word, than that every state of a disease has its'appropriate dose of medicine, the knowledge and application of which can alone con- stitute rational, or secure uniformly successful practice. I come now to say a few words upon those pal- liative remedies which are alike proper in every state of the pulmonary consumption. The first remedy under tiiis head isaDRY situ- ation. A damp air, whether breathed in a room, or out of doors, is generally hurtful in every form of this disease. A kitchen, or a bed-room, below the level of the ground, has often produced, and never fails to increase, a pulmonary consumption. I have often observed a peculiar paleness (the first symptom of general debility) to show itself very early in the faces of persons who work or sleep in cellar kitchens or shops. 2. Country air. The higher and .drier the situation which is chosen for the purpose of enjoy- ing the benefit of this remedy, the better. Situa- tions exposed to the sea, should be carefully avoid- ed ; for it is a singular fact, that while consumptive persons are benefited by the sea-air, when they breathe it on the ocean, they are alwrays injured VOL. II. p 114 ON PULMONARY CONSUMPTION. by that portion of it which they breathe on the sea-shore. To show its influence, not only in ag- gravating consumptions, but in disposing to them, and in adding to the mortality of another disease of the lungs, I shall subjoin the following facts. From one fourth to one half of all the adults who die in Great Britain, Dr. Willan says, perish with this disease. In Salem, in the state of Massachusetts, which is situated near the sea, and exposed, during many months in the year, to a moist east wind, there died, in the year 1799, one hundred and sixty persons; fifty-three died of the consumption, making in all nearly one third of all the inhabitants of the town. Eight more died of what is called a lung fever, probably of what is called in Pennsyl- vania the galloping grade of that disease. Con- sumptions are more frequent in Boston, Rhode- Island, and New-York, from their damp winds, and vicinity to the sea-shore, than they are in Phi- ladelphia. In the neighbourhood of Cape May, which lies near the sea-shore of New-Jersey, there are three .religious societies, among whom the in- fluenza prevailed in the year 1790. Its mortality, under equal circumstances, was in the exact ratio to their vicinity to the sea. The deaths were most numerous in that society which was nearest to it, and least so in that which was most remote from it. These unfriendly effects of the sea air, in the ON PULMONARY CONSUMPTION. 115 above pulmonary diseases, do not appear to be produced simply by its moisture. Consumptions are scarcely known in the moist atmosphere which so generally prevails in Lincolnshire, in England, and in the inland parts of Holland and Ireland. I shall not pause to inquire, why a mixture of land and sea air is so hurtful in the consumption, and at the same time so agreeable to persons in health, and so medicinal in many other diseases, but shall dismiss this head by adding a fact which was communicated to me by Dr. Matthew Irvine, of South-Carolina, and that is, That those situations which are in the neighbourhood of bays or rivers, where the salt and fresh waters mix their streams together, are more unfavourable to consumptive patients than the sea-shore, and therefore should be more carefully avoided by them in exchanging city for country air. S. A change of climate. It is remarkable that climates uniformly cold or warm, which sel- dom produce consumptions, are generally fatal to persons who visit them in that disease. Countries between the 30th and 40th degrees of latitude are most friendly to consumptive people. 116 on pulmonary consumption. 4. Loose dresses, and a careful accom- modation of them to the changes in the weather. Many facts might be mentioned to show the influence of compression and of tight liga- tures of every kind, upon the different parts of the body ; also of too much, or too little clothing, in producing, or increasing diseases of every kind, more especially those which affect the lungs. Tight stays, garters, waistbands, and collars, should all be laid aside in the consumption, and the quality of the clothing should be suited to die weather. A citizen of Maryland informed me, that he twice had a return of a cough and spitting of blood, by wearing his summer clothes a w7eek after the wea- ther became cool in the month of September. But it is not sufficient to vary the weight or quality of dress with the seasons. It should be varied wTith the changes which take place in the temperature of die air every day, even in the summer months, in middle latitudes. I know a citizen of Philadelphia, who has laboured under a consumptive diathesis near thirty years, who believes that he has lessened the frequency and violence of pulmonic complaints during that time, by a careful accommodation of his dress to the weather. He has been observ- ed frequently to change his waistcoat and small clothes twice or three times in a day, in a summer month. i ON PULMONARY CONSUMPTION. 117 A repetition of colds, and thereby an increase of the disease, will be prevented by wearing flan- nel next to the skin in winter, and muslin in the summer, either in the form of a shirt or a waist- coat : where these are objected to, a piece of flan- nel, or of soft sheepskin, should be worn next to the breast. They not only prevent colds, but fre- quently remove chronic pains from that part of the body. 5. Artificial evacuations, by means of blisters and issues. I suspect the usefulness of these remedies to be chiefly confined to the in- flammatory and hectic states of consumption. In the typhus state, the system is too weak to sustain the discharges of either of them. Fresh blisters should be preferred to such as are perpetual, and the issues, to be useful, should be large. They are supposed to afford relief by diverting a preternatu- ral secretion and excretion of mucus or pus from the lungs, to an artificial emunctory in a less vital part of the body. Blisters do most service when the disease arises from repelled eruptions, and when they are applied between the shoulders, and the upper and internal parts of the arms. When it arises from rheumatism and gout, the blisters should be applied to the joints, and such other ex- 118 ON PULMONARY CONSUMPTION. ternal parts of the body as had been previously affected by those diseases. 6. Certain fumigations and vapours. An accidental cure of a pulmonary affection by the smoke of rosin, in a man who bottled liquors, raised for a while the credit of fumigations. I have tried them, but without much permanent effect. I think I have seen the pain in the breast relieved by re- ceiving the vapour from a mixture of equal parts of tar, bran, and boiling water into the lungs. The sulphureous and saline air of Stabiae, between Mount Vesuvius and the Mediterranean Sea, and the effluvia of the pine forests of Lybia, were sup- posed, in ancient times, to be powerful remedies in consumptive complaints; but it is probable, the exercise used in travelling to those countries, con- tributed chiefly to the cures which were ascribed to foreign matters acting upon the lungs. 7. Lozenges, syrups, and demulcent teas. These are too common and too numerous to be mentioned. 8. Opiates. It is a mistake in practice, found* ed upon a partial knowledge of the qualities of opium, to administer it only at night, or to suppose that its effects in composing a cough depend upon ON pulmonary consumption. 119 its inducing sleep. It should be given in small doses during the day, as well as in larger ones at night. The dose should be proportioned to the degrees of action in the arterial system. The less this action, the more opium may be taken with safety and advantage. 9. Different positions of the body have been found to be more or less favourable to the abatement of the cough. These positions should be carefully sought for, and the body kept in that which procures the most freedom from coughing. I have heard of an instance in which a cough, which threatened a return of the haemorrhage from the lungs, was perfecdy composed for two weeks, by keeping the patient nearly in one posture in bed; but I have known more cases in which relief from coughing was to be obtained only by an erect posture of the body. 10. Considerable relief will often be obtained from the patient's sleeping between blan- kets in winter, and on a mattrass in summer. The former prevent fresh cold from night sweats; the latter frequendy checks them altogether. In cases where a sufficient weight of blankets to keep ^ up an agreeable warmth cannot be borne, with- out restraining easy and full acts of inspiration, 120 ON pulmonary consumption. ■ die patient should sleep under a light feather bed, or an eider down coverlet. They both afford more warmth than double or treble their weight of blankets. However comfortable this mode of producing warmth in bed may be, it does not protect the lungs from the morbid effects of the distant points of temperature of a warm parlour in the day time, and a cold bed-chamber at night. To produce an equable temperature of air at all hours, I have frequently advised my patients, when going to a! warm climate was not practicable, to pass their nights as well as days in an open stove room, in which nearly the same degrees of heat were kept up at all hours. I have found this practice, in several cases, a tolerable substitute for a warm cli- mate. 11. The moderate use of the lungs, in read- ing, public speaking, laughing, and sing- ing. The lungs, when debilitated, derive equal benefit with the limbs, or other parts of the body, from moderate exercise. I have mentioned, in an- other place*, several facts which support this opi- * An Account of the Effects of Common Salt in the Cuve* of Hemoptysis. 9N PULMONARY CONSUMPTION*. 121 nion. B>:■* too much pains cannot be taken to in- culcate upon our patients to avoid ail excess in the use of the lungs, by long, 01 loud reading, speak- ing, or singing, or by sudden and violent bursts of laughter. I shall long lament the death of a fe- male patient, who had discovered many hopeful signs of a recovery from a consumption, who re- lapsed, and died, in consequence of bursting a blood-vessel in her lungs, by a sudden fit of laugh- ter. 12. Are there any advantages to be derived from the excitement of certain passions in the treatment of consumptions ? Dr. Blane tells us, that many consumptive persons were relieved, and that some recovered, in consequence of the terror which was excited by a hurricane in Barbadoes, in the year 1780. It will be difficult to imitate, by artificial means, the accidental cures which are recorded by Dr. Biane; but we learn enough from them to inspire the invigorating passions of hope and confidence in the minds of our patients, and to recommend to them such exercises as pro- duce exertions of body and mind analogous to those which are produced 'oy terror. Van Sweiten and Smollet relate cures of consumptions, by pa- tients falling into streams ofhpld water. Perhaps, ki both instances, the cures were performed only VOL. II. Q 122 Oi\ PULMONARY CONSUMPTION. by the fright and consequent exertion produced by the fall. This is only one instance out of many which might be mentioned, of partial and unequal action being suddenly changed into general and equal excitement in every part of the system. The cures of consumptions which have been performed by a camp life*-, have probably been much assist- ed by the commotions in the passions which were excited by the various and changing events of war. 13. A salivation has lately been prescribed in this disease with success. An accident first suggested its advantages, in the Pennsylvania hos- pital, in the year 1800f. Since that time, it has performed many cures in different parts of the United States. It is to'be lamented, that in a ma- jority of the cases in which the mercury has been given, it has failed of exciting a salivation. Where it affects the mouth, it generally succeeds in re- cent cases, which is more than can be said of any, or of all other remedies in this disease. In its hectic state, a salivation frequently cures, and even in its typhus and last stage, I have more than once prescribed it with success. The same regard to the pulse should regulate the use of this new reme- * Vol. I. p. 204. t Medical Repository of New-York. Vol. V, ON PULMONARY CONSUMPTION. 123 dy in consumption, that has been recommended in other febrile diseases. It should never be advised until the inflammatory diathesis of the system has been in a great degree reduced, by the depleting remedies formerly mentioned. During the use of the above remedies, great care should be taken to relieve the patient from the in- fluence of all those debilitating and irritating causes which induced the disease. I shall say elsewhere that decayed teeth are one of them. These should be extracted where there is reason to suspect they have produced, or that they increase the disease. I have hitherto said nothing of the digitalis as a palliative remedy in pulmonary consumption. I am sorry to acknowledge that, in many cases in which I have prescribed it, it has done no good, and in some it has done harm. From the oppo- site accounts of physicians of the most respectable characters of the effects of this medicine, I have been inclined to ascribe its different issues, to a dif- ference in the soil in which it has been cultivated, or in the times of gathering, or in the manner of preparing it, all of which we know influence the qualities of many other vegetables. If the theory of consumption w hich I have endeavoured to esta- blish be admitted, that uncertain and unsafe medi- 124 ON PULMONARY CONSUMPTION. cine will be rendered unnecessary by the remedies. that have been enumerated, provided they are ad- ministered at the times, and in the manner that has been recommended. Before I proceed to speak of the radical cure of the consumption, it will be necessary to observe, that by means of the palliative remedies which have been mentioned, many persons have been re- covered, and some have had their lives prolonged by them for many years; but in most of these cases I have found, upon inquiry, that the disease recurred as soon as the patient left off the use of his remedies, unless they were followed by neces- sary or voluntary exercise. It is truly surprising to observe how long some persons have lived who have been affected by a consumptive diathesis, and by frequent attacks of many of the most troublesome symptoms of this disease. Van Sweiten mentions the case of a man, who had lived thirty years in this state. Morton relates the history of a man, in whom the symp- toms of consumption appeared with but little varia- tion or abatement from his early youth till the 70th year of his age. The widow of the .celebrated Se- nac lived to be 84 years of age, thirty of which she passed in a pulmonary consumption. Dr. Ni- ON PULMONARY CONSUMPTION. 125 cols was subject to occasional attacks of this dis- ease during his whole life, and he lived to be above eighty years of age. Bennet says he knew an in- stance in which it continued above sixty years. I prescribed for my first pupil, Dr. Edwards, in a consumption in the year 1769. He lived until 1802, and seldom passed a year without spitting blood, nor a week w ithout a cough, during tiiat long interval of time. The fatal tendency of his disease was constandy opposed by occasional blood-letting, rural exercises, a cordial, but temperate diet, the Peruvian bark, two sea voyages, and travelling in foreign countries. There are besides these instan- ces of long protracted consumptions, cases of it which appear in childhood, and continue for many years, I have seldom known them prove fatal under puberty. I am led here to mention another instance of the analogy between pneumony and the pulmonary consumption. We often see the same frequency of recurrence of both diseases in habits which are predisposed to them. I have attended a Ger- man citizen of Philadelphia, in several fits of the pneumony, who has been confined to his bed eight- and-twenty times, by the same disease, in the course of the same number of years. He has, for the most part, enjoyed good health in the inter- 126 ON PULMONARY CONSUMPTION. Yals of those attacks, and always appeared, till lately, to possess a good constitution. In the cases of the frequent recurrence of pneumony, no one has suspected the disease to have originated exclu- sively in a morbid state of the lungs ; on the con- trary, it appears evidently to be produced by the sudden influence of the same causes, which, by acting with less force, and for a longer time, pro- duce the pulmonary consumption. The name of pneumony is taken from the principal symptom of this disease, but it as certainly belongs to the whole arterial system as the consumption; and I add fur- ther, that it is as certainly produced by general predisposing debility. The hardness and fulness of the pulse do not militate against this assertion, for they are altogether the effects of a morbid and convulsive excitement of the sanguiferous system. The strength manifested by the pulse is moreover partial, for every other part of the body discovers, at the same time, signs of extreme debility. It would be easy, by pursuing this subject a little further, to mention a number of facts which, by the aid of principles in physiology and patho- logy, which are universally admitted, would open to us a new theory of fevers, but this would lead us too far from the subject before us. I shall only remark, that all that has been said of the ON PULMONARY CONSUMPTION. 127 influence of general debilitating causes upon the lungs, both in pneumony and consumption, and of the alternation of the consumption with other general diseases, w ill receive great support from considering the lungs only as a part of the whole external surface of the body, upon which most of the remote and exciting causes of both diseases produce their first effects. This extent of the sur- face of the body, not only to the lungs, but to the alimentary canal, was first taken notice of by Dr. Boerhaave; but was unhappily neglected by him in his theories of the diseases of the lungs and bowels. Dr. Keil supposes that the lungs, from the peculiar structure of the bronchial vessels, and air vesicles, expose a surface to the action of the air, equal to the extent of the whole external and visible-surface of the body. Thus have I mentioned the usual palliative re- medies for the consumption. Many of these re- medies, under certain circumstances, I have said have cured the disease, but I suspect that most of these cures have taken place only when the disease has partaken of an intermediate nature between a pneumony and a true pulmonary consumption. Such connecting shades, appear between the ex- treme points of many other diseases. In a former 128 ON PULMONARY CONSUMPTION^ essay*, I endeavoured to account for the transmu* tation (if I may be allowed the expression) of the pneumony into the consumption, by ascribing it to the increase of the debilitating refinements of civi- lized life. This opinion has derived constant sup- port from every observation I have made connected wTith this subject, since its first publication, in the year 1772. I come now to treat of the radical remedies for the pulmonary consumption. In an essay formerly alluded tof, I mentioned the effects of labour, and the hardships of a camp or naval life, upon this disease. As there must frequently occur such objections to each of those remedies, as to forbid their being recommended or adopted, it will be necessary to seek for substitutes for them in the different species of exercise. These are, active, passive, and mixed. The active in- cludes walking, and the exercise of the hands and feet in working or dancing. The passive includes rocking in a cradle, swinging, sailing, and riding * Inquiry into the Diseases and Remedies of the Indians of North-America; and a comparative view of their diseases and remedies with those of civilized nations. Vol. I. + Thoughts on the Pulmonary Consumption. Vol. I. ON PULMONARY CONSUMPTION. 12°. in carriages of different kinds. The mixed is con- fined chiefly to riding on horseback. I have mentioned all the different species of ex- ercise, not because I think they all belong to the class of radical remedies for the consumption, but because it is often necessary to use those which are passive, before we recommend those of a mixed or active nature. That physician does not err more who advises a patient to take physic, without spe- cifying its qualities and doses, than the physician does who advises a patient, in a consumption, to use exercise, without specifying its species and de- grees. From the neglect of this direction, we often find consumptive patients injured instead of being relieved by exercises, which, if used with judgment, might have been attended with the hap- piest effects. I have before suggested that the stimulus of every medicine, which is intended to excite action in the system, should always be in an exact ratio to its excitability. The same rule should be applied to the stimulus of exercise. I have heard a well- attested case of a.young lady, upon whose con- sumption the first salutary impression was made by rocking her in a cradle ; and I know another case in which a young lady, in the lowest state of that VOL. II. R 130 ON PULMONARY CONSUMPTION. debility which precedes an affection of the lungs, was prepared for the use of the mixed and active exercises, by being first moved gently backwards and forwards in a chariot without horses, for an hour every day. Swinging appears to act in the same gentle manner. In die case of a gardener, w ho was far advanced in a consumption, in the Pennsylvania hospital, I had the pleasure of observ- ing its good effects, in an eminent degree. It so far restored him, as to enable him to complete hig recovery by working at his former occupation. In cases of extreme debility, the following or,, der should be recommended in the use of the dif- ferent species of exercise. 1. Rocking in a cradle, or riding on an elagic board, commonly called a chamber-horse. 2. Swinging. 3. Sailing. 4. Riding in a carriage. 5. Riding on horseback. 6. Walking. ©W PULMONARY CONSUMPTION. 13J. 7. Running and dancing. In the use of each of those species of exercise great attention should be paid to the degree or force of action with which they are applied to the body. For example, in riding in a carriage, the exercise will be less in a four-wheel carriage than in a single horse chair, and less when the horses move in a walking, than a trotting gait. In riding on horse- back, the exercise will be less or greater according as the horse walks, paces, canters, or trots, in pas- sing over the ground. I have good reason to believe, that an English sea-captain, who was on the verge of the grave with the consumption, in the spring of the year 1790, owed his perfect recovery to nothing but the above gradual manner, in which, by my advice, he * made use of the exercises of riding in a carriage and on horseback. I have seen many other cases of the good effects of thus accommodating exer- cise to debility ; and I am sorry to add, that I have seen many cases in which, from the neglect of this manner of using exercise, most of the species and degrees of it, have either been useless, or done harm. However carelessly this observation may be read by physicians, or attended to by patients, I conceive no direction to be more necessary in the 132 ON PULMONARY CONSUMPTION. cure of consumptions. I have been thus particular in detailing it, not only because I believe it to be important, but that I might atone to society for that portion of evil which I might have prevented by a more strict attention to it in the first years of my practice. The more the arms are used in exercise the better. One of the proprietary governors of Penn- sylvania, who laboured for many years under a consumptive diathesis, derived great benefit from frequently rowing himself in a small boat, a few miles up and down the river Schuylkill. Two young men, who were predisposed to a consump- tion, were perfecdy cured by working steadily at a printing press in this city. A French physician in Martinique cured this disease, by simply rubbing Hhe arms between the shoulders and the elbows, until they inflamed. The remedy is strongly re- commended, by the recoveries from pulmonary consumption w hich have followed abscesses in the arm-pits. Perhaps the superior advantages of rid- ing on horseback, in this disease, may arise in part from the constant and gentle use of the arms in the management of the bridle and the whip. Much has been said in favour of sea voyages in consumptions. In the mild degrees of the disease ON PULMONARY CONSUMPTION. 133 they certainly have done service, but I suspect the relief given, or the cures performed by them, should be confined chiefly to seafaring people, who add to the benefits of a constant change of pure air, a share of the invigorating exercises of navigat- ing the ship. I have frequently heard of consump- tive patients reviving at sea, probably from die transient effects of sea sickness upon the whole system, and growing worse as soon as they came near the end of their voyage. It would seem as if the mixture of land and sea airs was hurtful to the lungs, in every situation and condition in which it could be applied to them. Nor are the peculiar and morbid effects of the first operation of land and sea airs upon the human body, in sea voyages, con- fined only to consumptive people. I crossed the Adantic ocean, in the year 1766, with a sea captain, who announced to his passengers the agreeable news that we were near the British coast, before any discovery had been made of our situation by sounding, or by a change in the colour of the wa- ter. Upon asking him upon what he founded his opinion, he said, that he had been sneezing, which, he added, was the sign of an approaching cold, and that, in the course of upwards of twenty years, he had never made the land (to use the seaman's phrase) without being affected in a similar manner. I have visited many sick people in Philadelphia, 134 ON PULMONARY CONSUMPTION. soon after their arrival from sea, who have inform- ed me, that they had enjoyed good health during the greatest part of their voyage, and that they had contracted their indispositions after they came with- in sight of the land. I mention these facts only to show the necessity of advising consumptive pa- tients, who undertake a sea voyage for the recovery of their health, not to expose themselves upon deck in the morning and at night, after they arrive with- in the region in which the mixture of the land and sea airs may be supposed to take place. I subscribe, from what I have observed, to the bold declaration of Dr. Sydenham, in favour of the efficacy of riding on horseback, in the cure of consumption. I do not think the existence of an abscess, when broken, or even tubercles in the lungs, when recent, or of a moderate size, the least objection to the use of this excellent remedy. An abscess in the lungs is not necessarily fatal, and tubercles have no malignity in them whicli should render their removal impracticable by this species of exercise. The first question, therefore, to be asked by a physician who visits a patient in this disease should be, not what is the state of his lungs, but, is he able to ride on horseback. »N PULMONARY CONSUMPTION. 135 There are two methods of riding for health in this disease. The first is by short excursions; the second is by long journies. In slight con- sumptive affections, and after a recovery from an acute illness, short excursions are sufficient to re- move the existing debility ; but in the more ad- vanced stages of consumption, they are seldom ef- fectual, and frequendy do harm, by exciting an occasional appetite without adding to the digestive powers. They, moreover, keep the system con- standy vibrating by their unavoidable inconstancy, between distant points of tone and debility*, and they are unhappily accompanied aUiall times, from the want of 41 succession of fresh objects to divert the mind, by the melancholy reflection that they are the sad, but necessary conditions of life. In a consumption of long continuance or of great danger, long journies on horseback are the most effectual modes of exercise. They afford a constant succession of fresh objects and company, which divert the mind from dwelling upon the dan- ger of the existing malady; they are moreover at- tended by a constant change of air, and they are not liable to be interrupted by company, or transi- * The bad effects of inconstant exercise have been taken notice of in the gout. Dr. Sydenham says, when it is used only by fits and starts in this disease, it does harm. 136 ON PULMONARY CONSUMPTION. ant changes in the weather, by which means ap- petite and digestion, action and power, all keep pace with each other. It is to be lamented that the use of this excellent remedy is frequently op- posed by indolence and narrow circumstances in both sexes, and by the peculiarity of situation and temper in the female sex. Women are attached to their families by stronger ties than men. They cannot travel alone. Their delicacy, which is in- creased by sickness, is liable to be offended at every stage; and, lastly, they sooner relax in their ex- ertions to prolong their lives than men. Of the- truth of the te.A. observation, sir William Hamil- ton has furnished us with a striking illustration. He tells us, that in digging into the ruins pro- duced by the late earthquake in Calabria, the wo- men who perished in it, were all found with their arms folded, as if they had abandoned themselves immediately to despair and death; whereas, the men were found with their arms extended, as if they had resisted their fate to the last moment of their lives. It would seem, from this fact, and many others of a similar nature which might be re- lated, that a capacity of bearing pain and distress with fortitude and resignation, was the distinguish- ing characteristic of the female mind ; while a dis- position to resist and overcome evil, belonged in a more peculiar manner to the mind of man. I have ON PULMONARY CONSUMPTION. 137 mentioned this peculiarity of circumstances and temper in female patients, only for the sake of con- vincing physicians that it will be necessary for them to add all the force of eloquence to their advice, when they recommend journies to women in pre- ference to all other remedies, for the recovery of their health. Persons, moreover, who pursue active employ- ments, frequendy object to undenaking journies, from an opinion that their daily occupations are sufficient to produce all the salutary effects we ex- pect from artificial exercise. It will be highly ne- cessary to correct this mistake, by assuring such persons that, however useful the habitual exercise of an active, or even a laborious employment may be to preserve health, it must always be exchanged for one which excites new impressions, both upon the mind and body, in every attempt to restore the system from that-debility which is connected with pulmonary consumption. As travelling is often rendered useless, and even hurtful in this disease, from being pursued in an improper manner, it will be necessary to furnish our patients with such directions as will enable them to derive the greatest benefit from their jour- nies. I shall, therefore, in this place, mention the VOL. ix. s 138 ON PULMONARY CONSUMPTION. substance of the directions which I have given in writing for many years to sueh consumptive patients as undertake journies by my advice. 1. To avoid fatigue. Too much cannot be said to enforce this direction. It is the hinge on which the recovery or death of a consumptive patient frequently turns. I repeat it again, therefore, that patients should be charged over and over when they set off on a journey, as well as when they use exercise of any kind, to avoid fatigue. For this purpose they should begin by travelling only a few- miles in a day, and increase the distance of their stages, as they increase their strength. By neglect- ing this practice, many persons have returned from journies much worse than when they left home, and many have died in taverns, or at the houses of their friends on the road. Travelling in stage- coaches is seldom safe for a consumptive patient. They are often crowded; they give too much mo- tion ; and they afford by their short delays and dis- tant stages, too little time for rest, or for taking the frequent refreshment which was formerly recom- mended. &. To avoid travelling too soon in the morning, and after the going down of the sun in the evening, and, if the weather be hot, never to travel in the ON PULMONARY CONSUMPTION. 139 middle of the day. The sooner a patient break- fasts after he leaves his bed the better; and in no case should he leave his morning stage with an empty stomach. 3. If it should be necessary for a patient to lie down, or to sleep in the day time, he should be advised to undress himself, and to cover his body between sheets or blankets. The usual ligatures of garters, stocks, knee-bands, waistcoats, and shoes, are very unfriendly to sound sleep; hence persons who lie down with their clothes on, often awake from an afternoon's nap in terror from dreams, or in a profuse sweat, or writh a head-ach or sick stomach; and generally out of humour. The surveyors are so sensible of the truth of this remark, that they always undress themselves when they sleep in the woods. An intelligent gende- man of this profession informed me, that he had frequently seen young woodsmen, who had refused to 'conform to this practice, so much indisposed in the morning, that, after the experience of a few nights, they were forced to adopt it. Great care should be taken in sleeping, whe- ther in the day time or at night, never to lie down in damp sheets. Dr. Sydenham excepts the dan- jjer from this quarter, when he speaks of the ef- 140 ON PULMONARY CONSUMPTION. ficacy of travelling on horseback in curing the con- sumption., 4. Patients who travel for health in this dis- • ease should avoid all large companies, more espe- cially evening and night parties. The air of a contaminated room, phlogisticated by the breath of fifteen or twenty persons, and by the same number of burning candles, is poison to a consumptive pa- tient. To avoid impure air from every, other source, he should likewise avoid sleeping in a crowded room, or with curtains around his bed, and even with a bed-fellow. 5. Travelling, to be effectual in this disease, should be conducted in such a manner as that a patient may escape the extremes of heat and cold. For this purpose he should pass the winter, and part of the spring, in Georgia or South-Caro- lina, and the summer in New-Hampshire, Massa- chusetts, or Vermont, or, if he pleases, he may still more effectually shun the summer heats, by crossing the lakes, and travelling along the shores of the St. Laurence to the city of Quebec. He will thus escape the extremes of heat and cold, par- ticularly the less avoidable one of heat; for I have constantly found the hot month of July to be as unfriendly to consumptive patients in Pennsylva- ON PULMONARY CONSUMPTION. 141 nia, as the variable month of March. By these means too he will enjoy nearly an equable tempe- rature of air in every month of the year; and his system will be free from the inconvenience of the alternate action of heat and cold upon it. The autumnal months should be spent in New-Jersey or Pennsylvania. In these journies from north to south, or from soutrjt to north, he should be careful, for reasons before* mentioned, to keep at as great a distance as possible from the sea coast. Should this inquiry fall into the hands of a British physician, I would beg leave to suggest to him, whether more advan- tages would not accrue to his consumptive patients from advising them to cross the Atlantic ocean, and afterwards to pursue the tour which I have recommended, than by sending them to Portugal, France, or Italy. Here they will arrive with such a mitigation of the violence of the disease, in con- sequence of the length of their sea voyage, as will enable them immediately to begin their journies on horseback. Here they will be exposed to fewer temptations to intemperance, or to unhealthy amusements, than in old European countries. And, lasdy, in the whole course of this tour, they will travel among a people related to them by a sameness of language and manners, and by an- 142 ON PULMONARY CONSUMPTION. cient or modern ties of citizenship. Long jour- nies for the recovery of health, under circumstances so agreeable, should certainly be preferred to tra- velling among strangers of different nations, lan- guages, and manners, on the continent of Europe. 6. To render travelling on horseback effectual in a consumption, it should be continued with mo- derate intervals from six to twelve months. But the cure should not be rested upon a single jour- ney. It should be repeated every two or three years, till our patient has passed the consumptive stages of life. Nay, he must do more ; he must acquire * a habit of riding constantiy, both at home and abroad; or, to use the words of Dr. Fuller, " he " must, like a Tartar, learn to live on horseback, " by which means he will acquire in time the con- " stitution of a Tartar*." Where benefit is expected from a change of cli- mate, as well as from travelling, patients should reside at least two years in the place which is chosen for that purpose. I have seldom known a resi- dence for a shorter time in a foreign climate do much service. * Medicina Gymnasticar p. 116. ON PULMONARY CONSUMPTION. 143 To secure a perfect obedience to medical advice, it would be extremely useful if consumptive pa- tients could always be accompanied by a physician. Celsus says, he found it more easy to cure the dropsy in slaves than in freemen, because they more readily submitted to the restraints he im- posed upon their appetites. Madness has become a curable disease in England, since the physicians of that country have opened private mad-houses, and have taken the entire and constant direction of their patients into their own* hands. The same successful practice would probably follow the treat- ment of consumptions, if patients were constantly kept under the eye and authority of their physi- cians. The keenness of appetite, and great stock of animal spirits, which those persons frequently possess, hurry them into many excesses which de- feat the best concerted plans of a recovery; or, if they escape these irregularities, they are frequently seduced from our directions by every quack reme- dy which is recommended to them. Unfortunately the cough becomes a signal of their disease, at every stage of their journey, and the easy or plea- sant prescriptions of even hostlers and ferrymen, are often substituted to the self-denial and exertion which have been imposed by physicians. The love of life in these cases seems to level all capaci- ties ; for I have observed persons of the most cul- 144 ON PULMONARY CONSUMPTION. tivated understandings to yield in common with the vulgar, to the use of these prescriptions. In a former volume I mentioned the good effects of accidental labour in pulmonary consumptions. The reader will find a particular account in the first volume of Dr. Coxe's Medical Museum, of a cler- gyman and Jiis wife, in Virginia, being cured hy the voluntary use of that remedy. The following circumstances and symptoms, in- dicate the longer or shorter duration of this disease, and its issue in life and death : The consumption from gout, rheumatism, and scrophula, is generally of long duration. It is more rapid in its progress to death, when it arises from a half cured pleurisy, or neglected colds, measles, and influenza. It is of shorter duration in persons under thirty, than in those who are more advanced in life. It is always dangerous in proportion to the length of time, in which the debilitating causes, that pre- disposed to it, have acted upon the body. ON PULMONARY CONSUMPTION. 145 It is more dangerous when a predisposition to it has been derived from ancestors, than when it has been acquired. It is generally fatal when accompanied with a bad conformation of the breast. Chilly fits occurring in the forenoon, are more favourable than when they occur in the evening. They indicate the disease to partake a little of the nature of an intermittent, and are a call for the use of the remedies proper in that disease. Rheumatic pains, attended with an abatement of the cough, or pains in the breast, are always favour- able; so are Eruptions, or an abscess on the external parts of the body, if they occur before the last stage of the disease. -A spitting of blood, in the early, or forming stage of the disease, is favourable, but after the lungs be- come much obstructed, or ulcerated, it is most commonly fatal. A pleurisy, occurring in the low state of the dis- ease, generally kills, but I have seen a case in VOL. II. t 4 146 ON PULMONARY CONSUMPTION. which it suddenly removed the cough and hectic fever, and thus became the means of prolonging the patient's life for several years. The discharge of calculi from t, the lungs by coughing and spitting, and of a thin watery liquid, with a small portion of pus swimming on its sur- face, are commonly signs of ancfrncurable consump- tion. No prediction unfavourable to life can be drawn from pus being discharged from the lungs. We see many recoveries after it has taken place, and many deaths where that symptom has been ab- sent. Large quantities of pus are discharged in consumptions attended with abscesses, and yet few die of them, where they have not been preceded by long continued debility of the whole system. No pus is expectorated from tubercles, and how generally fatal is the disease, after they are formed in the lungs! It is only after they ulcerate that they discharge pus, and it is only after ulcers are thus formed, that the consumption probably becomes uniformly fatal. I suspect these ulcers are sometimes of a cancerous nature. A sudden cessation of the cough, without a su- pervening diarrhoea, indicates death to be at hand. ON PULMONARY CONSUMPTION. 147 A constant vomiting' m .a consumption, is gene- rally a bad sign. Feet obstinately cold, also a swelling of the feet during the day, and of the face in the night, com- monly indicate a speedy and fatal issue of the dis- ease. Lice, and the falling off of the hair, often precede death. A hoarseness, in the beginning of the disease, is always alarming, but it is more soap its last stage. A change of the eyes from a blue, or dark, to a light colour, similar to that which takes place in very old people, is a sign of speedy dissolution. I have never seen a recovery after an apthous bore throat took place. Death from the consumption comes on in some or more than one, of the following ways : 1. With a diarrhoea. In its absence. 2. With wasting night sweats. 148 ON PULMONARY CONSUMPTION. 3. A rupture of an abscess. 4. A rupture of a large blood-vessel in the lungs, attended with external or internal haemorrhage. Sudden and unexpected death in a consumption is generally induced by this, or the preceding cause. 4>. Madness. The cough and expectoration cease with this disease. It generally carries off the patient in a week or ten days. v. % *' 6. A pleurisy, brought on by exposure to cold. 4 7. A typhus fever, attended with tremors, twitch- ings of the tendons, and a, dry tongue. 8. Swelled hands, feet, legs, thighs, and face. 9. An apthous sore throat. 10. Great and tormenting pains, sometimes of a spasmodic nature in the limbs. In a majority of the fatal cases of consumption, which I have seen, the passage out of life has been attended with pain; but I have seen many persons die with it, in whom all the above symptoms were so lenient, or so completely mitigated by opium, ON PULMONARY CONSUMPTION. 149 that death resembled a quiet transition from a wak- ing, to a sleeping state. I cannot conclude this inquiry without adding, ■ that the author of it derived from his paternal an- cestors a predisposition to the pulmonary appearance of dropsies in the winter and spring, in habits previously affected by the intermit- ting fever. The debility produced by this state of fever, frequently disposes to inflammatory dia- thesis, as soon as the body is exposed to the alter- nate action of heat and cold, nor is this inflamma- tory diathesis always laid aside, by the transition 158 ON DROPSIES. of the intermitting fever into a dropsy, in the suc- ceeding cold weather. 7. The injurious effects of stimulating medicines in certain dropsies, prove that there exists in them, at times, too much action in the blood-vessels. Dr. Tissot, in a letter to Dr. Haller, " De Vario- " lis, apoplexia, et hydrope," condemns, in strong terms, the use of opium in the dropsy. Now the bad effects of this medicine in dropsies, must have arisen from its having been given in cases of too much action in the arterial system ; for opium, we know, increases, by its stimulating qualities, the action and tone of the blood-vessels, and hence we find, it has been prescribed with success in drop- sies of too little action in the system. 8. The termination of certain fevers in dropsies in which blood-letting was not used. This has been ascertained by many observations. Dr. Wilkes relates*, that after " an epidemical fever, which began in Kidderminster, in 1728,. and soon afterwards spread, not only over Great Britain, but all Europe, more people died dropsical in three years, than did perhaps in twenty or thirty years * Historical Essay on the Dropsy, p. 326. ON DROPSIES. 159 before," probably from the neglect of bleeding in the fever. But the existence of too much action in the arterial system in certain dropsies, will appear more fully from the history of the effects of the remedies which have been employed either by design or ac- cident in the cure of these diseases. I shall first mention the remedies which have been used with success in tonic or inflammatory dropsies; and afterwards mention those which have been given with success in dropsies of a weak action in the arteries. I have constantly proposed to treat only of the theory and cure of dropsies in general, with- out specifying any of the numerous names it de- rives from the different parts of the body in which they may be seated; but in speaking of the reme- dies which have been used with advantage in both the tonic and atonic states, I shall occasionally men- tion the name or seat of the dropsy in which the remedy has done service. The first remedy that I shall mention for drop- sies is blood-letting. Dr. Hoffman and Dr. Home bodi cured dropsies accompanied by pulmonic con- gestion by means of this remedy. Dr. Monroe quotes a case of dropsy from Sponius, in which bleeding succeeded, but not till after it had been 160 ON DROPSIES. used twenty times*. Mr. Cruikshank relates a casef of accidental bleeding, which confirms the efficacy of blood-letting in these diseases. He tells us that he attended a patient with dropsical swellings in his legs, who had had a hoarseness for two years. One morning, in stooping to buckle his shoes, he bursted a blood-vessel in his lungs, from which he lost a quart of blood; in conse- quence of which, both the swellings and the hoarse- ness went off gradually, and he continued well two years afterwards. I have known one case in which spontaneous haemorrhages from the haemorrhodial vessels, and from the nose, suddenly reduced uni- versal dropsical swellings. In this patient there had been an uncommon tension and fulness in the pulse. I could add the histories of many cures of ana- sarca and ascites, performed by means of blood- letting, not only by myself, but by a number of respectable physicians in the United States. In- deed I conceive this remedy to be as much indi- cated by a tense and full pulse in those forms of dropsy, as it is in a pleurisy, or in any other com- mon inflammatory disease. * Treatise on the Dropsy. t Treatise on the Lymphatics. ON DROPSIES. 161 In those deplorable cases of hydrothorax, which do not admit of a radical cure, I have given tem- porary relief, and thereby protracted life, by taking away occasionally a few ounces of blood. Had Dr. Zimmerman used this remedy in the case of the king of Prussia, I cannot help thinking from the account which the doctor gives us of the diet and pulse of his royal patient, that he would have lessened his sufferings much more than by plenti- ful doses of dandelion; for I take it for granted, from the candour and integrity which the doctor discovered in all his visits to the king, that he did not expect that dandelion, or any other medicine, would cure him. Although a full and tense pulse is always an indication of the necessity of bleeding ; yet I can easily conceive there may be such congestions, and such a degree of stimulus to the arterial system, as to produce a depressed, or a low or weak pulse. Two cases of this kind are related by Dr. Monroe, one of which was cured by bleeding. The same symptom of a low and weak pulse is often met with in the first stage of pneumony, and apoplexy, and is only to be removed by the plentiful use of the same remedy. VOL. II. x 16.2 ON DROPSIES. II. Vomits have often been given with advan- tage in dropsies. Dr. Home says, that squills were useful in these diseases only when they pro- duced a vomiting. By abstracting excitement and action from the arterial system, it disposes the lym- phatics to absorb and discharge large quantities of water. The efficacy of vomits in promoting the absorption of stagnating fluids is not confined to dropsies. Mr. Hunter was once called to visit a patient in whom he found a bubo in such a state that he purposed to open it the next day. In the mean while, the patient went on bpard of a vessel, where he was severely affected by sea-sickness and vomiting ; in consequence of which the bubo dis- appeared, and the patient recovered without the use of the knife. Mr. Cruikshank further mentions a ease* of a swelling in the knee being nearly cured by a pa- tient vomiting eight and forty hours, in consequence of his taking a large dose of the salt of tartar instead of soluble tartar. III. Purges. The efficacy of this remedy, in the cure of dropsies, has been acknowledged by physicians in all ages and countries. Jalap, calo- * Letter to Mr. Clare, p. 166. ON DROPSIES. 163 mel, scammony, and gamboge, are often preferred for this purpose; but I have heard of two cases of ascites being cured by a table spoonful of sweet oil taken every day. It probably acted only as a gentle laxative. The cream of tartar, so highly commended by Dr. Home, seems to act chiefly in the same way. Gherlius, from whom Dr. Home learned the use of this medicine, says, that all the persons whom he cured by it were in the vigour of life, and that their diseases had been only of a few months continuance. From these two circum- stances, it is most probable they were dropsies of great morbid action in the arterial system. He adds further, that the persons who w^ere cured by this medicine, were reduced very low by the use of it. Dr. Home says that it produced the same effect upon the patients whom he cured by it, in the infirmary of Edinburgh. Dr. Sydenham pre- fers gende to drastic purges, and recommends the exhibition of them every day. Both drastic and gentle purges act by diminishing the action of the arterial system, and thereby promote the absorption and discharge of water. That purges promote ab- sorption, we learn not only from their effects in dropsies, but from an experiment related by Mr. Cruikshank*, of a man who acquired several * Letter to Mr. Clare, p. 117. 164 ON DROPSIES. • ounces of weight after the operation of a purge. The absorption in this case was from the atm6-. sphere. So great is the effect of purges in pro- moting absorption, that Mr. Hunter supposes the matter of a gonorrhoea, or of topical venereal ul- cers to be conveyed by them in some instances into every part of the body. IV. Certain medicines, which, by lessening the action of the arterial system, favour the absorption and evacuation of water. The only medicines of this class which I shall name are nitre, cream of tartar, and foxglove. 1. Two ounces of nitre dissolved in a pint of water, and a wine-glass full of it taken three times a-day have performed perfect cures, in two cases of ascites, which have *ome under my notice. I think I have cured two persons of anasarca, by giving one scruple of the same medioine three times a-day for several weeks. The two last cures were evidently dropsies of violent actiou in the ar- terial system. Where nitre has been given in ato- nic dropsies it has generally been useless, and some- times done harm. I have seen one instance of an incurable diarrhoea after tapping, which I suspected arose from the destruction of the tone of the sto- mach and bowels, by large and long continued ON DROPSIES. 165 doses of nitre, which the patient had previously taken by the advice of a person who had been cured by that remedy. To avoid this, or any other in- convenience from the use of nitre in dropsies, it should be given at first in small doses, and should always be laid aside, if it should prove ineffectual after having been given two or three weeks. 2. I can say nothing of the efficacy of cream of tartar in dropsies from my own experience, where it has not acted as a purge. Perhaps my want of decision upon this subject has arisen only from my not having persisted in the use of it for the same length of time which is mentioned by Dr. Home. 3. There are different opinions concerning the efficacy of foxglove in dropsies. From the cases related by Dr. Withering, it appears to have done good; but from those related by Dr. Lettsom* it seems to have done harm. I suspect the different accounts of those two gentlemen have arisen from their having given it in different states of the sys- tem, or perhaps from a difference in the quality of the plant from causes mentioned in another placef. * Medical Memoirs, vol. II. t Inquiry into the Causes and Cure of Pulmonary Con- sumption. 166 ON DROPSIES. I am sorry to add further, that after many trials of this medicine I have failed in most of the cases in which I have given it. I have discharged the wa- ter in three instances by it, but the disease return- ed, and my patients finally died. I can ascribe only one complete cure to its use, which was in the year 1789, in a young man in the Pennsylvania hospital, of five and thirty years of age, of a robust habit, and plethoric pulse. Where medicines have once been in use, and afterwards fall into disrepute, as was the case with the foxglove^ I suspect the cases in which they were useful, to have been either few or doubtful, and that the cases in which they had done harm, were so much more numerous and unequivocal, as justly to banish them from the materia medica. V. Hard labour, or exercise in such a degree as to produce fatigue, have, in several instances, cured the dropsy. A dispensary patient, in this city, was cured of this disease by sawing wood. And a patient in an ascites under my care in the Pennsylvania hospital, had his belly reduced seven inches in circumference in one day, by the labour of carrying wood from the yard into the hospital. A second patient belonging to the Philadelphia dispensary was cured by walking to Lancaster, 66 ON DROPSIES. 167 miles from the city, in the middle of winter. The efficacy of travelling in this disease, in cold weather, is taken notice of by Dr. Monroe, who quotes a case from Dr. Holler, of a French merchant, who was cured of a dropsy by a journey from Paris to England, in the winter season. It would seem, that in these two cases, the cold co-operated as a sedative with the fatigue produced by labour or exercise, in reducing the tone of the arterial sys- tem. VI. Low diet. I have heard of a woman who was cured of a dropsy by eating nothing but boiled beans for three weeks, and drinking no- thing but the water in which they had been boiled. Many other cases of the good effects of low diet in dropsies are to be found in the records of medicine. VII. Thirst. This cruel remedy acts by de- bilitating the system in two ways : 1st, by abstract- ing the stimulus of distention; and, 2dly, by pre- venting a supply of fresh water to replace that which is discharged by the ordinary emunctories of nature. VIII. Fasting. An accidental circumstance, related by sir John Hawkins, in the life of Dr. Johnson, first led me to observe the good effects 168 ON DROPSIES. of fasting in the dropsy. If the fact alluded to stood alone under the present head of this essay, it would be sufficient to establish the existence of too much action, and the efficacy of debilitating reme- dies in certain dropsies. I am the more disposed to lay a good deal of stress upon this fact, as it was the clue which conducted me out of the labyrinth of empirical practice, in which I had been bewildered for many years, and finally led me. to adopt the principles and practice which I am now endeavour- ing to establish. The passage which contains this interesting fact is as follows: "A few days af- " ter (says sir John) he [meaning Dr. Johnson] fc sent for me, and informed me, that he had dis- " covered in himself the symptoms of a dropsy, " and, indeed, his very much increased bulk, and " the swollen appearance of his legs, seemed to " indicate no less. It was on Thursday that I " had this conversation with him; in the course " thereof he declared, that he intended to devote " the whole of the next day to fasting, humilia- " tion, and such other devotional exercises as be- " came a man in his situation. On the Saturday " following I made him a visit, and, upon entering " his room, I observed in his countenance such a 11 serenity as indicated, that some remarkable crisis " of his disease had produced a change in his " feelings. He told me that, pursuant to the reso- ON DROPSIES. 169 if lution he had mentioned to me, he had spent the " preceding day in an abstraction from all worldly " concerns ; that to prevent interruption he had in " the morning ordered Frank [his servant] not to " admit any one to him, and, the better to enforce " the charge, had added these awful words, for " your master is preparing himself to die. He " then mentioned to me, that in the course of this " exercise he found himself relieved from the dis- " ease which had been growing upon him, and was '* becoming very oppressive, viz. the dropsy, by " the gradual evacuation of water, to the amount " of twenty pints, a like instance whereof he had " never before experienced." Sir John Hawkins ascribes this immense discharge of water to the influence of Dr. Johnson's prayers; but he ne- glects to take notice, that these prayers wrere ans- wered, in this instance, as they are in many others, in a perfect consistence with the common and esta- blished laws of nature. To satisfy myself that this discharge of water, in the case of Dr. Johnson, was produced by the fasting only, I recommended it, soon after I read the above account, to a gentlewoman whom I was then attending in an ascites. I was delighted with the effects of it. Her urine, which for some time before had not exceeded half a pint a-day, amounted VOL. II. y 170 ON DROPSIES. to two quarts on the day she fasted. I repeated the same prescription once a week for several weeks, and each time was informed of an increase of urine, though it was considerably less in the last experiments than in the first. Two patients in an ascites, to whom I prescribed the same remedy, in the Pennsylvania hospital, the one in the winter of 1790, and the other in the winter of 1792, ex- hibited proofs in the presence of many of the stu- dents of the university, equally satisfactory of the efficacy of fasting in suddenly increasing the quan- tity of urine. IX. Fear. This passion is evidently of a de- bilitating nature, and, therefore, it has frequendy afforded an accidental aid in the cure of dropsies, of too much action. I suspect, that the fear of death, which was so distinguishing a part of the character of Dr. Johnson, added a good deal to the efficacy of fasting, in procuring the immense discharge of water before-mentioned. In support of the efficacy of fear simply applied, in discharg- ing wrater from the body in dropsies, I shall men- tion the following facts. In a letter which I received from Dr. John Pennington, dated Edinburgh, August 3, 1790, I was favoured with the following communication. ON DROPSIES. 171 " Since the conversation I had with you on the sub- " ject of the dropsy, I feel more and more inclined " to adopt your opinion. I can furnish you with " a fact which I learned from a Danish sailor, on " my passage to this country, which is much in fa- " vour of your doctrine. A sailor in an ascites, fell " off the end of the yard into the sea; the wea- " ther being calm, he was taken up unhurt, but, to " use the sailor's own words, who told me the " story, he was frightened half to death, and as " soon as he was taken out of the water, he dis- " charged a gallon of urine or more. A doctor on " board ascribed this large evacuation to sea bath- " ing, and accordingly ordered the man to be the violent, or long continued exercise of the un- derstanding, imagination, and passions in study, business, or pleasure, and, lastly, the use of ardent, and fermented liquors. The last are absolutely necessary to produce that form of gout which ap- pears in the ligaments and muscles. I assert this, not only from my own observations, but from those of Dr. Cadogan, and Dr. Darwin, who say they THE GOUT. 231 never saw a case of gout in the limbs in any per- son who had not used spirits or wine in a great- er or less quantity. Perhaps this may be another reason why women, who drink less of those liquors than men, are so rarely affected with this disease in the extreme parts of their bodies. Wines of all kinds are more disposed to. produce this form of gout than spirits. The reason of this must be re- solved into the less stimulus in the former, than in the latter liquors. Wine appears to resemble, in its action upon the body, the moderate stimulus of miasmata which produce a common remitting fe- ver, or intermitting fever, while spirits resemble that violent action induced by miasmata which pas- ses by the blood-vessels, ligaments, and muscles, and invades at once the liver, bowels, and brain. There is one symptom of the gout in the extremi- ties which seems to be produced exclusively by ardent spirits, and that is a burning in the palms of the hands, and soles of the feet. This is so uni- form, that I have sometimes been able to convict jmy patients of intemperance in the use of spirits, when no other mark of their having taken them in excess, appeared in the system. I have enumerated among the remote causes of the gout, the use of strong tea. I infer its predis- posing quality to that disease, from its frequency 232 OBSERVATIONS ON at Japan, where tea is used in large quantities, and from the gout being more common among that sex in our country who drink the most, and the strong- est tea. 7. The exciting causes of the gout are frequently a greater degree, or a sudden application of its re- mote and predisposing causes. They act upon the accumulated excitability of the system, and by de- stroying its equilibrium of excitement, and regular order of actions, produce convulsion, or irregular morbid and local excitement. These exciting causes are either of a stimulating, or of a sedative nature. The former are violent exercise, of body or mind, night-watching, and even sitting up late at night, a hearty meal, a fit of drunkenness, a few glasses of claret or a draught of cyder, where those liquors have not been habitual to the patient, a sud- den paroxysm of joy, anger, or terror, a dislocation of a bone, straining of a joint, particularly of the ankle, undue pressure upon the foot, or leg, from a tight shoe or boot, an irritated corn, and the usual remote causes of fever. The latter exciting causes are sudden inanition from bleeding, purging, vo- miting, fasting, cold, a sudden stoppage of mois- ture on the feet, fear, grief, excess in venery, and the debility left upon the system by the crisis of a fever. All these causes act more certainly when THE GOUT. 233 they are aided by the additional debility induced upon the system in sleep. It is for this reason that the gout generally makes its first attack in the night, and in a part of the system most remote from the energy of the brain, and most debilitated by exercise, viz. in the great toe, or in some part 4>f the foot. In ascribing a fit of the gout to a cause which is of a sedative nature, the reader will not suppose that I have departed from the simplicity and uniformity of a proposition I have elsewhere delivered, that disease is the effect of stimulus. The abstraction of a natural and habitual impres- sion of any kind, by increasing the force of those which remain, renders the production of morbid and excessive actions in the system as much the effect of preternatural or disproportioned stimulus, as if they were induced by causes that are exter- nally and evidently stimulating. It is thus in many other of the operations of nature, opposite causes produce the same effects. 8. The gout consists simply in morbid excite- ment, accompanied with irregular action, or the ab- sence of all action from the force of stimulus. There is nothing specific in the morbid excitemenj and ac- tions which take place in the gout different from what occur in fevers. It is to be lamented that a kind of metastasis of error has taken place in patho- vol. n. 2 g 234 OBSERVATIONS ON logy. The rejection of a specific acrimony as the cause of each disease, has unfortunately been fol- lowed by a belief in as many specific actions as there are different forms and grades of disease, and thus perpetuated the evils of our ancient systems of medicine. However varied morbid actions may- be by their causes, seats, and effects, they are all of the same nature, and the time will probably come when the whole nomenclature of morbid actions will be absorbed in the single name of disease. I shall now briefly enumerate the symptoms of the gout, as they appear in the ligaments, the blood- vessels, the viscera, the nervous system, the alimen- tary canal, the lymphatics, the skin, and the bones of the human body, and here we shall find that it is an epitome of all disease. I. The ligaments which connect the bones are the seats, of what is called a legitimate or true gout. They are affected with pain, swelling, and inflammation. The pain is sometimes so acute as to be compared to the gnawing of a dog. We per- ceive here the sameness of the gout widi the rheu- matism. Many pages, and indeed whole essays, have been composed by writers to distinguish them, but they are exactly the same disease while the mor- bid actions are confined to this part of the body. THE GOUT. 235 They are, it is true, produced by different remote causes, but this constitutes no more difference in their nature, than is produced in a coal of fire, whe- ther it be inflamed by a candle, or by a spark of electricity. The morbid actions which are induced by the usual causes of rheumatism affect, though less frequently, the lungs, the trachea, the head, the bowels, and even the heart, as well as the gout. Those actions, moreover, are the means of a fluid being effused, which is changed into calcareous matter in the joints and other parts of the body, ex- actlv like that which is produced by the gout. They likewise twist and dislocate the bones in common with the gout, in a manner to be described here- after. The only difference between what are called gouty, and rheumatic actions, consists in their seats, and in the degrees of their force. The debility which predisposes to the gout, being greater, and more extensively diffused through the body than the debility which precedes rheumatism, the mor- bid actions, in the former case, pass more readily from external to internal parts, and produce in both more acute and more dangerous effects. A simile derived from the difference in the degrees of action produced in the system by marsh miasmata, made use of upon a former occasion, will serve me again to illustrate this part of our subject. A mild re- mittent, and a yellow fever, are different grades of 236 OBSERVATIONS ON the same disease. The former, like the rheuma- tism, affects the bones chiefly with pain, while the latter, like the gout, affects not only the bones, but the stomach, bowels, brain, nerves, lymphatics, and all the internal parts of the body. II. In the arterial system the gout produces fe- ver. This fever appears not only in the increased force or frequency of the pulse, but in morbid affections of all the viscera. It puts on all the dif- fere»t grades of fever, from the malignity of the plague, to the mildness of a common intermittent. It has moreover its regular exacerbations and re- missions once in every four and twenty hours, and its crisis usually on the fourteenth day, in violent cases. In moderate attacks, it runs on from twenty to forty days in common with the typhus or slow chronic state of fever. It is common for those per- sons who consider the gout as a specific disease, when it appears in the above forms, to say, that it is complicated with fever; but this is an error, for there can exist but one morbid action in the blood- vessels at once, and the same laws are imposed upon the morbid actions excited in those parts of the body by the remote causes of the gout, as by . the common causes of fever. I have seen two in- stances of this disease appearing in the form of a genuine hectic, and one in which it appeared to THE GOUT. 237 vield to lunar influence, in the manner described by Dr. Balfour. In the highly inflammatory state of the gout, the sensibility of the blood-vessels far exceeds what is seen in the same state of fever from more common causes. I have known an instance in which a translation of the gouty action to the eye produced such an exquisite degree of sensibility, that the patient was unable to bear the feeble light which was emitted from a few coals of fire in his room, at a time too when the coldness of the wea- ther would have made a large fire agreeable to him. It is from the extreme sensibility which the gout imparts tome stomach, that the bark is so generally rejected by it. I knew a British officer who had nearly died from taking a spoonful of the infusion of that medicine, while his arterial system was in this state of morbid excitability, from a fit of the s:out. It is remarkable that the emit is most dis- posed to assume a malignant character, during the prevalence of an inflammatory constitution of the atmosphere. This has been long ago remarked by Dr. Huxham. Several instances of it have occur- red in this pity since the year 1793. III. The gout affects most of the viscera. In the brain it produces head-ach, vertigo, coma, apo- plexy, and palsy. In the lungs it produces pneu- monia vera, notha, asthma,, haemoptysis, pulmonary 238 OBSERVATIONS ON consumption, and a short necking cough, first de- scribed by Dr. Sydenham. In the throat it pro- duces inflammatory angina. In the uterus it pro- duces haemorrhagia uterina. It affects the kidneys with inflammation, strangury, diabetes, and calculi. The position of the body for weeks or months on the back, by favouring the compression of the kid- neys by the bowels, is the principal reason why those parts suffer so much in gouty people. The strangury appears to be produced by the same kind of engorgement or choking of the vessels of the kidneys, which takes place in the small-pox and yellow fever. Four cases of it are described in the 3d volume of the Physical and Literaiy Essays of Edinburgh, by Dr. David Clerk. I have seen one instance of death in an old man from this cause. The catheter brought no water from his bladder. The late Mr. John Penn, formerly governor of Pennsylvania, I have been informed by one of his physicians, died from a similar affection in his kid- neys from gout. The catheter was as ineffectual in giving him relief, as it was in the case of my patient. The neck of the bladder sometimes be- comes the seat of the gout. It discovers itself by ^pasm, and a suppression of urine in some cases, and occasionally by a habitual discharge of mucus through the urethra. This disease has been called, by Lieutaud, " a catarrh of the bladder." Dr. THE GOUT. 239 Stoll describes it, and calls it " haemorrhoids of the bladder." But of all the viscera, the liver suffers most from the gout. It produces in it inflamma- tion, suppuration, melena, schirrus, gall-stones, jaundice, and a habitual increased secretion and ex- cretion of bile. These affections of the liver ap- pear most frequently in southern countries, and in female habits. They are substitutes for a gout in the ligaments, and in the extremities of the body. They appear likewise in drunkards from ardent spirits. It would seem that certain stimuli act spe- cifically«upon the liver, probably for the wise pur- pose of discharging such parts of the blood from the body, as are vitiated by the rapidity of its cir- culation. I shall, in another place*, take notice of the action of marsh miasmata upon the livers of men and beasts. It has been observed that hogs that live near brewhouses, and feed upon the fer- mented grains of barley, always discover enlarged or diseased livers. But a determination of the blood to the liver, and an increased action of its vessels, are produced by other causes than marsh miasmata, and fermented and distilled liquors. They appear in the fever which accompanies mad- ness and die malignant sore-throat, also in contu- sions of the brain, and in the excited state of the * Volume IV. 240 OBSERVATIONS ON blood-vessels which is produced by anger and ex- ercise. I have found an attention to these facts useful in prescribing for diseases of the liver, inas- much as they have led me from considering them as idiopathic affections, but as the effects only of morbid actions excited in other parts of the body. IV. The gout sometimes affects the arterial and nervous systems jointly, producing in the brain, coma, vertigo, apoplexy, palsy, loss of memory, and madness, and in the nerves, hysteria, hypochon- driasis, and syncope. It is common to say the gout counterfeits all these diseases. But this is an in- accurate mode of speaking. All those diseases have but one cause, and they are exacdy the same, however different the stimulus may be, from which they arc derived. Sometimes the gout affects the brain and nerves exclusively, without producing the least morbid action in the blood-vessels. I once attended a gentleman from Barbadoes who suffered, from this affection of his brain and nerves, the most intolerable depression of spirits. It yielded to large doses of wine, but his relief was perfect, and more durable, when a pain was excited by nature or art, m his hands or feet. The muscles are sometimes affected by the gout with spasm, with general and partial convulsions, THE COUT. 241 and lasdy with great pain. Dr. Stoll describes a case of opisthotonos from it. The angina pectoris, or a sudden inability to breathe after climbing a hill, or a pair of stairs, and after a long walk, is sometimes a symptom of the gout. There is a pain which suddenly pervades the head, breast, and limbs, which resembles an electric shock. I have known two instances of it in gouty patients, and have taken the liberty of calling it the " aura arthri- tica." But the pain which affects the muscles is often of a more permanent nature. It is felt with most severity in the calves of the legs. Sometimes it affects the muscles of the head, breast, and limbs, exciting in them large and distressing swel- lings. But further; the gout in some cases seizes upon the tendons, and twists them in such a man- ner as to dislocate bones in the hands and feet. It even affects the cartilages. Of this I once saw an instance in colonel Adams, of the state of Maryland. The external parts of both his ears were so much inflamed in a fit of the gout, that he was unable to lie on either of his sides. * V. The gout affects the alimentaiy canal, from the stomach to its termination in the rectum. Flatulency, sickness, acidity, indigestion, pain, or vomiting, usually usher in a fit of the disease. The sick head-ach, also dyspepsia, with all its train of VOL. II. 2 h 242 OBSERVATIONS ON distressing evils, are frequently the effects of gout concentrated in the stomach. I have seen a case in which the gout, by retreating to this viscus, pro- duced the same burning sensation which is felt in the yellow fever. The patient who was the subject of this symptom died two days afterwards with a black vomiting. It was Mr. Patterson, formerly collector of the port of Philadelphia, under the Bri- tish government. I was not surprised at these two uncommon symptoms in the gout, for I had long been familiar with its disposition to affect the bilia- ry secretion, and the actions of the stomach. The colic and dysentery are often produced by the gout in the bowels. In the southern states of America, it sometimes produces a chronic diarrhoea, which is known in some places by the name of the " down- ward consumption." The piles are a common symptom of gout, and where they pour forth blood occasionally, render it a harmless disease. I have known an instance in which a gouty pain in the rectum produced involuntary stools in a gendeman in this city, and I have heard from a southern gen- tleman, who had been afflicted with gouty symp- toms, that a similar pain was excited in the same part to such a degree, whenever he went into a crowded room lighted by candles, as to oblige him to leave it. In considering the effects of the gout upon this part, I am led to take notice of a trouble- THE GOUT. 243 some itching in the anus which has been described by Dr. Lettsom, and justiy attributed by him to this disease*. I have known several cases of it. They always occurred in gouty habits. A dis- tressing collection of air in the rectum, which ren- ders frequent retirement from company necessary to discharge it, is likewise a symptom of gout. It is accompanied with frequent, and small, but hard stools. Of the above morbid affections of the nerves, stomach, and bowels, the hysteria, the sick head- ach, and the colic, appear much oftener in women than in men. I have said that dyspepsia is a symp- tom of gout. Out of more than 500 persons w ho were the patients of the Liverpool infirmary and dispensary, in one year, Dr. Currie informs us, ** a great majority were femalesf," VI. The gout affects the glands and lymphatics. It produced a salivation of a profuse nature in ma- jor Pearce Butler, which continued for two days. It produced a bubo in the groin in a citizen of Phi- ladelphia. He had never been infected with the * Medical Memoirs, vol. III. t Medical Reports on the Effects of Hot and Cold Water, p. 215. 244 OBSERVATIONS ON venereal disease, of course no suspicion was enter- tained by me of its being derived from that cause. I knew a lady who had periodical swellings in her breasts, at die same season of the year in which she had before been accustomed to have a regular fit of the gout. The scrophula and all the forms of dropsy are the effects in many cases of the disposi- tion of the gout to attack the lymphatic system. There is a large hard swelling without pain, of one, or both the legs and thighs, which has been called a dropsy, but is very different from the common disease of that name. It comes on, and goes off suddenly. It has lately been called in England the dumb gout. In the spring of 1798 I attended co- lonel Innes, of Virginia, in consultation with my Edinburgh friend and fellow-student, Dr. Walter Jones, of the same state. The colonel had large anasarcous swellings in his thighs and legs, which we had reason to believe were the effects of an in- dolent gout. We made several punctures in his feet and ancles, and thereby discharged a large quantity of water from his legs and thighs. A day or two afterwards his ancles exhibited in pain and inflammation, the usual form of gout in those parts. In the year 1794 I attended Mrs. Lloyd Jones, who had a swelling of the same kind in her foot and leg. Her constitution, habits, and the sober manners of her ancestors, gave me no reason to suspect it THE GOUT. 245 to arise from the usual remote causes of gout. She was feverish, and her pulse was tense. I drew ten ounces of blood from her, and gave her a purge. The swelling subsided, but it was succeeded by an acute rheumatic pain in the part, which was cured in a few days. I mention tiiese facts as an addi- tional proof of the sameness of the gout and rheu- matism, and to show that the vessels in a simple disease, as well as in malignant fevers, are often oppressed beyond that point in which they emit the sensation of pain. Under this head I shall include an account of the mucous discharge from the urethra, which sometimes takes place in an attack of the gout, and which has ignorantly been ascribed to a venereal gonorrhaea. There is a description of this symp- tom of the gout in the 3d volume of the Physical and Literary Essays of Edinburgh, by Dr. Clark. It was first taken notice of by Sauvages by the name of " gonorrhaea podagrica," in a wwk entitled Pathologia Methodica. I have known three in- stances of it in this city. In the visits which the gout pays to the genitals, it sometimes excites great pain in the testicles. Dr. Whytt mentions three cases of this kind. One of them was attended with a troublesome itching of the scrotum. I have seen one case in which the testicles were affected 246 OBSERVATIONS ON with great pain, and the penis with an obstinate priapism. They succeeded a sudden translation of the gout from the bowels. From the occasional disposition of the gout to produce a mucous discharge from the urethra in men, it is easy to conceive that it is the frequent cause of the fluor albus in women, for in them, the gout which is restrained from the feet, by a cause formerly mentioned, is driven to other parts, and particularly to that part which, from its offices, is more disposed to invite disease to it, than any other. The fluor albus sometimes occurs in fe- males, apparendy of the most robust habits. In such persons, more especially if they have been descended from gouty ancestors, and have led in- dolent and luxurious lives, there can be no doubt but the disease is derived from the gout, and should be treated with remedies which act not only upon the affected part, but the whole system. An itching similar to that I formerly mentioned in the anus, sometimes occurs in the vagina of wo- men. Dr. Lettsom has described it. In all the cases I have known qf it, I believe it was derived from the usual causes of the gout. VII. There are many records in the annals of medicine of the gout affecting the skin. The ery- THE GOUT. 247 sipelas, gangrene, and petechias are its acute, and tetters, and running sores are its usual chronic forms when it appears in this part of the body. I attended a patient with the late Dr. Hutchinson, in whom the whole calf of one leg was destroyed by a mortification which succeeded the gout. Dr. Alexander, of Baltimore, informed me that petechias were among the last symptoms of this disease in the Rev. Mr. Oliver, who died in the town of Balti- more, about two years ago. In the disposition of the gout to attack external parts, it sometimes af- fects the eyes and ears with the most acute and distressing inflammation and pain. I hesitate the less in ascribing them both to the gout, because they not only occur in gouty habits, but because they now and then effuse a calcareous matter of the same nature with that which is found in die liga- ments of the joints. VIII. Even the bones are not exempted from the ravages of this disease. I have before mentioned that the bones of the hands and feet are sometimes dislocated by it. I have heard of an instance in which it dislocated the thigh bone. It probably- produced this effect by the effusion of that part of the blood which constitutes chalk-stones, or by an excrescence of flesh in the cavity of the joint. Two instances have occurred in this city of its dislodg- 248 OBSERVATIONS ON ing the teeth, after having produced the most dis- tressing pains in the jaws. The long protracted, and acute pain in the face, which has been so accu- rately described by Dr. Fothergill, probably arises wholly from the gout acting upon the bones of the part affected. I have more than once hinted at the sameness of some of the states of the gout, and the yellow fe- ver. Who can compare the symptoms and seats of both diseases, and not' admit the unity of the remote and immediate causes of fever ? Thus have I enumerated proofs of the gout being a disease of the whole system. I have only to add under this proposition, that it affects different parts of the body in different people, according to the nature of their congenial or acquired temperaments, and that it often passes from one part of the body to another in the twinkling of an eye. The morbid excitement, and actions of the gout, when seated in the ligaments, the blood-vessels, and viscera, and left to themselves, produce effects dif- ferent in their nature, according to the parts in which they take place. In the viscera they pro- duce congestions composed of all the component parts of the blood. From the blood-vessels which THE GOUT. 249 terminate in hollow cavities and in cellular mem- brane, they produce those effusions of serum which compose dropsies. From the same vessels proceed those effusions which produce on the skin erysipe- las, tetters, and all the different kinds of eruptions. In the ligaments they produce an effusion of coagu- lable lymph, which by stagnation is changed into what are callec^chalk-stones. In the urinary organs they produce an effusion of particles of coagulable lymph or red blood, which, under certain circum- stances, are changed into sand, gravel, and stone. All these observations are liable to some exceptions. There are instances in which chalk-stones have been found in the lungs, mouth, on the eye-lids, and in the passages of the ears, and a preternatural flux of water and blood has taken place from the kidneys. Pus has likewise been formed in the joints, and air has been found in the cavity of the belly, instead of water. Sometimes the gout is said to combine with the fevers which arise from cold and miasmata. We are not to suppose from this circumstance, that the system is under a twofold stimulus. By no means. The symptoms which are ascribed to the gout, are the effects of morbid excitement excited by the cold, or miasmata acting upon parts previously de- bilitated by the usual remote causes of that disease. VOL. II. 2 I 250 OBSERVATIONS ON A bilious diathesis in the air so often excites the peculiar symptoms of gout, in persons predisposed to it, that it has sometimes been said to be epide- mic. This was the case, Dr. Stoll says, in Vienna, in the years 1782 and 1784. The same mixture of gouty and bilious symptoms was observed by Dr. Hillary, in the fevers of Barbadoes. From a review of the symptoms of the gout, the impropriety of distinguishing it from its various seats, by specific names, must be obvious to the reader. As well might we talk of a yellow fever in the brain, in the nerves, or in the groin, when its symptoms affect those parts, as talk of misplaced or retrocedent gout. The great toe, and the joints of the hands and feet, are no more its exclusive seats, than the " stomach is the throne of the yel- " low fever." In short, the gout may be com- pared to a monarch whose empire is unlimited. The whole body crouches before it. It has been said as a reflection upon our profes- sion, that physicians are always changing their opi- nions respecting chronic diseases. For a long while they were all classed under the heads of ner- vous, or bilious. These names for many years afforded a sanctuary for the protection of fraud and and error in medicine. They have happily yielded THE GOUT. 251 of late years to the name of gout. If we mean by this disease a primary affection of the joints, we have gained nothing by assuming that name ; but if we mean by it a disease which consists simply of morbid excitement, invited by debility, and dis- posed to invade every part of the body, we con- form our ideas to facts, and thus simplify theory and practice in chronic diseases. I proceed now to treat of the method of cure. Let not the reader startle when I mention curing the gout. It is not a sacred disease. There will be no profanity in handling it freely. It has been cured often, and I hope to deliver such directions under this head, as will reduce it as much under the power of medicine, as a pleurisy or an intermit- ting fever. Let not superstition say here, that the gout is the just punishment of folly, and vice, and that the justice of Heaven would be defeated by curing it. The venereal disease is more egregi- ously the effect of vice than the gout, and yet Heaven has kindly directed human reason to the discovery of a remedy which effectually eradicates it from the constitution. This opinion of the gout being a curable disease, is as humane as it is just. It is calculated to prompt to early application for medical aid, and to prevent that despair of relief 252 OBSERVATIONS on which has contributed so much to its duration, and mortality. But does not the gout prevent other diseases, and is it not improper upon thi^fccount to cure it ? I answer, that it prevents •other' diseases, as the daily use of drams prevents the intermitting fever. In doing this, they bring on a hundred more incura- ble morbid affections. The yellow fever carried off many chronic diseases in the year 1793, and yet who would wish for, or admit such a remedy for a similar purpose ? The practice of encourag- ing, and inviting what has been called a " friendly fit" of the gout as a cure for other diseases, resem- bles the practice of school boys who swallow the stones of cherries to assist their stomachs in digest- ing that delicate fruit. It is no more necessaiy to produce the gout in the feet, in order to cure it, than it is to wait for, or encourage abscesses or na- tural haemorrhages, to cure a fever. The practice originated at a time when morbific matter was sup- posed to be the cause of the gout, but it has unfor- tunately continued under the influence of theories which have placed the seat of the disease in the solids. The remedies for the gout naturally divide them- selves into the following heads. the gout. 253 I. Such as are proper in its approaching, or forming state. II. Such as are proper in violent morbid action in the blood-vessels and viscera. III. Such as are proper in a feeble morbid action in the same parts of the body. IV. Such as are proper to relieve certain local symptoms which are not accompanied by general morbid action. And V. Such as are proper to prevent its recurrence, or, in other words, to eradicate it from the system. I. The symptoms of an approaching fit of the gout are great languor, and dulness of body and mind, doziness, giddiness, wakefulness, or sleep disturbed by vivid dreams, a dryness, and some- times a coldness, numbness, and prickling in the feet and legs, a disappearance of pimples in the face, occasional chills, acidity and flatulency in the stomach, with an increased, a weak, or a defect of appetite. These symptoms are not universal, but more or less of them usher in nearly every fit of the gout. The reader will see at once their sameness with the premonitory symptoms of fever from cold 254 OBSERVATIONS ON and miasmata, and assent from this proof, in addi- tion to others formerly mentioned, to the propriety of considering a fit of the gout, as a paroxysm of fever. The system, during the existence of these symp- toms, is in a state of morbid depression. The disease is as yet unformed, and may easily be pre- vented by the loss of a few ounces of blood, or, if this remedy be objected to, by a gentle doze of physic, and afterwards by bathing the feet in warm water, by a few drops of the spirit of hartshorn in a little sage or camomile tea, by a draught of wine whey, or a common doze of liquid laudanum, and, according to a late Portuguese physician, by taking a few doses of bark. It is worthy of notice, that if these remedies are omitted, all the premonitory symptoms that have been mentioned disappear as soon as the arthritic fever is formed, just as lassitude and chilliness yield to a paroxysm of fever from other causes. II. Of the remedies that are proper in cases of great morbid action in the blood-vessels and vis- cera. THE GOUT. 255 I shall begin this head by repudiating the notion of a specific cure for the gout existing in any sin- gle article of the materia medica. Every attempt to cure it by elixirs, diet-drinks, pills, or, boluses, which were intended to act singly on the system, has been as unsuccessful as the attempts to cure the whooping cough by spells, or tricks of legerdemain. The first remedy that I shall mention for redu- cing great morbid action in the blood-vessels and viscera, is blood-letting. I was first taught the safety of this remedy in the gout by reading the works of Dr. Lister, above thirty years ago, and I have used it ever since with great advantage. It has the sanction of Dr. Hoffman, Dr. Cullen, and many others of the first names in medicine in its favour. The usual objections to bleeding as a remedy, have been urged with more success in the gout, than in any other disease. It has been forbidden, because the gout is said to be a disease of debility. This is an error. Debility is not a disease. It is only its predisposing cause. Disease is preterna- tural strength in the state of the system now under consideration, occasioned by the abstraction of ex- citement from one part, and the accumulation of it in another part of the body. Every argument in 256 OBSERVATIONS ON favour of bleeding in a pleurisy applies in the pre- sent instance, for they both depend upon the same kind of morbid action in the blood-vessels. Bleed- ing acts moreover alike in both cases by abstracting the excess of excitement from the blood-vessels, and restoring its natural and healthy equality to every part of the system. It has been further said, that bleeding disposes to more frequent returns of the gout. This objec- tion to the lancet has been urged by Dr. Syden- ham, who was misled in his opinion of it, by his theory of the disease being the offspring of morbi- fic matter. The assertion is unfounded, for bleed- ing in a fit of the gout has no such effect, provided the remedies to be mentioned hereafter are used to prevent it. But a fit of the gout is not singular in its disposition to recur after being once cured. The rheumatism, the pleurisy, and the intermitting fever are all equally disposed to return when per- sons are exposed to their remote and exciting causes, and yet we do not upon this account con- sider them as incurable diseases, nor do we abstain from the usual remedies which cure them. The inflammatory or violent state of the gout is said most commonly to affect the limbs. But this is far from being the case. It frequently makes THE GOUT. 257 its first attack upon the head, lungs, kidneys, sto- mach, and bowels. The remedies for expelling it from the stomach and bowels are generally of a stimulating nature. They are as improper in full habits, and in the recent state of the disease, as cordials are to drive the small-pox from the vitals to the skin. Hundreds have been destroyed by them. Bleeding in these cases affords the same speedy and certain relief that it does in removing pain from die stomach and bowels in the first stage of the yellow fever. Colonel Miles owes his life to the loss of 60 ounces of blood in an attack of the gout in his bow-els, in the winter of 1795, and major Butler derived the same benefit from the loss of near 30 ounces, in an attack of die gout in his stomach in the spring of 1798. I could add many more instances of the efficacy of the lancet in the gout when it affects the viscera) from my own experience, but I prefer mentioning one only from sir John Floyer, which is more strik- ing than any I have met with in its favour. He tells us, sir Henry Coningsby was much disposed to the palsy from the gout when he was 30 years old. By frequent bleedings, and the use of the cold bath, he recovered, and lived to be 88. Dur- ing his old age, he was bled every three months. vol. n. 2 K 258 OBSERVATIONS ON I have said, in the history of the symptoms of die gout, that it sometimes appeared in the form of a hectic fever. I have prescribed occasional bleed- ings in a case of this kind accompanied w ith a tense pulse,' with the happiest effects. It confined the disease for several years wholly to the blood- vessels, and it bid fair in time to eradicate it from the system. The state of die pulse, as described in anodier place*, should govern the use of the lancet in this disease. Bleeding is required as much in its de- pressed, as in its full and chorded state. Colonel Miles's pulse, at the time he suffered from the gout in his bowels, was scarcely perceptible. It did not rise till after a second or third bleeding. Some advantage may be derived from examin- ing the blood. I have once known it to be dis- solved ; but for the most part I have observed it, with Dr. Lister, to be covered with the buffy coat of common inflammation. The arguments made use of in favour of bleed- ing in the diseases of old people in a former vo- lume, apply with equal force to its use in the gout. r Defence of Blood-letting, vol. IV. THE GOUT. 259 The inflammatory state of this disease frequently occurs in the decline of life, and bleeding is as much indicated in such cases as in any other in- flammatory fever. The late Dr. Chovet died with an inflammation in his liver from gout, in the 86th year of his age. He was twice bled, and his blood each time was covered with a buffy coat. Where the gout affects the head with obstinate pain, and appears to be seated in the muscles, cup- ping and leeches give great relief. This mode of bleeding should be trusted in those cases only in which the morbid action is confined chiefly to the head, and appeal's in a feeble state in the rest of the arterial system. The advantages of bleeding in the gout, when performed under all the circumstances that have been mentioned, are as follow :» 1. It removes or lessens pain. 2. It prevents those congestions and effusions which produce apoplexy, palsy, pneumonia notha, calculi in the kidneys and bladder, and chalk-stones in the hands and feet. The gravel and stone are nine times in ten, I believe, the effects of an effu- sion of lymph or blood from previous morbid ao^ 260 OBSERVATIONS ON tion in the kidneys. If this disease were narrowly watched, and cured as often as it occurs, by the loss of blood, we should have but little gravel or stone among gouty people. A citizen of Philadel- phia died a few years ago, in the 96th year of his age, who had been subject to the strangury the greatest part of his life. His only remedy for it was bleeding. He lived free from the gravel and stone, and died, or rather appeared to fall asleep in death, from old age. Dr. Haller mentions a simi- lar case in his Bibliotheca Medicinae, in which bleeding had the same happy effects. 3. It prevents the system from wearing itself down by fruitless pain and sickness, and thereby inducing a predisposition to frequent returns of the disease. 4. It shortens the duration of a fit of gout, by throwing it, not into the feet, but out of the sys- tem, arid thus prevents a patient's lying upon his back for two or three months with a writhing face, scolding a wife and family of children, and some- times cursing every servant that comes near enough to endanger the touch of an inflamed limb. Besides preventing all this parade of pain and peevishness, it frequently, when assisted with other remedies to be mentioned presently, restores a man to his busi- THE GOUT. 261 ness and society in two or three days: a circum- stance this of great importance in the public as well as private pursuits of men ; for who has not read of the most interesting affairs of nations being ne- glected or protracted, by the principal agents in them being suddenly confined to their beds, or chairs, for weeks or months, by a fit of the gout ? 2. A second remedy in the state of the gout which has been mentioned, is purging. Sulphur is generally preferred for this purpose, but castor oil, cream of tartar, sena, jalap, rhubarb, and calo- mel, may all be used with equal safety and' advan- tage. The stomach and habits of the patient should determine the choice of a suitable purge in every case. Salts are generally offensive to the stomach. They once brought on a fit of die gout in Dr. Brown. 3. Vomits may be given in all those cases where bleeding is objected to, or where the pulse is omy moderately active. Mr. Small, in an excellent paper upon the gout, in the 6th volume of the Me- dical Observations and Inquiries, p. 205, contain- ing the history of his own case, tells us that he always took a vomit upon the first attack of the gout, and that it never failed of relieving all its symptoms. The matter discharged by this vomit 262 OBSERVATIONS ON indicated a morbid state of the liver, for it was al- ways a dark greenish bile, which was insoluble in water. A British lieutenant, whose misfortunes reduced him to the necessity of accepting a bed in the poor-house of this city, informed the late Dr. Stuben, that he had once been much afflicted with the gout, and that he had upon many occasions strangled a fit of it by the early use of an emetic. Dr. Pye adds his testimony to those which have been given in favour of vomits, and says further, that they do most service when they discharge an ackl humour from the stomach. They appear to act in part by equalizing the divided excitement of the system, and in part by discharging the contents of the gall-bladder and stomach, vitiated by the previous debility of those organs. Care should b6 taken not to exhibit this remedy where the gout attacks the stomach with symptoms of inflammation, or where it has a tendency to fix itself upon the brain. 4. Nitre may be given with advantage in cases of inflammatory action, where the stomach is not affected. 5. A fifth remedy is cool or cold air. This is as safe and useful in the gout as in any other in- flammatory state of fever. The affected limbs THE GOUT. 263 should be kept out of bed, uncovered. In this way Mr. Small says he moderated the pains of the gout in his hands and feet*. I have directed the same practice with great comfort, as well as advantage to my patients. Even cold water has been applied with good effects to a limb inflamed by the gout. Mr. Blair M'Clenachan taught me the safety and benefit of this remedy, by using it upon himself without the advice of a physician. It instantly re- moved his pain, nor was the gout translated by it to any other part of his body. It was removed in the same manner, Dr. Heberden tells us, by the celebrated Dr. Harvey from his own feet. Per- haps it would be best in most cases to prefer cool, or cold air, to cold water. The safety and advan- tages of both these modes of applying cold to the affected limbs, show the impropriety of the com- mon practice of wrapping them in flannel. 6. Diluting liquors, such as are prescribed in common inflammatory fevers, should be given in such quantities as to dispose to a gentle -perspira- tion. 7. Abstinence from wine, spirits, and malt li- quors, also from such aliments as afford much nou- * Medical Observations and Inquiries, vol VI. p. 201. 264 OBSERVATIONS ON rishment or stimulus, should be carefully enjoined. Sago, panada, tapioca, diluted milk with bread, and the pulp of apples, summer fruits, tea, coffee, weak chocolate, and bread soaked in chicken water or beef tea, should constitute the principal diet of patients in this state of the gout. 8. Blisters are an invaluable remedy in this dis- ease, when used at a proper time, that is, after the reduction of the morbid actions in the system by evacuations. They should be applied to the joints of the feet and wrrists in general gout, and to the neck and sides, when it attacks the head or breast. A strangury from the gout is no objection to their use. So far from increasing this complaint, Dr. Clark and Dr. Whytt iniorm us, that they remove it*. But the principal advantage of blisters is de- rived from their collecting and concentrating scat- tered and painful sensations, and conveying them out of the system, and thus becoming excellent substitutes for a tedious fit of the gout. 9. Fear and terror have in some instances cured a paroxysm of this disease. A captain of a British ship of war, who had been confined for several weeks to his cabin, by a severe fit of the gout in * Physical and Literary Essays, vol. III. p. 469. THE GOUT. 265 his feet, was suddenly cured by hearing the cry of fire on board his ship. This fact was communicat- ed to me by a gendeman who was a witness of it. Many similar cases are upon record in books of medicine. I shall in another place insert an ac- count of one in which the cure effected by a fright, eradicated the disease from the system so com- pletely, as ever afterwards to prevent its return. Thus have I enumerated the remedies which are proper in the gout when it affects the blood-vessels and viscera with great morbid action. Most of those remedies are alike proper when the morbid actions are seated in the muscular fibres, whether of the bowels or limbs, and whether they produce local pain, or general convulsion, provided they are of a violent nature. There are some remedies under this head of a doubtful nature, on which I shall make a few ob- servations. Sweating has been recommended in this state of the gout. All the objections to it in preference to other modes of depletion, mentioned in another place*, apply against its use in the inflammatory * Defence of Blood-letting. VOL. II. 2 L 266 OBSERVATIONS ON state of the gout. It is not only less safe than. bleeding, purging, and abstinence, but it is often an impracticable remedy. The only sudorific me- dicine to be trusted in this state of the disease is the Seneka snake-root. It promotes all the secre- tions and excretions, and exerts but a feeble stimu- lus upon the arterial system. ' Many different preparations of opium have been advised in this state of the gout. They are all hurtiul if given before the morbid action of the system is nearly reduced. It should then be given in small doses accommodated to the excitability of the system. Applications of various kinds to the affected limbs have been used in a fit of the gout, and some of them with success. The late Dr. Chalmers of South-Carolina used to meet the pain of the gout as soon as it fixed in any of his limbs, with a blis- ter, and generally removed it by that means in two or three days. I have imitated this practice in se- veral cases, and always with success, nor have I ever seen the gout thrown upon any of the viscera by means of this remedy. Caustics have sometimes been applied to gouty limbs with advantage. The moxa described and used by sir William Temple, which is nothing but culinary fire, has often not THE GOUT. 267 only given relief to a pained limb, but carried off a fit of the gout in a few hours. These powerful applications may be used with equal advantage in those cases in which the gout by falling upon the head produces coma, or symptoms of apoplexy. A large caustic to the neck roused Mr. John M. Nesbit from a coma in which he had lain for three days, and thereby appeared to save his life. Blis- ters, and cataplasms of mustard, had been previ- ously used to different parts of his body, but with- out the least effect. In cases of moderate pain, where a blister has been objected to, I have seen a cabbage leaf afford considerable relief. It produ- ces a moisture upon the part affected, without ex- citing any pain. An old sea captain taught me to apply molasses to a limb inflamed or pained by the gout. I have frequently advised it, and generally with advantage. All volatile and stimulating lini- ments are improper, for they not only endanger a translation of the morbid excitement to the viscera, but where they have not this effect, they increase the pain and inflammation of the part affected. The sooner a patient exercises his lower limbs by walking, after a fit of the gout, the better. " I made it a constant ruje (says Mr. Small) to walk abroad as soon as the inflammatory state of tiie gout was past, and though by so doing, I often 268 OBSERVATIONS ON suffered great pain, I am well convinced that the free use I now enjoy of my limbs is chiefly owing to my determined perseverance in the use of that exercise ; nor am I less persuaded that nine in ten of gouty cripples owe their lameness more to in- dolence, and fear of pain, than to the genuine effects of the gout*." Sir William Temple con- firms the propriety of Mr. Small's opinion and practice, by an account of an old man who obvi- ated a fit of the gout as often as he felt it coming in his feet, by walking in the open air, and after- wards by going into a warm bed, and having the parts well rubbed where the pain began. " By following this course (he says) he was never laid up with the gout, and before his death recommend- ed the same course to his son if ever he should fall into that accident." Under a conviction of the safety of this practice the same author* con- cludes the history of his own case in the following words: "I favoured it [viz. the swelling in my feet] all this while more than I needed, upon the common opinion, that walking too much might draw down the humour, which I have since had reason to conclude is a great mistake, and that if I had walked as much as I could from the first day ' Medical Observations and Inquiries, vol. vi. p. 220. THE GOUT. 269 the pain left me, the swelling might have left me too in a much less time*." III. I come now to mention the remedies which are proper in that state of the gout in which a feeble morbid action takes place in die blood-vessels and viscera. I shall begin this head, by remarking, that this state of the gout is often created, like the typhus state of fever, by the neglect, or too scanty use of evacuations in its first stage. When the prejudices which now prevent the adoption of those remedies in their proper time, are removed, we shall hear but little of the low state of the arthritic fever, nor . of the numerous diseases from obstruction which are produced by the blood-vessels disorganizing the viscera, by repeated and violent attacks of the disease. To determine the character of a paroxysm of gout and the remedies proper to relieve it, the cli- mate, the season of the year, the constitution of the atmosphere, and the nature of the prevailing epidemic, should be carefully attended to by a phy- * Essay upon the Cure of the Gout by Moxa, vol. i. folio edition, p. 143 and 141. 270 OBSERVATIONS ON sician. But his principal dependence should be placed upon the state of the pulse. If it do not discover the marks winch indicate bleeding formerly referred to, but is weak, quick, and soft, the reme- dies should be such as are calculated to produce a more vigorous, and equable action in the blood-ves- sels and viscera. They are, 1. Opium. It should at first be given in small doses, and afterwards increased, as circumstances may require. 2. Madeira or Sherry wine alone, or diluted with water, or in the form of whey, or rendered more cordial by having any agreeable spice infused in it. It may be given cold or warm, according to the taste of the patient, or the state of his stomach. If this medicine be rejected in all the above forms, 3. Porter should be given. It is often retained when no other liquor will lie upon the stomach. I think I once saved the life of Mr. Nesbit by this medicine. It checked a vomiting, from the gout, which seemed to be the last symptom of his depart- ing life. If porter fail of giving relief, 4. Ardent spirits should be given, either alone, ©r in the form of grog, or toddy. Cases have ©c- THE GOUT. 271 curred in which a pint of brandy has been taken in the course of an hour with advantage. Great be- nefit has sometimes been found from Dr. Warner's tincture, in this state of the gout. As these obser- vations may fall into the hands of persons who may not have access to Dr. Warner's book, I shall here insert the receipt for preparing it. Of raisins, sliced and stoned, half a pound. Rhubarb, one ounce. Sena, two drachms. Coriander and fennel seeds, of each one drachm. Cochineal, saffron, and liquorice root, each half a drachm. Infuse them for ten days in a quart of French brandy, then strain it, and add a pint more of bran- dy to the ingredients, afterwards strain it, and mix both tinctures together. Four table spoons full of this cordial are to be taken every hour, mixed with an equal quantity of water, until relief be obtained. Ten drops of laudanum may be added to each dose in those cases in which the cordial does not produce its intended effects, in two or three hours. If all the different forms of ardent spirits which have been mentioned fail of giving relief, 272 OBSERVATIONS ON 5. From 30 drops to a tea spoonful of at her should be given in any agreeable vehicle. Also, 6. Volatile alkali. From five to ten grains of this medicine should be given every two hours. 7. Aromatic substances, such as alspice, ginger, Virginia snake-root, cloves, and mace in the form of teas, have all been useful in this state of the gout. All these remedies are indicated in a more espe- cial manner when the gout affects the stomach. They are likewise proper when it affects the bowels. The laudanum in this case should be given by way of glyster. After the vomiting was checked in Mr. Nesbit by means of porter, he was afflicted with a dull and distressing pain in his bowels^ which was finally removed by two anodyne glys- ters injected daily for two or three weeks. 8. Where the gout produces spasmodic or con- vulsive motions, the oil of amber may be given with advantage. I once saw it remove for a while a convulsive cough from the gout. 9. In cases where the stomach will bear the bark, it should be given in large and frequent doses. It THE GOUT. 273 does the same service in this state of gout, that it does in the slow, or lo v states of fever from any other cause. Where the gout appears in the form of an intermittent, the bark affords the same relief that it does in the same disease from autumnal ex- halations. Mr. Snail found great benefit from it after discharging the contents of his stomach and bowels by a dose of tartar emetic. " I do not call (says this gentleman) a fit of the gout a paroxysm, for there are several paroxysms in the fit, each of which is ushered in with a rigour, sickness at sto- mach, and subsequent heat. In this the gout bears a resemblance to an irregular intermittent, at least to a remitting fever, and hence perhaps the efficacy of the bark in removing the gout*." 10. The warm bath is a powerful remedy in ex- citing a regular and healthy action in the sanguifer- ous system. Where the patient is too weak to be taken out of bed, -and put into a bathing tub, his limbs and body should be wrapped in flannels dip- ped in warm water. In case of a failure of all the above remedies, 11. A salivation should be excited as speedily as possible, by means of mercury. Dr. Cheyne ' Medical Observations and Inquiries, vol. vi. p. 220. VOL. II. 2 M 214 OBSERVATIONS ON commends it in high terms. I have once used it with success. The mercury, when used in this way, brings into action an immense mass of latent excitement, and afterwards diffuses it equally through every part of the body. 12. Besides these internal remedies, frictions with brand,, and volatile liniment, should be used to the stomach and bowels. Blisters should be applied to parts in which congestion or pain is seated, and stimulating cataplasms should be ap- plied to the lower limbs. The flour of mustard has been justly preferred for this purpose. It should be applied to the upper part of the foot. The reader will perceive, in the account I have given of the remedies proper in the feeble state of chronic fever, that they are the same which are used in the common typhus, or what is called nerv- ous fever. There is no reason why they should not be the same, for the supposed two morbid states of the system are but one disease. It is agreeable in medical researches to be under the direction of principles. They render unneces- sary, in many instances, the slow and expensive operations of experience, and thus multiply know- ledge, by lessening labour. The science of navi- c THE COUT. 275 gation has rested upon this basis, since the disco- very of the loadstone. A mariner who has navi- gated a ship to one distant port, is capable of conducting her to every port on the globe. In like manner, the physician who can cure one disease by a knowledge of its principles, may by the si me means cure all the diseases of the human bod}', for their causes are the same. Judgment is required, only in accommodating the force of remedies to the force of each disease. The difference in diseases which arises from their seats, from age, sex, habit, season, and climate, may be known in a short time, and is within the compass of very moderate talents. IV. Were I to enumerate all the local symptoms of gout which occur without fever, and the reme- dies that are proper to relieve them, I should be led into a tedious digression. The reader must con- sult practical books for an account of them. I shall only mention the remedies for a few of them. The theory of the gout which has been deliver- ed, will enable us to understand the reason why a disease which properly belongs to the whole sys- tem, should at any time be accompanied only with local morbid affection. The whole body is a unit, and hence morbid impressions which are resisted by 276 OBSERVATIONS ON sound parts are propagated to such as are weak, where they excite thobe morbid actions we call disease. The head-ach is a distressing symptom of the gout. It yields to depleting or tonic remedies, ac- cording to the degree of morbid action which ac- companies it. I have heard an instance of an old man, who was cured of an obstinate head-ach by throwing aside his nightcap, and sleeping with his bare head exposed to the night air. The disease in this case was probably attended with great morbid action. In this state of the vessels of the brain, cupping, cold applications to the head, purges, a temperate diet, and blisters behind the ears, are all proper remedies, and should be used together, or in succession, as the nature of the disease may re- quire. Many persons have been cured of the same complaint by sleeping in woollen nightcaps. The morbid action in these cases is always of a feeble nature. With this remedy, tonics, particularly the bark and cold bath, will be proper. I have once known a chronic gouty pain in the head cured by an issue in the arm, after pounds of bark, and ma- ny other tonic remedies, had been taken to no purpose. THE GOUT. 277 The ophthalmia from gout should be treated with the usual remedies for that disease when it arises from other causes, with the addition of such local applications to other and distant parts of the body, as may abstract the gouty action from the eyes. Dull but constant pains in the limbs yield to fric- tions, volatile liniments, muslin and woollen worn next to the skin, electricity, a salivation, and the warm and cold bath. A gentleman who was afflict- ed with a pain of this kind for three years and a half in one of his arms, informed me, that he had been cured by wearing a woollen stocking that had been boiled with sulphur in water, for two weeks upon the affected limb. He had previously worn flannel upon it, but without receiving any benefit from it. I have known wool and cotton, finely carded, and made into small mats, worn upon the hips, when affected by gout, with great advantage. In obstinate sciatic pains, without fever or inflam- mation, Dr. Pitcairn's remedy, published by Dr. Cheyne, has peformed many cures. It consists in taking from one to four tea-spoons full of the fine spirit of turpentine every morning, for a week or ten days, in three times the quantity of honey, and afterwards in drinking a large quantity of sack whey, to settle it on the stomach, and carry it into 278 OBSERVATIONS ON the blood. An anodyne should be taken every night after taking this medicine. A gouty diarrhoea should be treated with the usual astringent medicines of the shops. Blisters to the wrists and ankles, also a salivation, have^ often cured it. I have heard of its being checked, after continuing for many years, by the patient eat- ing large quantities of alspice, which he carried loose in his pocket for that purpose. The angina pectoris, which I have said is a symptom of the gout, generally comes on with ful- ness and tension in the pulse. After these are re- duced by two or three bleedings, mineral tonics seldom fail of giving relief. Spasms in the stomach, and pains in the bowels, often seize gouty people in the midst of business or pleasure, or in the middle of the night. My con- stant prescription for these complaints is ten drops of laudanum every half hour, till relief be obtained. If this medicine be taken in the forming state of these pains, a single dose generally removes the dis- ease. It is preferable to spiced wine and spirits, inasmuch as it acts quicker, and leaves no disposi- tion to contract a love for it when it is not required to ease pain. THE GOUT. 279 The pain in the rectum which has been describ- ed, yields to the common remedies for the piles. Cold water applied to the part, generally gives im- mediate relief. For a preternatural secretion and excretion of bile, gentle laxatives, and abstinence from oily food, full meals, and all violent exercises of the body and mind, are proper. The itching in the anus, which I have supposed to be a symptom of gout, has yielded in one instance that has cOme within my knowledge to mercurial ointment applied to the part affected. Dr. Lettsom recommends fomenting the part with a decoction of poppy heads and hemlock, and ad- vises lenient purges and a vegetable diet as a radi- cal cure for the disease*. For the itching in the vagina I have found a so- lution of the sugar of lead in water to be an excel- lent palliative application. Dr. Lettsom recom- mends as a cure for it, the use of bark in delicate habits, and occasional bleeding, with a light and moderate diet, if it occur about the time of the cessation of the menses. * Medical Memoirs, vol. III. 280 OBSERVATIONS ON Obstinate cutaneous eruptions, which are the ef- fects of gout, have been cured by gentle physic, a suitable diet, issues, and applications of the un- guentum citrinum to the parts affected. The arthritic gonorrhoea should be treated with the same remedies as a gonorrhoea from any other cause. In the treatment of all the local symptoms that have been enumerated, it will be of great conse- quence to inquire, before we attempt to cure them, whether they have not succeeded general gout, and thereby relieved the system from its effects in parts essential to life. If this have been the case, the cure of them should be undertaken with caution, and the danger of a local disease being exchanged for a general one, should be obviated by remedies that are calculated to eradicate the gouty diathesis altogether from the system. The means for this purpose, agreeably to our order, come next under our consideration. Before I enter upon this head, I shall premise, that I do not admit of the seeds of die gout remaining in the body to be eliminated by art after a complete termination of one of its paroxysms, any more than I admit of the seeds of a pleurisy or intermitting fever remaining in the body, after they have been cured by blood-letting THE GOUT. 281 or bark. A predisposition only remains in the system to a return of the gout, from its usual re- mote and exciting causes. The contrary idea took its rise in those ages of medicine in which morbific matter was supposed to be the proximate cause of the gout, but it has unfortunately continued since the rejection of that theory. Thus in many cases we see wrong habits continue long after the princi- ples have been discarded, horn which they were derived. I have known several instances in which art, and I have heard and read of others in which acciden- tal suffering from abstinence, pain, and terror have been the happy means of overcoming a predisposi- tion to the gout. A gendeman from one oi the West-India islands, who had been for many years afilicted with the gout, was perfectly cured of it by living a year or two upon the temperate diet of the jail in this city, into which he was thrown for debt by one of his creditors. A large haemorrhage from the foot, inflamed and swelled by the gout, acci- dentally produced by a penknife which fell upon it, effected in an Irish gentleman a lasting cure of the disease. Hildanus mentions the history of a gentleman, whom he knew intimately, who was radically cured of a gout with which he had been long afflicted, by the extreme bodily pain he suf- vol. n. 2 n 282 OBSERVATIONS ON fered innocently from torture in the canton of Berne. He lived to be an old man, and ever after- wards enjoyed good health*. The following let- ter from my brother contains the history of a case in which terror suddenly eradicated the gout from the system. " Reading, July 27th, 1797. " DEAR BROTHER, " WHEN I had the pleasure of seeing you last week, I mentioned an extraordinary cure of the gout in this town, by means of a fright. In compliance with your request, I now send an exact narration of the facts. " Peter Fether, the person cured, is now alive, a householder in Reading, seventy-three years of age, a native of Germany, and a very hearty man. The first fit of the gout he ever had, was about the year 1773 ; and from that time till 1785, he had a regular attack in the spring of every year. His feet, hands, and elbows were much swollen and inflamed; the fits lasted long, and were excruciat- ing. In particular, the last fit in 1785 was so severe, as to induce an apprehension, that it would * Observat. Chirurg. Cent. 1. Cbs. 79. THE GOUT. 283 inevitably carry him off, when he was suddenly relieved by the following accident. " As he lay in a small back room adjoining the ]fard, it happened that one of his sons, in turning a waggon and horses, drove the tongue of the "^[Waggon with such force against the window, near Wwhich the old man fey stretched on a bed, as to beat in the sash ©f the window, and to scatter the pieces of brokei^ glass all about him. To such a degree was he alarme*! by the noise and violence, **that he instantly leaped out of bed, forgot that he had ever usedterutcfieX and eagerly inquired what was the matter. Hi#>vife, hearing the uproar, ran into the room, where, to her astonishment, she found her husbaRFoh his feet, bawling against the author of the mischief, with the most passionate vehemence. From that moment, he has been entkiljrexem'pt from the gout, has never had the slijHSflitoilfn of it, and now enjoys perfect health, has a good appetite, and says he was never heartier [his is probably the more remarkable, lat he has ahvays been used to the farm, and since the year 1785 has frequently mowed in his own meadow, which I understand is low and wet. I am well informed, in his mode of living, he has been temperate, oc- ft inJ|^ife. jfhi wrMR add,»i£ hard work oira 284 OBSERVATIONS ON casionally indulging in a glass of wine, after the manner of the German farmers, but not to excess. " To you, who have been long accustomed to explore diseases, I leave the task of developing the principles, on which this .mysterious restoration J ML from the lowest dejcrepitu&^uid bodily wretched-' 1 ness, to a state of perfect h^Eh? has been accom^F1*^ plished. I well know t^t toothvachs, head-achs, hiccoughs, &c. are often fcemota^l by the sudden impression of fear, and thfflf tney return, again. But to see a debilitated sHItty frame instantlv re-,': stored to vigour; to see the whplesy^|em in a mo- ment, as it were, undergd§B perfect and entire change, and the most inveteg^fcand incurable dis- ease radically expelled, is sure^^&jlfferent thing, and must be acknowledged a very singular and mar- vellous event. If an old mam laBjg&ishing under disease and infirmity, had died 6T in$re* frjjflj^no- ftre* fnahi* n it% \M m body v/ould have been surprised at in hut that he should be absolutely cured, and his constitution re- novated by it, is a most extraordinajr fact,^Afch, while I am compelled to believe by uftxcepBHole evidence, I am totally at a loss to account ,0r.' " I am your sincerely " affectionate brother, " JACOB RUSH." THE GOUT. 285 These facts, and many similar ones which might be mentioned, afford ample encouragement to"*prp- ceed in enumerating the means which are proper to prevent the recurrence of the gout, or, in ^frei* words, to eradicate it from the system. ™ V. I shall first mention the means of preventing the return of that state of the disease which is ac- companied with violent action, and afterwards take notice of the means of preventing the return of that state of it, in which a feeble morbid action takes place in the blood-vessels. The means for this purpose consist in avoiding all the remote, ex- citing, and predisposing causes of the gout which »;**. 4iave been mentioned. I shall say a few words up- on the most important of them, in the order that has been proposed. I. The first remedy for obviating the violent state of gout is, 1. Temperance. This should Jpe regulated in its degrees by the age, habits, and constitution of the patient. A diet consisting wholrf of milk, vege- tables, and simple water, has been found necessary to prevent the recurrence of the gout in some cases. But, in general, fish, eggs, the white meats and weak broths may be taken in small quantities once 286 OBSERVATIONS ON a day, with milk and vegetables at other times. A little salted meat, which affords less nourishment than fresh, may be eaten occasionally. It imparts vigour to the stomach, and prevents dyspepsia from a^liet consisting chiefly of vegetables. The low and acid wines should be avoided, but weak Ma- deira or sherry wine and water, or small beer, may be drunken at meals. The latter liquor was the favourite drink of Dr. Sydenham in his fits of the gout. Strong tea and coffee should not be tasted, where there is reason to believe the habitual use of them has contributed to bring on the disease. From the disposition of the gout to return in the spring and autumn, greater degrees of abstinence in eating and drinking will be necessary at those seasons than at any other time. With this diminu- tion of aliment, gentle purges should be taken, to obviate an attack of the gout. In persons above fifty years of age, an abstemious mode of living should be commenced with great caution. It has sometimes, when entered upon suddenly, and car- ried to its utmost extent, induced fits of the gout, and precipitated death. In such persons, the ab- stractions from their usual diet should be small, and our dependence should be placed upon other means to prevent a return of the disease. THE GOUT. 287 2. Moderate labour and gentle exercise have frequently removed that debility and vibratility in the blood-vessels, on which a predisposition to the gout depends. Hundreds of persons who have been reduced by misfortunes to the necessity of working for their daily bread, have thrown off a gouty diathesis derived from their parents, or ac- quired by personal acts of folly and intemperance. The employments of agriculture afford the most wholesome labour, and walking, the most salutary exercise. To be useful, they should be moderate. The extremes of indolence and bodily activity meet in a point. They both induce debility, which pre- disposes to a recurrence of a fit of the gout. Rid- ing in a carriage, and on horseback, are less pro- per as a means of preventing the disease than walk- ing. Their action upon the body is partial. The lower limbs derive no benefit from it, and on these the violent state of gout generally makes its first attack. In England, many domestic exercises have been contrived for gouty people, such as shuttle-cock, bullets, the chamber-horse, and tire like, but they are all trifling in their effects, com- pared with labour, and exercise in the open air. The efficacy of the former of those prophylactic remedies will appear in a strong pqjnt of light, when we consider, how much the operation of the remote and exciting causes of the gout which act 288 OBSERVATIONS ON more or less upon persons in the humblest ranks of society, are constantly counteracted in their effects, by the daily labour which is necessary for their subsistence. 3. To prevent the recurrence of the gout, cold should be carefully avoided, more especially when it is combined with moisture. Flannel should be worn next to the skin in winter, and muslin in sum- mer, in order to keep up a steady and uniform per- spiration. Fleecy hosiery should be worn in cold weather upon the breast and knees, and the feet should be kept constantly warm and dry by means of socks and cork-soaled shoes. It was by wetting his feet, by standing two or three hours upon the damp ground, that colonel Miles produced the s:out in his stomach and bowels which had nearer destroyed him in the year 1795. 4. Great moderation should be used by persons who are subject to the gout in the exercise of their understandings and passions. Intense study, fear, terror, anger, and even joy, have often excited the disease into action. It has been observed, that the political and military passions act with more force upon the sygtem, than those which are of a social and domestic nature ; hence generals and statesmen are so often afflicted with the gout, and that too, THE GOUT. 289 as was hinted in another place, in moments the most critical and important to the welfare of a na- tion. The combination of the exercises of the un- derstanding, and the passion of avarice in gaining, have often produced an attack of this disease. These facts show the necessity of gouty people subjecting their minds, with all their operations, to the government of reason and religion. The un- derstanding should be exercised only upon light and pleasant subjects. No study should ever be pur- sued till it brings on fatigue ; and, above all things, midnight, and even late studies should be strictly avoided. A gouty man should always be in bed at an early hour. This advice has the sanction of Dr. Sydenham's name, and experience proves its effi- cacy in all chronic diseases. 5. The venereal appetite should be indulged with moderation. And, 6. Costiveness should be prevented by all per- sons who wish to escape a return of violent fits of the gout. Sulphur is an excellent remedy for this purpose. Dr. Cheyne commends it in high terms. His words are, " Sulphur is one of the best re- medies in the intervals of the gout. In the whole extent of the materia medica, I know not a more VOL. n. 2 o 29U OBSERVATIONS ON safe and active medicine*." Two cases have come within my knowledge, in which it has kept off fits of the gout for several years, in persons who had been accustomed to have them once or twice a year. Rhubarb in small quantities chewed, or in the form of pills, may be taken to obviate costive- ness, by persons who object to the habitual use of sulphur. Dr. Cheyne, who is lavish in his praises of that medicine as a gentle laxative, says, he " knew a noble lord of great worth and much gout, who, by taking from the hands of a quack a drachm of rhubarb, tinged with cochineal to disguise it, every morning for six weeks, lived in health, for four years after, without any symptom of itf." I have said that abstinence should be enjoined with more strictness in the spring and autumn, than at any other time, to prevent a return of the gout. From the influence of the weather at those seasons in exciting febrile actions in the system, the loss of a pint of blood will be useful in some cases for the same purpose. It will be the more necessary if the gout has not paid its habitual visits to the sys- tem. The late Dr. Gregory had been accustomed to an attack of the gout every spring. Two sea- * Essny on the Nature and True Method of Treating the Gout, p. 36. t Page 30. THE GOUT. 291 sons passed awray without his feeling any symptoms of it. He began to flatter himself with a hope that the predisposition to the disease had left him. Soon afterwards he died suddenly of an apoplexy. The loss of a few ounces of b:ood at the luual time in which the gout affected him, would proba- bly have protracted his life for many years. In the year 1796, in visiting a patient, I was accidentally introduced into a room where a gentleman from the Delaware state had been lying on his back for near six weeks with an acute fit of the gout. He gave me a history of his sufferings. His pulse was full and tense, and his whole body was covered w ith sweat from the intensity of his pain. He had not had his bowels opened for ten days. I advised purging and bleeding in his case. The very names of those remedies startled him, for he had adopted the opinion of the salutary nature of a fit of the gout, and therefore hugged his chains. After ex- plaining the reason of my prescriptions, he inform- ed me, in support of them, that he had escaped the gout but two years in twenty, and that in one of these two years he had been bled for a fall from his horse, and, in the other, his body had been reduced by a chronic fever, previously to the time of the annual visit of his gout. 292 OBSERVATIONS ON As a proof of the efficacy of active, or passive depletion, in preventing the gout, it has been found that persons who sweat freely, either generally or partially, or who make a great deal of water, are rarely affected by it. An epitome of all that has been said upon the means of preventing a return of the gout, may be delivered in a,few words. A man who has had one fit of it, should consider himself in the same state as a man who has received the seeds of a malignant fever into his blood. He should treat his body as if it were a Florence flask. By this means he wall probably prevent, during his life, the re-excitement of the disease. Are issues proper to prevent the return of the violent state of gout ? I have heard of an instance of an issue in the leg having been effectual for this purpose ; but if the remedies before-mentioned be used in the manner that has been directed, so un- pleasant a remedy can seldom be necessary. Are bitters proper to prevent a return of this state of gout? It will be a sufficient answer to this question to mention, that the duke of Port- land's powder, which is composed of bitter ingre- THE GOUT. 293 dients, excited a fatal gout in many people who used it for that purpose. I should as soon expect to see gold produced by the operations of fire upon copper or lead, as expect to see the gout prevented or cured by any medicine that acted upon the sys- tem, without the aid of more or less of the reme- dies that have been mentioned. II. We come now, in the last place, to mention the remedies which are proper to prevent a return of that state of gout which is attended with a feeble morbid action in the blood-vessels and viscera. This state of gout generally occurs in the evening of life, and in persons of delicate habits, or in such as have had their constitutions worn down by re- peated attacks of the disease. The remedies to prevent it are, 1. A gently stimulating diet, consisting of animal food well cooked, with sound old Madeira or sherry wine, or wreak spirit and water. Salted, and even smoked meat may be taken, in this state of the system, with advantage. It is an agreeable tonic, and is less disposed to create plethora than fresh meat. Pickles and vinegar should seldom be tasted. * They dispose to gouty spasms in the stomach and 294 OBSERVATIONS ON bowels'. Long intervals between meals should be carefully avoided, The stomach, when over- stretched or empty, is always alike predisposed to disease. There are cases in which the evils of in- anition in the stomach will be prevented, by a gouty patient eating in the middle of the night. 2. The use of chalybeate medicines. These are more safe when used habitually, than bitters. I have long been in the practice of giving the differ- ent preparations of iron in large doses, in chronic diseases, and in that state of debility which disposes to them. A lady of a weak constitution informed Dr. Cheyne*, that she once asked Dr. Sydenham how long she might safely take steel. His answer was, that " she might take it for thirty years, and then begin again if she continued ill*." Water impregnated with iron, either by nature or art, may be taken instead of the solid forms of the metal. It will be more useful if it be drunken in a place where patients will have the benefit of country air. 3. The habitual use of the volatile tincture of gum guiacum, and of other cordial and gently sti- * Essay on the Nature, and True Method of Treating the Gout, p. 69. THE GOUT. 295 mulating medicines. A clove of garlic taken once or twice a day, has been found useful in debilitated habits predisposed to the gout. It possesses a wonderful power in bringing latent excitement into action. It moreover acts agreeably upon the nerv- ous system. Mr. Small found great benefit from breakfasting upon a tea made of half a drachm of ginger cut into small slices, in preventing occasional attacks of the gout in his stomach. Sir Joseph Banks was much relieved by a diet of milk, with ginger boiled in it. The root of the sassafras of our country might probably be used with actoantage for the same purpose. Aurelian speaks of certain reme- dies for the gout which he calls " annalia*." The above medicines belong to this class. To be effec- tual, they should be persisted in, not for one year only, but for many years. 4. Warmth, uniformly applied, by means of suit- able dresses, and sitting rooms, to every part of the body. • 5. The warm bath in winter, and the temperate, or cold bath in summer. *' Morborum Chronicorum. Lib. v. Cap. 2. 296 OBSERVATIONS ON 6. Exercise. This may be in a carriage, or on horseback. The viscera being debilitated in this state of predisposition to the gout, are strengthened in a peculiar manner by the gentle motion of a horse. Where this or other modes of passive ex- ercise cannot be had, frictions to the limbs and body should be used every day. 7. Costiveness should be avoided by taking oc- casionally one or two table spoons full of Dr. War- ner's purging tincture prepared by infusing rhubarb, orange peel, and caraway seeds, of each an ounce, for three days in a quart of Madeira, or any other white wine/ Jj.$£his medicine be ineffectual for opening the bow els, rhubarb may be taken in the manner formerly mentioned. 8. The understanding and passions should be constantly employed in agreeable studies and pur- suits. Fatigue of mind and body should be care- fully avoided. 9. A warm climate often protracts life in persons subject to this state of gout. The citizens of Rome who had worn down their constitutions by intemperance, added many years to their lives, by migrating to Naples, and enjoying there, in a warm- er sun, the pure air of the Mediterranean, and sir THE GOUT. 297 William Temple says the Portuguese obtain the same benefit by transporting themselves to the Brazils, after medicine and diet cease to impart vigour to their constitutions in their irative country. Thus have I enumerated the principal remedies for curing and preventing the gout. Most of them are to be met with in books of medicine, but they have been administered by physicians, or taken by patients with so little regard to the different states of the system, that they have in many instances done more harm than good. Solomon places all wisdom, in the management of human affairs, in finding out the proper times for performing certain actions. Skill in medicine, consists in an eminent degree in timing remedies. There is a time to bleed, and a time to withhold the lancet. There is a time to give physic, and a time to trust to the operations of nature. There is a time to eat meat, and there is a time to abstain from it. There is a time to-give tonic medicines, and a time :o reihin from them. In a word, the cure of the gout de- pends wholly upon two thing;,, viz. proper reme- dies, in their proper times, and places. I shall take leave of this disease, by comparing it to a deep and dreary cave in a new country, in which ferocious beasts and venomous reptiles, w ith vei. n. 2 r 298 OBSERVATIONS, &C. numerous ghosts and hobgoblins, are said to re- side. The neighbours point at the entrance of this cave with horror, and tell of the many ravages that have been committed upon their domestic animals, by the cruel tenants which inhabit it. At length a school-boy, careless of his safety, ventures to en- ter this subterraneous cavern, when ! to his great delight, he finds nothing in it but the same kind of stones and water he left behind him upon the sur- face of the earth. In like manner, I have found no other principles necessary to explain the cause of the gout, and no other remedies necessary to cure it, than such as are admitted in explaining the causes, and in prescribing for the most simple and common diseases. OBSERVATIONS UPON THE NATURE AND CURE OF THE HTDROPHOBIA. OBSERVATIONS, &c. IN entering upon the consideration of this formidable disease, I feel myself under an involun- tary impression, somewhat like that which was produced by the order the king of Syria gave to his captains when he was conducting them to bat- tie: " Fight not with small or great, save only with the king of Israel*." In whatever light we con- template the hydrophobia, it may be considered as pre-eminent in power and mortality, over all other diseases. It is now many years since the distress and hor- ror excited by it, both in patients and their friends, led me with great solicitude to investigate its na- ture. I have at length satisfied myself with a the- * II. Chron. xviii. 30. 302 OBSERVATIONS ON ory of it, which, I hope, will lead to a rational and successful mode of treating it. For a history of the symptoms of the disease, and many interesting facts connected with it, I beg leave to refer the reader to Dr. Mease's learned and ingenious inaugural dissertation, published in the year 1792. The remote and exciting causes of the hydropho- bia are as follow: 1. The bite of a rabid animal. Wolves, foxes, cats, as well as dogs, impart the disease. It has been said that blood must be drawn in order to produce it, but I have heard of a case in Lancaster county, in Pennsylvania, in which a severe contu- sion, by the teeth of the rabid animal, without the effusion of a drop of red blood, excited the dis- ease. Happily for mankind, it cannot be commu- nicated by blood, or saliva falling upon sound parts of the body. In Maryland, the negroes eat w7ith safety the flesh of hogs that have perished from the bite of mad dogs; and I have heard of the milk of a cow, at Chestertown, in the same state, having been used without any inconvenience by a whole family, on the very day in w hich she was affected by this disease, and which killed her in a few hours. . 561. THE HYDROPHOBIA. 307 above causes upon them, are determined to the sar liva, in which a change seems to be induced, simi- lar to that which takes place in the perspirable matter of the human species from the operation of similar causes upon it. This matter, it is well known, is the remote cause of the jail fever. No wonder the saliva of a dog should produce a disease of the same kind, after being vitiated by the same causes, and thereby disposed to produce the same Effects. *•' 2. The disease called canine madness, prevails occasionally among dogs at those times in which malignant fevers are epidemic. This will not sur- prise those persons who have been accustomed to observe the prevalence of the influenza and bilious fevers among other domestic animals at a time when they are epidemic among the human species. 3. Dogs, when they are said to be mad, exhibit the usual symptoms of fever, such as a want of ap- petite, great heat, a dull, fierce, red, or watery eye, indisposition to motion, sleepiness, delirium, and madness. The symptom of madness is far from being universal, and hence many dogs are diseased and die with this malignant fever, that are inoffen- sive, and instead of biting, continue to fawn upon their masters. Nor is the disposition of the fever 308 OBSERVATIONS ON to communicate itself by infection universal among dogs any more than the same fever in the human species, and this I suppose to be one reason why many people are bitten by what are called mad dogs, who never suffer any inconvenience from it. 4. A dissection of a dog, by Dr. Cooper, that died with this fever, exhibited all the usual marks of inflammation and effusion which take place in common malignant fevers. I shall in another place mention a fifth argument in favour of the disease in dogs being a malignant fever, from the efficacy of one of the most powerful remedies in that state of fever, having cured it in two instances. II. The disease produced in the human species by the bite of a rabid animal, is a malignant fever. This appears first from its symptoms. These, as recorded by Aurelian, Mead, Fothergill, Plummer, Anioid, Baumgarten, and Morgagni, are chills, great heat, thirst, nausea, a burning sensation in the stomach, vomiting, costiveness; a small, quick, tense, irregular, intermitting, natural, or slow pulse; a cool skin, great sensibility to cold air, partial cold and clammy sweats on the hands, or sweats accom- panied with a warm skin diffused all over the body, difficulty of breathing, sighing, restlessness, hiccup, giddiness, head-ach, delirium, coma, false vision. THE HYDROPHOBIA. 309 dilatation of the pupils, dulness of sight, blindness, glandular swellings, heat of urine, priapism, palpi- tation of the heart, and convulsions. I know that there are cases of hydrophobia upon record, in which there is said to be a total absence of fever. The same thing has been said of the plague. In both cases the supposed absence of fever is the effect of stimulus acting upon the blood-vessels with so much force as to suspend morbid action in them. By abstracting a part of this stimulus, a fever is excited, which soon discovers itself in the pulse and on the skin, and frequently in pains in every part of the body. The dread of water, and the great sensibility of the system to cold air, are said to give a specific character to the hydrophobia; but the former symptom, it has been often seen, oc- curs in diseases from other causes, and the latter has been frequendy observed in the yellow fever. It is no more extraordinary that a fever excited by the bite of a rabid animal should excite a dread of water, than that fevers from other causes should produce aversion from certain aliments, from light, and from sounds of all kinds ; nor is it any more a departure from the known lawrs of stimulants, that the saliva of a mad dog should affect the fauces, than that mercury should affect the salivary glands. Both stimuli appear to act in a specific manner. 310 OBSERVATIONS ON 2. The hydrophobia partakes of the character of a malignant fever, in appearing at different intervals from the time in which the infection is received into the body. These intervals are from one day to five or six months. The small-pox shows it- self in intervals from eight to twenty days, and the plague and yellowr fever from the moment in which the miasmata are inhaled, to nearly the same dis- tance of time. This latitude in the periods at which infectious and contagious matters are brought into action in the body, must be resolved into the influence which the season of the year, the habits of the patients, and the passion of fear have upon them. Where the interval between the time of being bitten, and the appearance of a dread of water, exceeds five or six months, it is probable it may be occasioned by a disease derived from another cause. Such a person is predisposed in common with other people to all the diseases of which the hydrophobia is a symptom. The recollection of the poisonous wound he has received, and its usual consequences, is seldom absent from his mind for months or years. A fever, or an affection of his nerves from their most common causes, cannot fail of exciting in him apprehensions of the disease THE HYDROPHOBIA. 311 which usually follows the accident to which he has been exposed. His fears are then let loose upon his system, and produce in a short time a dread of water which appears to be wholly unconnected with the bite of a rabid animal. Similar instances of the effects of fear upon the human body are to be met with in books of medicine. The pains produced by fear acting upon the imagination in supposed venereal infections, are as real and severe as they are in the worst state of that disease. 3. Blood drawn in the hydrophobia exhibits the same appearances which have been remarked in malignant fevers. In Mr. Bellamy, the gentleman whose case is so minutely related by Dr. Fother- gill, the blood discovered with " slight traces of size, serum remarkably yellow." It was uncom- monly sizy in a boy of Mr. George Oakley whom I saw, and bled for the first time, on the fourth day of his disease, in the beginning of the year 1797. His pulse imparted to the fingers the same kind of quick and tense stroke which is common in an acute inflammatory fever. He died in convul- sions the next day. He had been bitten by a mad dog on one of his temples, three weeks be- fore he discovered any signs of indisposition. There are several other cases upon record, of the blood exhibiting, in this disease, the same appear- 312 OBSERVATIONS ON ances as in common malignant and inflammatory fevers. 4. The hydrophobia accords exactly with malig- nant fevers in its duration. It generally terminates in death, according to its violence, and the habit of the patient, in the first, second, third, fourth, or fifth day, from the time of its attack, and with the same symptoms which attend the last stage of ma- lignant fevers. 5. The body, after death from the hydrophobia, putrifies with the same rapidity that it does after death from a malignant fever in which no depletion has been used. 6 Dissections of bodies which have died of the hydrophobia, exhibit the same appearances which are observed in the bodies of persons who have perished of malignant fevers. These appearances, according to Morgagni and Tauvry*, are marks of inflammation in the throat, oesophagus, trachea, brain, stomach, liver, and bowels. Effusions of water, and congestions of blood in the brain, large quantities of dark-coloured or black bile in the gall-bladder and stomach, mortifications in the * Bibliotheque Choisie de Medecine, tome XV. p. 210. THE HYDROPHOBIA. 313 bowels and bladder, livid spots on the surface of the body, and, above all, the arteries filled with fluid blood, and the veins nearly empty. I am aw^are, that two cases of death from hydrophobia are related by Dr. Vaughan, in which no appear- ance of disease was discovered by dissection in any part of the body. Similar appearances have occa- sionally been met with in persons who have died of malignant fevers. In another place I hope to prove, that we err in placing disease in inflamma- tion, for it is one of its primary effects only, and Jience, as wTas before remarked, it does not take place in many instances in malignant fevers, until the arteries are so far relaxed by two or three bleedings, as to be able to relieve themselves by effusing red blood into serous vessels, and thus to produce that error loci which I shall say hereafter is essential to inflammation*. The existence of * In the 6th volume of the Medical Observations and In- quiries, there is an account of a dissecJon of a person who had been destroyed by taking opium. " No morbid ap- " pearance (says Mr. Whaleley, the surgeon who opened '; the body) was found in any part of the body, except that u the villous coat of the stomach was very slightly inflamed." The stimulus of the opium in this case tither produced an action which transcended inflammation, or destroyed action altogether by its immense force, by which means the more common morbid appearances which follow disease in a dead body could not take place. VOL. II. 2 R 314 OBSERVATIONS ON this grade of action in the arteries may always be known by the presence of sizy blood, and by the more obvious and common symptoms of fever. The remedies for hydrophobia, according to the principles I have endeavoured to establish, divide themselves naturally into two kinds. I. Such as are proper to prevent the disease, after the infection of the rabid animal is received into the body. II. Such as are proper to cure it when formed. The first remedy under the first general head is, abstracting or destroying the virus, by cutting or burning out the wounded part, or by long and fre- quent effusions of water upon it, agreeably to the advice of Dr. Haygarth, in order to wash the saliva from it. The small-pox has been prevented, by cutting out the part in which the puncture was made in the arm with variolous matter. There is no reason why the same practice should not suc- ceed, if used in time, in the hydrophobia. Where it has failed of success, it has probably been used after the poison has contaminated the blood. The wound should be kept open and running for seve- ral months. In this way a servant girl, who was THE HYDROPHOBIA. 315 bitten by the same cat that bit Mr. Bellamy, is supposed by Dr. Fothergill to have escaped the disease. Dr. Weston of Jamaica believes that he prevented the disease by the same means, in two instances. Perhaps an advantage would arise from exciting a good deal of inflammation in the wound. We observe after inoculation, that the more inflam- ed the puncture becomes, and the greater the dis- charge from it, the less fever and eruption follow in the small-pox. A second preventive is a low diet, such as has been often used with success to mitigate the plague and yellow fever. The system, in this case, bends beneath the stimulus of the morbid saliva, and thus obviates or lessens its effects at a future day. During the use of these means to prevent the disease, the utmost care should be taken to keep up our patient's spirits, by inspiring confidence in die remedies prescribed for him. Mercury has been used in order to prevent the disease. There are many well-attested cases upon record, of persons who have been salivated after being bitten by mad animals, in whom the disease did not show itself, but there are an equal number •f cases to be met with, in which a salivation did 316 OBSERVATIONS ON not prevent it. From this it would seem probable, that the saliva did not infect in the cases in which the disease was supposed to have been prevented by the mercury. At the time calomel was used to prepare the body for the small-pox, a salivation was often induced by it. The affection of the sali- vary glands in many instances lessened the number of pock, but I believe in no instance prevented the eruptive fever. I shall say nothing here of the many other medi- c'nes which have been used to prevent the disease. No one of them has, I believe, done any more good, than the boasted specifics which have been used to eradicate the gout, or to procure old age. They appear to have derived their credit from some of the following circumstances accompanying the bite of the animal. 1. The animal may have been angry, but not diseased with a malignant fever such as I have de- scribed. 2. He may have been diseased, but not to such a degree as to have rendered his saliva infectious. 3. The saliva, when infectious, may have been so washed off in passing through the patient's THE HYDROPHOBIA. 317 clothes, as not to have entered the wound made in the flesh. And 4. There may have been no predisposition in the patient to receive the fever. This is often observed in persons exposed to the plague, yellow fever, small-pox, and to the infection of the itch, and the venereal disease. The hydrophobia, like the small-pox, generally comes on with some pain, and inflammation in the part in which the infection was infused into the body, but to this remark, as in the small-pox, there are some exceptions. As soon as the disease discovers itself, whether by pain or inflammation in the wounded part, or by any of the symptoms for- merly mentioned, the first remedy indicated is blood- letting. All the facts which have been mentioned, relative to its cause, symptoms, and the appearances of the body after death, concur to enforce the use of the lancet in this disease. Its affinity to the plague and yellow fever in its force, is an addition- al argument in favour of that remedy. To be ef- fectual, it should be used in the most liberal man- ner. The loss of 100 to 200 ounces of blood will probably be necessaiy in most cases to effect a cure. The pulse should govern the use of the lancet as in other states of fever, taking care not to 318 OBSERVATIONS ON be imposed upon by the absence of frequency in it, in the supposed absence of fever, and of tension in affections of the stomach, bowels, and brain. This practice, in the extent I have recommended it, is justified not only by the theory of the disease, but by its having been used with success in the follow- ing cases. Dr. Nugent cured a woman by two copious bleedings, and afterwards by the use of sweating and cordial medicines. Mr. Wrightson was encouraged by Dr. Nu- gent's success to use the same remedies with the same happy issue in a boy of 15 years of age*. Mr. Falconer cured a young woman of the name of Hannah Moore, by " a copious bleeding," and another depleting remedy to be mentioned here- afterf. Mr. Poupart cured a woman by bleeding until she fainted, and Mr. Berger gives an account of a number of persons being bitten by a rabid animal, * Medical Transactions, vol. ii. p. 192. t Ditto, p. 222. THE HYDROPHOBIA. 319 all of whom died, except two who were saved by bleeding*. In the 40th volume of the Transactions of the Royal Society of London, there is an account of a man being cured of hydrophobia by Dr. Hartiey, by the loss of 120 ounces of blood. Dr. Tilton cured this disease in a woman in the Delaware state by very copious bleeding. The remedy was suggested to the doctor by an account taken from a London magazine of a dreadful hy- drophobia being cured by an accidental and profuse haemorrhage from the temporal arteryf. A case is related by Dr. Innest, of the loss of 116 ounces of blood in seven days having cured this disease. In the patient who was the subject of this cure, the bleeding was used in the most de- pressed, and apparently weak state of the pulse. It rose constantly with the loss of blood. The cases related by Dr. Tilton and Dr. Innes were said to be of a spontaneous nature, but the * Bibliotheque Choisie de Medecine, tome xv. p. 212* t Medical Essays of Edinburgh, vol. i. p. 226. \ Medical Commentaries, vol. iii. p. 496. 320 OBSERVATIONS ON morbid actions were exactly the same in both pa- tients with those which are derived from the bite of a rabid animal. There is but one remote cause of disease, and that is stimulus, and it is of no conse- quence in the disease now under consideration, whether the dread of water be the effect of the saliva of a rabid animal acting upon the fauces, or of a morbid excitement determined to those parts by any other stimulus. The inflammation of the sto- mach depends upon the same kind of morbid ac- tion, whether it be produced by the miasmata of the yellow fever, or the usual remote and exciting causes of the gout. An apoplexy is the same dis- ease when it arises from a contusion by external violence, that it is when it arises spontaneously from the congestion of blood or water in the brain. A dropsy from obstructions in the liver induced by strong drink, does not differ in its proximate cause from the dropsy brought on by the obstruc- tions in the same viscus which are left by a ne- glected, or half cured bilious fever. These re- marks are of extensive application, and, if duly attended to, would deliver us from a mass of error which has been accumulating for ages in medicine: I mean the nomenclature of diseases from their re- gnote causes. It is the most offensive and injuri- ous part of the rubbish of our science. THE HYDROPHOBIA. 321 I grant that bleeding has been used in some in- stances in hydrophobia without effect, but in all such cases it was probably used out of time, or in too sparing a manner. The credit of this remedy has suffered in many other diseases from the same causes. I beg it may not be tried in this disease, by any physician who has not renounced our mo- dern systems of nosology, and adopted, in their ut- most extent, the principles and practice of Botallus and Sydenham in the treatment of malignant fe- vers. Before I quit the subject of blood-letting in hy- drophobia, I have to add, that it has been used with success in two instances in dogs that had ex- hibited all the usual symptoms of what has been called madness. In one case, blood was drawn by cutting off the tail, in the other, by cutting off the ears of the diseased animal. I mention these facts with pleasure, not only because they serve to sup- port the theory and practice which I have endea- voured to establish in this disease, but because they will render it unnecessary to destroy the life of a useful and affectionate animal in order to prevent his spreading it. By curing it in a dog by means of bleeding, we moreover beget confidence in the same remedy in persons who have been bitten by VOL. n. 2 s 522 OBSERVATIONS ON him, and thus lessen the force of the disease, by preventing the operation of fear upon the system. 2. Purges and glysters have been found useful in the hydrophobia. They discharge bile which is frequently vitiated, and reduce morbid action in the stomach and blood-vessels. Dr. Coste ascribes the cure of a young woman in a convent wholly to glysters given five or six times every day. 3. Sweating after bleeding completed the cure of the boy whose case is mentioned by Mr. Wright- son. Dr. Baumgarten speaks highly of this mode of depleting, and says further, that it has never been cured " but by evacuations of some kind." 4. All the advantages which attend a salivation in common malignant fevers, are to be expected from it in the hydrophobia. It aided blood-letting in two persons who were cured by Mr. Falconer and Dr. Le Compt. There are several cases upon record in which musk and opium have afforded evident relief in this disease. A physician in Virginia cured it by large doses of bark and wine. I have no doubt of the efficacy THE HYDROPHOBIA. 323 of these remedies when the disease is attended witii a moderate or feeble morbid action in the system, for I take it for granted, it resembles malignant fe- vers from other causes in appearing in different grades of force. In its more violent and common form, stimulants of all kinds must do harm, unless they are of such a nature, and exhibited in such quantities, as to exceed in their force the stimulus of the disease; but this is not to be expected, more especially as the stomach is for the most part so irritable as sometimes to reject the mildest aliments as '.veil as the most gentle medicines. After the morbid actions in the system have been weakened, tonic remedies would probably be use- ful in accelerating the cure. Blisters and stimulating cataplasms, applied to the feet, might probably be used with the same advantage in the declining state of the disease, that they have been used in the same stage of other malignant fevers. The cold bath, also long immersion in cold wa- ter, have been frequently used in this disease. The former aided the lancet, in the cure of the man whose case is related by Dr. Hartley. There can be no objection to the cold water in either of the 324 OBSERVATIONS ON above forms, provided no dread is excited by it in the mind of the patient. The reader will perceive here that I have deserted an opinion which I formerly held upon the cause and cure of the tetanus. I supposed the hydro- phobia to depend upon debility. This debility I have since been led to consider as partial, depend- ing upon abstraction of excitement from some, and a morbid accumulation of it in other parts of the body. The preternatural excitement predo- minates so far, in most cases of hydrophobia, over debility, that depleting remedies promise more speedily and safely to equalize, and render it natu- ral, than medicines of an opposite character. In the treatment of those cases of hydrophobia which are not derived from the bite of a rabid ani- mal, regard should always be had to its remote and exciting causes, so as to accommodate the reme- dies to them. The imperfection of the present nomenclature of medicine has become die subject of general com- plaint. The mortality of the disease from the bite of a rabid animal, has been increased by its name. The terms hydrophobia and canine madness, con- vey ideas of the symptoms of the disease only, THE HYDROPHOBIA. 325 and of such of them too as are by no means uni- versal. If the theory t have delivered, and the practice I have recommended, be just, it ought to be called the hydrophobic state of fever. This name associates it at once with all the other states of fever, and leads us to treat it with the remedies which are proper in its kindred diseases, and to vary them constantly with the varying state of the system. In reviewing what has been said of this disease, I dare not say that I have not been misled by the principles of fever which I have adopted; but if I have, I hope the reader will not be discouraged by my errors from using his reason in medicine. By contemplating those errors, he may perhaps avoid the shoals upon which I have been wrecked. In all his researches, let him ever remember that there is the same difference between the knowledge of a physician who prescribes for diseases as limited by genera and species, and of one who prescribes under the direction of just principles, that there is between the knowledge we obtain of the nature and extent of the sky, by viewing a few feet of it from the bottom of a well, and viewing from the top of a mountain the whole canopy of heaven. 326 OBSERVATIONS ON Since the first edition of the foregoing observa- tions, I have seen a communication to the editors of the Medical Repository*, by Dr. Physick, which has thrown new light upon this obscure dis- ease, and which, I hope, will aid the remedies that have been proposed, in rendering them more effec- tual for its cure. The doctor supposes death from hydrophobia to be the effect of a sudden and spas- modic constriction of the glottis, inducing suffoca- tion, and that it might be prevented by creating an artificial passage for air into the lungs, whereby life might be continued long enough to admit of the disease being cured by other remedies. The fol- lowing account of a dissection is intended to show the probability of the doctor's proposal being at- tended with success. On the 13tii of September, 1802, I was called, with Dr. Physick, to visit, in consultation with Dr. Griffitts, the son of William Todd, Esq. aged five years, who was ill with the disease called hy- drophobia, brought on by the bite of a mad dog, on the 6th of the preceding month. The wound was small, and on his cheek, near his mouth, two circumstances which are said at all times to increase * Volume V. THE HYDROPHOBIA. 327 the danger of wounds from rabid animals. From the time he was bitten, he used the cold bath daily, and took the infusion, powder, and seeds of the anagallis, in succession, until the 9th of Septem- ber, when he was seized with a fever which at first resembled the remittent of the season. Bleeding, purging, blisters, and the warm bath were prescrib- ed for him, but without success. The last named remedy appeared to afford him some relief, which he manifested by paddling and playing in the water. At the time I saw him he was much agitated, had frequent twitchings, laughed often; but, with this uncommon excitement in his muscles and nerves, his mind was unusually correct in all its operations. He discovered no dread of wTater, except in one instance, when he turned from it with horror. He swallowed occasionally about a spoon full of it at a time, holding the cup in his own hand, as if to pre- vent too great a quantity being poured at once into his throat. The quick manner of his swallowing, and the intervals between each time of doing so, were such as we sometimes observe in persons in the act of dying of acute diseases. Immediately after swallowing water, he looked pale, and panted for breath. He spoke rapidly, and with much diffi- culty. This was more remarkably the case when he attempted to pronounce the words carriage, 328 OBSERVATIONS ON water, and river. After speaking he panted for breath in the same manner that he did after drink- ing. He coughed and breathed as patients do in the moderate grade of the cynanche trachealis. The dog that had bitten him, Mr. Todd informed me, made a similar noise in attempting to bark, a day or two before he was killed. We proposed mak- ing an opening into his windpipe. To this his pa- rents readily consented; but wriile we were pre- paring for the operation, such a change for the worse took place, that we concluded not to perform it. A cold sweat, with a feeble and quick pulse, came on; and he died suddenly, at 12 o'clock at night, about six hours after I first saw him. He re- tained his reason, and a playful humour, till the last minute of his life. An instance of the latter ap- peared in his throwing his handkerchief at his fa- ther just before he expired. The parents consented to our united request to examine his body. Dr. Griffitts being obliged to go into the country, and Dr. Physick being indisposed, I undertook this business the next morning; and, in the presence of Dr. John Dorsey (to whom I gave the dissecting knife), and my pupil Mr. Murduck, I discovered the following appearances. All the muscles of the neck had a livid colour, such as we sometimes ob- serve, after death, in persons who have died of the sore throat. The* muscles employed in deglutition THE HYDROPHOBIA. 329 and speech were suffused with blood. The epi- glottis was inflamed, and the glottis so thickened and contracted, as barely to admit a probe of the common size. The trachea below it was likewise inflamed and thickened, and contained a quantity of mucus in it, such as we observe, now and then, after death from cynanche trachealis. The oeso- phagus exhibited no marks of disease; but the stomach had several inflamed spots upon it, and contained a matter of a brown appearance, and which emitted an offensive odour. From the history of this dissection, and of many others, in which much fewer marks appeared of violent disease, in parts whose actions are essential to life, it is highly probable death is not induced in the ordinary manner in which malignant fevers produce it, but by a sudden or gradual suffocation. It is the temporary closure of this aperture which produces the dread of swallowing liquids: hence the reason why they are swallowed suddenly, and with intervals, in the manner that has been de- scribed ; for, should the glottis be closed during the time of two swallows, in the highly diseased state of the system which takes place in this dis- ease, suffocation would be the immediate and cer- tain consequence. The same difficulty and danger attend the swallowing saliva, and l^ence the symp- vol. ir. 2 t 330 OBSERVATIONS ON torn of spitting, which has been so often taken no- tice of in hydrophobia. Solids are swallowed more easily than fluids, only because they descend by intervals, and because a less closure of the glot- tis is sufficient to favour their passage into the stomach. This remark is confirmed by the fre- quent occurrence of death in the very act of swal- lowing, and that too widi the common symptoms of suffocation. To account for death from this cause, and in the manner that has been described, it will be necessary to recollect, that fresh air is more necessary to the action of the lungs in a fever than in health, and much more so in a fever of a ma- lignant character, such as the hydrophobia appears to be, than in fevers of a milder nature. An aver- sion from swallowing liquids is not peculiar to this disease. It occurs occasionally in the yellow fever. It occurs likewise in die disease which has pre- vailed among the cats, both in Europe and Ame- rica, and probably, in both instances, from a dread of suffocation in consequence of the closure of the glottis, and sudden abstraction of fresh air. The seat of the disease, and the cause of death, being, I hope, thus ascertained, the means of pre- venting death come next under our consideration. Tonic remedies, in all their forms, have been ad- ministered to no purpose. The theory of the dis- i THE HYDROPHOBIA. 331 ease would lead us to expect a remedy for it in blood-letting. But this, though now and then used with success, is not its cure, owing, as we now see, to the mortal seat of the disease being so far removed from the circulation, as not to be affected by die loss of blood in the most liberal quantity, As well might we expect the inflamma- tion and pain of a paronychia, or what is called a felon on* the finger, to be removed by the same remedy. Purging and sweating, though occasion- ally successful, have failed in many instances ; and even a salivation, when excited (which is rarely the case), has not cured it. An artificial aperture into the windpipe alone bids fair to arrest its tendency to death, by removing the symptom which gene-, rally induces it, and thereby giving time for other remedies, which have hitherto been unsuccessful, to produce their usual salutary effects in similar diseases*. In removing faintness, in drawing off the water in ischuria, in composing convulsions, and in stopping haemorrhages in malignant fever, we do not cure the disease, but we prevent death, and thereby gain time for the use of the remedies which are proper to cure it. Laryngotomy, ac- * The hoarse barking, or the total inability of mad dogs i to bark, favours still further the idea that the mortal seat of the disease is in the glottis, and that the remedy which has been proposed is a rational one. ^32 OBSERVATIONS ON Cording to Fourcroy's advice, in diseases of the throat which obstruct respiration, should be pre- ferred to tracheotomy, and the incision should be made in the triangular space between the thyroid and cricoid cartilages. Should this operation be adopted, in order to save life, it will not offer near so much violence to humanity as many other ope- rations. We cut through a large mass of flesh in- to the bladder in extracting a stone. We cut into the cavity of the thorax in the operation for the empyema. We perforate the bones of the head in trepanning ; and we cut through the uterus, in performing the Caesarian operation, in order to save life. The operation of laryngotomy is much less painful and dangerous than any of them ; and be- sides permitting the patient to breathe and to swal- low, it is cacuiated to serve the inferior purpose of lessening the disease of the glottis by means of local depletion. After an aperture has been thus made through the larynx, the remedies should be such as are indicated by the state of the system, particularly by the state of the pulse. In hot cli- mates it is, I believe, generally a disease of feeble re-a^tion, and requires tonic remedies; but in the micfdle and northern states of America it is more commonly attended w ith so much activity and ex- citement of the blood-vessels, as to require copious blood-letting and other depleting remedies. THE HYDROPHOBIA. 333 Should this new mode of attacking this furious disease be adopted, and become generally success- ful, the discovery will place the ingenious gentle. man who suggested it in the first rank of the medi- cal benefactors of mankind. I have only to add a fact upon this subject which may tend to increase confidence in a mode of pre- preventing the disease which has been recommend- ed by Dr. Haygarth, and used with success in se- veral instances. The same dog which bit Mr. Todd's son, bit, at the same time, a cow, a pig, a dog, and a black servant of Mr. Todd's. The cow and pig died ; the dog became mad, and was killed by his master. The black man, who was bitten on one of his fingers, exposed the wound for some time, immediately after he received it, to a stream of pump water, and washed it likewise with soap and water. He happily escaped the disease, and is now in good health. That his wound was poisoned is highly probable, from its having been made eight hours after the last of the above ani- mals was bitten, in which time there can be but little doubt of such a fresh secretion of saliv^. hav- ing taken place as would have produced the hydro- phobia, had it not been prevented by the above simple remedy. I am not, however, so much en- couraged by its happy issue in this case as to advise 534> OBSERVATIONS, &.C. it in preference to cutting out the wounded part. It should only be resorted to where the fears of a patient, or his distance from a surgeon render it impossible to use the knife. i A ;w AN ACCOUNT OF %C THE MEASLES, AS TH^EY APPEARED IN PHILADELPHIA, IN THE SPRING OF 1789. A >i AN ACCOUNT, &c. THE weather in December, 1788, and in January, 1789, was variable, but seldom very cold. On the first of February, 1789, at six o'clock in the morning, the mercury in Fahrenheit's thermo- meter fell 5° below 0, in the city of Philadelphia. At twenty miles from the city, on the Schuylkill, it fell 12° below 0, at the same hour. On the 19th and 20th of this month, there fell a quantity of snow, the depth of which, upon an average, was supposed to be about eight or ten inches. On the 23d, 24th, 25th, and 27th, the weather w^as very cold. The mercury fluctuated during these days between 4° and 10° above 0. In the intervals between these cold days, the weather frequently moderated, so that the Dela- ware was frozen and thawed not less than four vol. n. 2 u 338 AN ACCOUNT OF THE times. It was not navigable till the 8th of March, There were in all, during the winter and month of March, sixteen distinct falls of snow. In April and May there were a few warm days; but upon the whole, it was a very cold and back- ward spring. The peaches failed almost univer- sally. There were no strawberries or cherries on the 24th of May, and every other vegetable pro- duct was equally backward. A country woman of 84 years of age informed me, that it was the coldest spring she had ever known. It was un- comfortable to sit without fire till the first of June. The measles appeared first in the Northern Li- berties, in December. They spread slowly in January, and were not universal in the city till Fe- bruary and March. This disease, like many others, had its precursor. It was either a gum-boil, or a sore on the tongue. They were both very common, but not universal. They occurred, in some instances, several days before the fever, but in general they made their appearance during the eruptive fever, and were a sure mark of the approaching eruption of the measles. I was first led to observe this fact, from having read Dr. Quin's accurate account of the MEASLES IN 1789. 339, measles in Jamaica. I shall now proceed to men- tion the symptoms of the measles as they appeared in the different parts of the body. 1. In the head, they produced great pain, swel- ling of the eye-lids, so as to obstruct the eye-sight, tooth-ach, bleeding at the nose, tinnitus aurium, and deafness ; also coma for two days, and convul- sions. I saw the last symptom only in one instance. It was brought on by a stoppage of a running from the ear. 2. In the throat and lungs, they produced a soreness and hoarseness, acute or dull pains in the breast and sides, and a painful or distressing cough. In one case, this cough continued for two hours without any intermission, attended by copious ex- pectoration. In two cases, I saw a constant invo- luntary discharge of phlegm and mucus from the mouth, without any cough. One of them ter- minated fatally. Spitting of blood occurred in several instances. The symptoms of pneumonia vera notha and typhoides were very common. I saw two fatal cases from pneumonia notha, in both of which the patients died with the trunk of the body in an erect posture. I met with two cases in which there was no cough till the eruption made its appearance on the fourth day, and one which 340 AN ACCOUNT OF THE was accompanied by all the usual symptoms of the cynanche trachealis. 3. In the stomach the measles produced, in ma- ny instances, sickness and vomiting. And 4. In the bowels, griping, diarrhoea, and, in some instances, bloody stools. The diarrhoea oc- curred in every stage of the disease, but it was bloody and most painful in its decline. I attended a black girl who discharged a great many worms, but without the least relief of any of her symptoms. There was a great variety in this disease. 1. In the time of the attack of the fever, from the time of the reception of the contagion. In general the interval was fourteen days, but it frequently appear- ed before, and sometimes later than that period. 2. In the time of the eruption, from the begin- ning of the fever. It generally appeared on the third and fourth days. In one case, Dr. Waters informed me, it did not appear till the eighth day. 3. In the abatement or continuance of the fever after the eruption. MEASLES IN 1789. 341 4. In the colour and figure of the eruption. In some it put on a pale red, in others a deep, and in a few a livid colour, resembling an incipient mor- tification. In some there appeared red blotches, in others an equally diffused redness, and in a few, eruptions like the small-pox, called by Dr. Cullen, rubiola varioloides. 5. In the duration of the eruption on the skin. It remained in most cases only three or four days; but in one, which came under my care, it remained nine days. 6. In the manner of its retrocession. I saw very few cases of its leaving the branny appearance so generally spoken of by authors on the skin. 7. In not affecting many persons, and even fa- milies who were exposed to it, The symptoms which continued in many after the retrocession of the measles, were cough, hoarse- ness, or complete aphonia, which continued in two cases for two weeks; also diarrhoea, opthalmy, a bad taste in the mouth, a defect or excess of appe- tite, and a fever, which in some instances was of the intermitting kind, but which in more assumed the more dangerous form of the typhus mitior. 342 AN ACCOUNT OF THE Two cases of internal dropsy of the brain followed them. One was evidently excited by a fall. They1 bodi ended fatally. During the prevalence of the disease I observed several persons (who had had the measles, and who were closely confined to the rooms of persons ill wdth them) to be affected with a slight cough, sore throat, and even sores in the mouth. I find a si- milar fact taken notice of by Dr. Quier. But I observed further, many children to be af- fected by a fever, cough, and all the other symp- toms of the measles which have been mentioned, ex- cept a general eruption, for in some there was a trifling efflorescence about the neck and breast. I observed the same thing in 1773 and 1783. In my note book I find the following account of the appearance of this disease in children in the year 1773. " The measles appeared in March ; a ca- " tarrh (for by that name I then called it) appear- " ed at the same time, and was often mistaken for " them, the symptoms being nearly the same in " both. In the catarrh there was in some instances " a trifling eruption. A lax often attended it, and " some who had it had an extremely sore mouth." MEASLES IN 1789. 343 I was the more struck with this disease, from finding it was taken notice of by Dr. Sydenham. He calls it a morbillous fever. I likewise find an account of it in the 2d article of the 5th volume of the Edinburgh Medical Essays. The words of the author, who is anonymous, are as follow. " During this measly season, several persons, " who never had the measles, had all the symp- " toms of measles, which went off in a few days *' without any eruptions. The same persons had " the measles months or years afterwards." Is this disease a common fever, marked by the reign- ing epidemic, and produced in the same manner, and by the same causes, as the variolous fever de- scribed by Dr. Sydenham, which he says prevailed at the same time with the small-pox ? I think it is not. My reasons for this opinion are as follow. 1. I never saw it affect any but children, in the degree that has been mentioned, and such only as had never had the measles. 2. It affected whole families at the same time. It proved fatal to one of three children whom it affected on the same day. 3. It terminated in a pulmonary consumption jn a boy of ten years old, with all the symptoms 344 AN ACCOUNT OF THE which attend that disease when it follows the regu- lar measles. 4. It affected a child in one family, on the same day that two other members of the same family were affected by the genuine measles. 5. It appeared on the usual days of the genuine measles, from the time the persons affected by it were exposed to its contagion. And, 6. It communicated the disease in one family, in the usual time in which the disease is taken from the genuine measles. The measles, then, appear to follow the analogy of the small-pox, which affects so superficially as to be taken a second time, and which produce on per- sons who have had them what are called the nurse pock. They follow likew ise the analogy of another disease, viz. the scarlatina anginosa. In the ac- count of the epidemic for 1773, published in the third volume oi the Edinburgh Medical Essays, we are told, that such patients as had previously had the scarlet fever without sore throats, took the sore throat, and had no eruption, while those who had previoiio.y had die sore throat had a scarlet erup- MEASLES IN 1789. 345 tion, but the throat remained free from the distem- per. All other persons who were affected had both. From these facts, I have taken the liberty of galling it the internal measles, to distinguish it from those which are external. I think the dis- covery of this new state of this disease of some application to practice. 1. It will lead us to be cautious in declaring any disease to be the external measles, in which there is not a general eruption. From my ignorance of this, I have been led to commit several mistakes, which were dishonourable to the profession. I was called, during the prevalence of the measles in the above-named season, to visit a girl of twelve years old, with an eruption on the skin. I called it the measles. The mother told me it was im- possible, for that I had in 1783 attended her for the same disease. I suspect the anonymous author before-mentioned has fallen into the same error. He adds to the account before quoted the followr- ing words. " Others, Avho had undergone the il measles formerly, had at this time a fever of the " erysipelatous kind, with eruptions like to which " nettles cause, and all the previous and concomi- «' tant symptoms of the measles, from the begin- " ning to the end of the disease." VOL. II. 2 x 346 AN ACCOUNT OF THE , 2. If inoculation, or any other mode of lessen- ing the violence of the disease, should be adopted, it will be of consequence to know what persons are secure from the attacks of it, and who are still ex- posed to it. I shall now add a short account of my method of treating tiiis disease. Many hundred families came through the dis- ease without the help of a physician. But in many cases it was attended with peculiar danger, and in some with death. I think it was much more fatal than in the years 1773 and 1783, probably owing to the variable weather in the winter, and the coldness and dampness of the succeeding spring. Dr. Huxham says, he once saw the measles attend- ed with peculiar mortality, during a late cold and damp spring in England. It was much more fatal (cseteris paribus) to adults than to young people. The remedies I used were, 1. Bleeding, in all cases where great pain and cough with a hard pulse attended. In some I found it necessary to repeat this remedy. But I met with many cases in which it was forbidden by MEASLES IN 1789. 347 the weakness of the pulse, and by other marks of a feeble action in the blood-vessels. 2. Vomits. These were very useful in remov- ing a nausea; they likewise favoured the eruption of the measles. 3. Demulcent and diluting drinks. These were barley water, bran, and flaxseed tea, dried cherry and raw apple water, also beverage, and cyder and water. The last drink I found to be the most agreeable to my patients of any that have been mentioned. 4. Blisters to the neck, sides, and extremities, according to the symptoms. They were useful in every stage of the disease. 5. Opiates. These were given not only at night, but in small doses during the day, when a trouble- some cough or diarrhoea attended. 6. Where a catarrhal fever ensued, I used bleed- ing and blisters. In those cases in which this fe- ver terminated in an intermittent, or in a mild ty- phus fever, I gave the bark with evident advantage. In that case of measles, formerly mentioned, which was accompanied by symptoms of cynanche tra- 348 AN ACCOUNT OF THE chealis, I gave calomel with the happiest effects, In the admission of fresh air I observed a medium as to its temperature, and accommodated it to the degrees of action in the system. In different parts of the country, in Pennsylvania and New-Jersey, I heard with great pleasure of the cold air being used as freely and as successfully in this disease, as in the inflammatory small-pox. The same people who wTere so much benefited by cool air, I was in- formed, drank plentifully of cold water during every stage of the fever. One thing in favour of this country practice deserves to be mentioned, and that is, evident advantage arose in all the cases which I attended, from patients leaving their beds in the fe- brile state of this disease. But this was practised only by those in whom inflammatory diathesis pre- vailed, for these alone had strength enough to bear it. The convalescent state of this disease required particular attention. 1. A diarrhoea often continued to be trouble- some after other symptoms had abated. I relieved it by opiates and demulcent drinks. Bleeding has been recommended for it, but I did not find it ne- cessaiy in a single case. MEASLES IN 1789. 349 2. An opthalmia which sometimes attended, yielded to astringent collyria and blisters. 3. Where a cough or fever followed so slight as not to require bleeding, I advised a milk and vege- table diet, country air, and moderate warmth ; for whatever might have been the relation of the lungs in the beginning of the disease to cold air, they were now evidently too much debilitated to bear it. 4. It is a common practice to prescribe purges after the measles. After the asthenic state of this disease they certainly do harm. In all cases, the effects of them may be better obviated by diet, full or low, suitable clothing, and gentie exercise, or country air. I omitted them in several cases, and no eruption or disease of any kind followed their disuse. I shall only add to this account of the measles, that in several families, I saw evident advantages from preparing the body for the reception of the contagion^ by means of a vegetable diet. AN ACCOUNT OF THE INFLUENZA, AS IT APPEARED IN PHILADELPHIA, IS THE AVTTJMU OT 1789, IN THE SPRING OF 1790, AND IK THE WINTER »V 1791. AN ACCOUNT, &c. THE latter end of the month of August, in the summer of 1789, was so very cool that fires became agreeable. The month of September was cool, dry, and pleasant. During the whole of this month, and for some days before it began, and af- ter it ended, there had been no rain. In the begin- ning of October, a number of the members of the first congress, that had assembled in New-York, under the present national government, arrived in Philadelphia, much indisposed with colds. They ascribed them to the fatigue and night air to which they had been exposed in travelling in the public stages; but from the number of persons who wrere affected, from the uniformity of their complaints, and from the rapidity with which it spread through our city, it soon became evident that it was the VOL. II. 2 Y 354 OF THE INFLUENZA disease so well known of late years by the name of the influenza. The symptoms which ushered in the disease were generally a hoarseness, a sore throat, a sense of weariness, chills, and a fever. After the disease was formed, it affected more or less the following parts of the body. Many complained of acute pains in the head. These pains were frequently fixed between the eye-balls, and, in three cases which came under my notice, they were terminated by abscesses in the frontal sinus, which discharged themselves through the nose. The pain, in one of these cases, before the rupture of the abscess, wa6 so exquisite, that my patient informed me, that he felt as if he should lose his reason. Many com- plained of a great itching in the eye-lids. In some., the eye-lids were swelled. In others, a copious ef- fusion of water took place from the eyes ; and in a few, there was a true ophthalmia. Many com- plained of great pains in one ear, and some of pains in both ears. In some, these pains terminated in abscesses, which discharged for some days a bloody or purulent matter. In others, there was a swel- ling behind each ear, without a suppuration.— Sneezing was a universal symptom. In some, it occurred not less than fifty times in a day. The !matter discharged from the nose was so acrid as t© i in 1789, 1790, and 1791. 355 inflame the nostrils and the upper lip, in such a manner as to bring on swellings, sores, and scabs in many people. In some, the nose discharged drops, and in a few, streams of blood, to the amount, in one case, of twenty ounces. In many cases, it was so much obstructed, as to render breathing through it difficult. In some, there was" a total defect of taste. In others, there was a bad taste in the mouth, which frequently continued through the whole course of the disease. In some, there was a want of appetite. In others, it was perfectly natural. Some complained of a soreness in their mouths, as if they had been inflamed by holding pepper in them. Some had swelled jaws, and many complained of the tooth-ach. I saw only one case in which the disease produced a coma. Many were affected w ith pains in the breast and sides. A difficulty of breathing attended in some, and a cough was universal. Sometimes this cough alternated with a pain in the head. Sometimes it preceded this pain, and sometimes it followed it. It was at all times distressing. In some instances, it resembled the chin-cough. One person expired in a fit of coughing, and many persons spat blood in consequence of its violence. I saw several pa- tients in whom the disease affected the trachea chiefly, producing great difficulty of breathing. 356 OF THE INFLUENZA and, ill one case, a suppression of the voice, and I heard of another in which the disease, by falling on the trachea, produced a cynanche tracheal is. In most of the cases which terminated fatally, the patients died of pneumonia notha. The stomach was sometimes affected by nau- sea and vomiting; but this was far from being a universal symptom. I met with four cases in which the whole force of the disease fell upon the bowels, and went off in a diarrhoea ; but in general the bowels were regu- lar or costive. The limbs were affected with such acute pains as to be mistaken for the rheumatism, or for the break-bone-fever of 1780. The pains were most acute in the back and thighs. Profuse sweats appeared in many over the whole body in the beginning, but without affording any relief. It was in some instances accompanied by erysipelatous, and in four cases which came to my knowledge, it was followed by miliary eruptions. The pulse was sometimes tense and quick, but seldom full. In a great majority of those whom I visited it was quick, weak, and soft. in 1789, 1790, and 1791. 357 There was no appearance in the urine different from what is common in all fevers. The disease had evident remissions, and the fe- ver seldom continued above three or four days; but the cough, and some other troublesome symp- toms, sometimes continued two or three weeks. In a few persons, the fever terminated in a tedi- ous and dangerous typhus. In several pregnant women it produced uterine haemorrhages and abortions. It affected adults of both sexes alike. A few old people escaped it. It passed by children un- der eight years old with a few exceptions. Out of five and thirty maniacs in the Pennsylvania hos- pital, but three were affected by it. No profes- sion or occupation escaped it. The smell of tar and tobacco did not preserve the persons who worked in them from the disease, nor did the use of tobacco, in snuff, smoking, or chewing, afford a security against it.* * Mr. Howard informs us that the use of tobacco is not a preservative against the plague, as has formerly been sup- posed ; of course that apology for the use of an offensive weed should not be admitted. 358 OF THE INFLUENZA * Even previous and existing diseases did not pro- tect patients from it. It insinuated into sick cham- bers, and blended itself with every species of chro- nic complaint. It was remarkable that persons who worked in the open air, such as sailors, and 'long-shore-men, (to use a mercantile epithet) had it much worse than tradesmen who worked within doors. A body of surveyors, in the eastern woods of Penn- sylvania, suffered extremely from it. Even the vigour of constitution which is imparted by the sa- vage life did not mitigate its violence. Mr. An- drew Ellicott, the geographer of the United States, informed me that he was a witness of its affecting the Indians in the neighbourhood of Niagara with peculiar force. The cough which attended tins disease wras so new and so irritating a complaint among them, that they ascribed it to witchcraft. It proved most fatal on the sea-shore of the United States. Many people who had recovered, were affected a second time with all the symptoms of the disease. I met with a woman, who, after recovering from it in Philadelphia, took it a second time in New-York, and a third time upon her return to Philadelphia. in 1789, 1790, and 1791. S59 Many thousand people had the disease who were not confined to their houses, but transacted busi- ness as usual out of doors. A perpetual'coughing was heard in every street of the city. Buying and selling were rendered tedious by the coughing of the farmer and the citizen who met in market places. It even rendered divine service scarcely intelligible in the churches. A few persons who were exposed to the disease escaped it, and some had it so lightly as scarcely to be sensible of it. Of the persons who were con- fined to their houses, not a fourth part of them kept their beds. It proved fatal (with few exceptions) only to old people, and to persons who had been previously debilitated by consumptive complaints. It likewise carried of several hard drinkers. It terminated in asthma in three persons whose cases came under my notice, and in pulmonary consumption, in many more. I met with an instance in a lady, who was much relieved of a chronic complaint in her liver; and I heard of another instance of a clergyman whose general health was much improved by a se- vere attack of this disease. 360 ©N THE INFLUENZA It was not wholly confined to the human species. It affected two cats, two house-dogs, and one horse, within the sphere of my observations. One of the dogs disturbed his mistress so much by coughing at night, that she gave him ten drops of laudanum for several nights, which perfectly composed him. One of the cats had a vomiting with her cough. The horse breathed as if he had been affected by the cynanche trachealis. The scarlatina anginosa, which prevailed during the summer, disappeared after the first of October; but appeared again after the influenza left the city. Nor was the remitting fever seen during the pre- valence of the reigning epidemic. I inoculated about twenty children for the small- pox during this prevalence of the influenza, and ne- ver saw that disease exhibit a more favourable ap- pearance. In the treatment of the influenza I was governed by the state of the system. Where inflammatory diathesis discovered itself by a full or tense pulse, or where great difficulty of breathing occurred, and the pulse was low and weak in the beginning of the disease, I ordered moderate bleeding. In a in 1789, 1790, and 1791. 361 few cases in which the symptoms of pneumony attended, I bled a second time with advantage. In all these instances of inflammatory affection, I gave the usual antiphlogistic medicines. I found that vomits did not terminate the disease, as they often do a common catarrh, in the course of a day, or of a few hours. In cases where no inflammatory action appeared in the system, I prescribed cordial drinks and diet, and forbad every kind of evacuation. I saw seve- ral instances of persons who had languished for a week "or two with the disease, who wrere suddenly cured by eating a hearty meal, or by drinking half a pint of wine, or a pint of warm punch. In all these cases of weak action in the blood-vessels, liquid laudanum gave great relief, not only by sus- pending the cough, but by easing the pains in the bones. I met with a case of an old lady who was sud- denly and perfecdy cured of her cough by a fright. The duration of this epidemic in our city was about six weeks. It spread from New-York and Philadelphia in all directions, and in the course of a few months pervaded every state in the union. It was carried from the United States to several of vol. n. 2 z 362 OF THE INFLUENZA the West-India islands. It prevailed in the island of Grenada in the month of November, 1789, and it was heard of in the course of the ensuing winter in the. Spanish settlements in South-America. The following winter was unusually mild, inso- much that the navigation of the Delaware was not interrupted during the whole season, only from the 7th to the 24th of February. The weather on the 3d and 4th days of March was very cold, and on the 8th and 9th days of the same month, the mercury in Fahrenheit's thermometer stood at 4° at 7 o'clock in the morning. On the 10th and 11th, there fell a deep snow. The weather during the remaing part of the month was cold, rainy, and variable. It continued to be variable during the month of April. About the middle of the month there fell an unusual quantity of rain. The showers whichfellon thenightofthe 17thwilllongbeconnect- ed in the memories of the citizens of Philadelphia with the time of the death of the celebrated Dr. Franklin. Several pleurisies appeared during this month; also a few cases of measles. In the last week of the month the influenza made its appear- ance. It was brought to the city from New-Eng- land, and affected, in its course, all the intermediate states. Its symptoms were nearly the same as they were in the preceding autumn, but in many people in 1789, 1790, and 1791. 363 it put on some new appearances. Several persons who were affected by it had symptoms of madness, one of whom destroyed himself by jumping out of a window7. Some had no cough, but very acute pains in the back and head. It was remarked that those who had the disease chiefly in the breast the last year, complained now chiefly of their heads, while those whose heads were affected formerly, now complained chiefly of their breasts. In many it put on the type of an intermitting fever. Seve- ral complained of constant chills, or constant sweats ; and some were much alarmed by an un- common blue and dark colour in their hands. J saw one case of ischuria, another of an acute pain in the rectum, a third of anasarca, and a fourth of a palsy in the tongue and arms ; all of which appear- ed to be anomalous symptoms of the influenza. Sneezing, and pains in the ears and frontal sinus, were less common now than they were in the fall; but a pain in the eye-balls was a universal symptom. Some had a pain in the one eye only, and a few had sore eyes, and swellings in the face. Many women who had it, were affected by an irregular appearance of the catamenia. In two persons whom I saw, the cough was incessant for three days, nor could it be composed by any other re- medy than plentiful bleeding. A patient of Dr. Samuel Duffield informed me, after his recovery, 364 OF THE INFLUENZA that he had had no other symptom* of the disease than an efflorescence on his skin, and a large swel- ling in his groin, which terminated in a tedious ab- scess. The prisoners in the jail who had it in the au- tumn, escaped it this spring. During the prevalence of this disease, I saw no sign of any other epidemic. It declined sensibly about the first week in June, and after the 12th day of this month I was not called to a single patient in it. The remedies for it were the same as were used in the fall. I used bleeding in several cases on the second, third, and fourth days of the disease, where it had appeared to be improper in its first stage. The cases which required bleeding were far from being general. I saw two instances of syncope of an alarming nature, after the loss of ten ounces of blood; and I heard of one instance of a boy who died in half an hour after this evacuation. in 1789, 1790, and 1791. 365 I remarked that purges of all kinds worked more violently than usual in this disease. The convalescence from it was very slow7, and a general languor appeared to pervade the citizens for several weeks after it left the city. The month of December, 1790, was extremely and uniformly' cold. In the beginning of the month of January, 1791, the weather moderated, and continued to be pleasant till the 17th, on which day the navigation of the Delaware, wrhich had been completely obstructed by the ice, was opened so as to admit of the arrival of several vessels. During the month of December many people com- plained of colds; but they were ascribed wholly to the weather. In January four or five persons in a family were affected by colds at the same time; which created a suspicion of a return of the influ- enza. This suspicion was soon confirmed by ac- counts of its prevailing in the neighbouring coun- ties of Chester and Montgomery, in Pennsylvania, and in the distant states of Virginia and Rhode- Island. It did not affect near so generally as in the two former times of appearance. There was no difference in the method of treating it. While the common inflammatory diseases of the winter bore the lancet as usual, it wras remarked that pa- 366 OF THE INFLUENZA tients who were attacked by the influenza, did not bear bleeding in a greater proportion, or in a larger quantity, than in the two former times of its appearance in the city. I shall conclude this account of the influenza by the following observations : 1. It exists independently of the sensible quali- ties of the air, and in all kinds of weather. Dr. Patrick Russel has proved the plague to be equally independent of the influence of the sensible qualities of the atmosphere, to a certain degree. 2. The influenza passes with the utmost rapidity through a country, and affects the greatest number of people, in a given time, of any disease in the world. 3. It appears from the histories of it which arc upon record, that neither climate, nor the different states of society, have produced any material change in the disease. This will appear from com- paring the account I have given, with die histories of it which have lately been given by Dr. Grey, Dr. Hamilton, Dr. A. Fothergill, Mr. Chisholm, and other modern physicians. It appears further, that even time itself has not been able materially to in 1789, 1790, and 1791. 367 change the type of this disease. This is evident, from comparing modern accounts of it with those which have been handed down to us by ancient phycicians. I have hinted in a former essay at the diminutives of certain diseases. There is a state of influenza, which is less violent and more local, than that which has been described. It generally prevails in the winter season. It seems to originate from a mor- bid matter, generated in crowded and heated churches, and other assemblies of the people. I have seen a cold, or influenza, frequently universal in Philadelphia, which I have distinctly traced to this source. It would seem as if the same species of diseases resembled pictures, and that while some of them partook of the deep and vivid nature of mosaic work, others appeared like the feeble and transient impressions of water colours. AN INQUIRY INTO THE CAUSE OF ANIMAL LIFE. IN THREE LECTURES, DELIVERED IN THE UNIVERSITY OF PENNSYLVANIA. VOL. II. 3 A % 4N INQUIRY, fcfc. LECTURE I. Gentlemen, MY business in this chair is to teach the institutes of medicine. They have been divided into physiology, pathology, and therapeutics. The objects of the first are, the laws of the human body in its healthy state. The second includes the his- tory of the causes and seats of diseases. The sub- jects of the third are the remedies for those diseases. In entering upon the first part of our course, I am met by a remark delivered by Dr. Hunter in his introductory lectures to his course of anatomy. " In our branch (says the doctor) those teachers who study to captivate young minds with ingeni- ous speculations, will not leave a reputation be- hind them that will outlive them half a century. 372 INQJJIRY INTO THE When they cease from their labours, their labours will be buried along with them. There never was a man more followed and admired in physio- logy, than Dr. Boerhaave. I remember the ve- neration in which he was held. And now, in the space of forty years, his physiology is-----it shocks me to think in what a light it appears*." Painful as this premonition may be to the teachers of physiology, it should not deter them from spe- culating upon physiological subjects. Simple ana- tomy is a mass of dead matter. It is physiology which infuses life into it. A knowledge of the structure of the human body occupies only the me- mory. Physiology introduces it to the higher and more noble faculties of the mind. The compo- nent parts of the body may be compared to the materials of a house, lying without order in a yard. It is physiology, like a skilful architect, which con- nects them together, so as to form from them an elegant and useful building. The writers against physiology resemble, in one particular, the writers against luxury. They forget that the functions they know and describe belong to the science of physiology ; just as the declaimers against luxury forget that all the conveniencies which they enjoy beyond what are possessed in the most simple stage of society, belong to the luxuries, of life. * Lect. xi. p. 198, CAUSE OF ANIMAL LIFE. 373 The anatomist who describes the circulation of the blood, acts the part of a physiologist,, as much as he does, who attempts to explain the functions of the brain. In this respect Dr. Hunter did ho- nour to our science ; for few men ever explained that subject, and many others equally physiologi- cal, with more perspicuity and eloquence, than that illustrious anatomist. Upon all new and difficult subjects there must be pioneers. It has been my lot to be called to this office of hazard and drudge- ry ; and if in discharging its duties I should meet the fate of my predecessors, in this branch of me- dicine, I shall not perish in vain. My errors, like the bodies of those w ho fall in forcing a breach, will serve to compose a bridge for those who shall come after me, in our present difficult enterprise. This consideration, aided by just views of the na- ture and extent of moral obligation, will overba- lance the evils anticipated by Dr. Hunter, from the loss of posthumous fame. Had a prophetic voice whispered in the ear of Dr. Boerhaave in the evening of his life, that in the short period of fort} years, the memory of his physiological works would perish from the earth, I am satisfied, from die knowledge we have of his elevated genius and piety, he would have treated the prediction wi'di the same indifference that he would have done, had he been told, that in the same time, his name 374 INOJJIRY INTO THE should be erased from a pane of glass, in a noisy and vulgar country tavern. The subjects of the lectures I am about to deli- ver, you will find in a syllabus which 1 have pre- pared and published, for the purpose of giving \ ou a succinct view of the extent and connection of our course. Some of these subjects will be new in lectures upon the institutes of medicine, parti- cularly those which relate to morals, metaphysics, and theology. However thorny these questions may appear, we must approach and handle them; for they are intimately connected with the history of the faculties and operations of the human mind; and these form an essential part of the animal eco- nomy. Perhaps it is because physicians have hi- therto been restrained from investigating, and de- ciding upon these subjects, by an erroneous belief that they belong exclusively to another profession, that physiology has so long been an obscure and conjectural science. In beholding the human body, the first thing that strikes us, is its life. This, of course, should be the first object of our inquiries. It is a most im- portant subject; for the end of all the studies of a physician is to preserve life; and this cannot be perfectly done, until we know in whit it consists. CAUSE OF ANIMAL LIFE. 375 I include in animal life, as applied to the human body, motion, sensation, and thought. These three, when united, compose perfect life. It may exist without thought, or sensation; but neither sensa- tion, nor thought, can exist without motion. The lowest grade of life, probably exists in the absence of even motion, as I shall mention hereafter. I have preferred the term motion to those of oscillation and vibration, which have been employed by Dr. Hart- ley in explaining the laws of animal matter; because I conceived it to be more simple, and better adapted to common apprehension. In treating upon this subject, I shall first consider animal life as it appears in the waking and sleeping states in a healthy adult, and shall afterwards in- quire into the modification of its causes in the foe- tal, infant, youthful, and middle states of life, in certain diseases, in different states of society, in different climates, and in different animals. I shall begin by delivering three general proposi- tions. I. Every part of the human body (the nails and hair excepted) is endowed with sensibility, or ex- citability, or with both of them. By sensibility is meant the power of having sensation excited by the 376 INQJ7IRY INTO THE action of impressions. Excitability denotes that property in the human body, by which motion is excited by means of impressions. This property has been called by several other names, such as irri- tability, contractility, mobility, and stimulability. I shall make use of the term excitability, for the most part, in preference to any of them. I mean by it, a capacity of imperceptible, as well as obvi- ous motion. It is of no consequence to our pre- sent inquiries, whether this excitability be a quality of animal matter, or a substance. The latter opi- nion has been maintained by Dr. Girtanner, and has some probability in its favour. II. The whole human body is so formed and connected, that impressions made in the healthy state upon one part, excite motion, or sensation, or both, in every other part of the body. From this view, it appears to be a unit, or a simple and in- divisible quality, or substance. Its capacity for re- ceiving motion, and sensation, is variously modified by means of what are called the senses. It is ex- ternal, and internal. The impressions which act upon it shall be ennumerated in order. III. Life is the effect of certain stimuli acting upon the sensibility and excitability which are ex- tended, in different degrees, over every external CAUSE OF ANIMAL LIFE. 37J and internal part of the body. These stimuli are as necessary to its existence, as air is to flame. Animal life is truly (to use the words of Dr. Brown) " a forced state." I have said the words of Dr. Brown ; for the opinion was delivered by Dr. Cul- len in the university of Edinburgh, in the year 1766, and was detailed by me in this school, many years before the name of Dr. Brown was known as a teacher of medicine. It is true, Dr. Cullen af- terwards deserted it; but it is equally true, I never did ; and the belief of it has been the foun- dation of many of the principles and modes of practice in medicine which I have since adopted. In a lecture which I delivered in the year 1771, I find the following words, which are taken from a manuscript copy of lectures given by Dr. Cullen upon the institutes of medicine. " The human body is not an automaton, or self-moving machine; but is kept alive and in motion, by the constant action of stimuli upon it." In thus ascribing the discovery of the cause of life which I shall endea- vour to establish, to Dr. Cullen, let it not be sup- posed I mean to detract from the genius and merit of Dr. Brown. To his intrepidity in reviving and propagating it, as well as for the many other truths contained in his system of medicine, posterity, I have no doubt, will do him ample justice, after the errors that are blended with them have been VOL. II. 3 b 378 IHQJJIRY INTO THE corrected, by their unsuccessful application to the cure of diseases. Agreeably to our last proposition, I proceed to remark, that the action of the brain, the diastole and systole of the heart, the pulsation of the arte- ries, the contraction of the muscles, the peristaltic motion of the bowels, the absorbing power of the lymphatics, secretion, excretion, hearing, seeing, smelling, taste, and the sense of touch, nay more, thought itself, are all the effects of stimuli acting upon the organs of sense and motion. These sti- muli have been divided into external and internal. The external are light, sound, odours, air, heat, exercise, and the pleasures of the senses. The in- ternal stimuli are food, drinks, chyle, the blood, a certain tension of the glands, which contain secret- ed liquors, and the exercises of the faculties of the mind; each of whlJi I shall treat in the order in which they have been mentioned. I. Of external stimuli. The first of these is light. It is remarkable that the progenitor of the human race was not brought into existence until all die luminaries of heaven were created. Light acts chiefly through the medium of the organs of vision. Its influence upon animal life is feeble, compared with some other stimuli to be mentioned hereafter; C-AUSE OF ANIMAL LIFE. 379 but it has its proportion of force. Sleep has been said to be a tendency to death ; now the absence of light we know invites to sleep, and the return of it excites the waking state. The late Mr. Ritten- house informed me, that for many years he had constantly awoke with the first dawn of the morn- ing light, both in summer and winter. Its influ- ence upon the animal spirits strongly demonstrates its connection with animal life, and hence we find a cheerful and a depressed state of mind in many people, and more especially in invalids, to be inti- mately connected with the presence or absence of the rays of the sun. The well-known pedestrian traveller, Mr. Stewart, in one of his visits to this city, informed me, that he had spent a summer in Lapland, in the latitude of 69°, during the greatest part of which time the sun was seldom out of sight. He enjoyed, he said, during this period, uncom- mon health and spirits, both of which he ascribed to the long duration, and invigorating influence of light. These facts will surprise us less when we attend to the effects of light upon vegetables. Some of them lose their colour by being deprived of it; many of them discover a partiality to it in the di- rection of their flowers; and all of them discharge their pure air only while they are exposed to it*. * " Organization, sensation, spontaneous motion, and life, exist only at the surface of the earth, and in places exposed 380 INQJJIRY INTO THE 2. Sound has an extensive influence upon hu- man life. Its numerous artificial and natural sour- ces need not be mentioned. I shall only take no- tice, that the currents of winds, the passage of insects through the air, and even the growth of vegetables, are all attended with an emission of sound; and although they become imperceptible from habit, yet there is reason to believe they all act upon die body, through the medium of the ears. The existence of these sounds is established by the reports of persons who have ascended two or three miles from the earth in a balloon. They tell *us that the silence which prevails in those re- gions of the air is so new and complete, as to pro- duce an awful solemnity in their minds. It is not necessaiy that these sounds should excite sensation or perception, in order to their exerting a degree of stimulus upon the body. There are a hundred impressions daily made upon it, which from habit are not followed by sensation. The stimulus of aliment upon the stomach, and of blood upon the heart and arteries, probably cease to be felt, only to light. We might affirm the flame of Prometheus's torch was the expression of a philosophical truth that did not es- cape the ancients. Without light, nature was lifeless, ina- nimate, and dead. A benevolent God, by producing life, has spread organization, sensation, and thought over the surface of the earth."—Lavoisier. OAUSE OF ANIMAL LIFE. 381 from the influence of habit. The exercise of walk- ing, which was originally the result of a deliberate act of the will, is performed from habit without the least degree of consciousness. It is unfortunate for this, and many other parts of physiology, that we forget what passed in our minds the first two or three years of our lives. Could we recollect the manner in which we acquired our first ideas, and the progress of our knowledge with the evolution of our senses and faculties, it would relieve us from many difficulties and controversies upon this subject. Perhaps this forgetfulness by children, of the origin and progress of their knowledge, might be remedied by our attending more closely to the first effects of impressions, sensation, and perception upon them, as discovered by their little actions; all of which probably have a meaning, as determined as any of the actions of men or women. The influence of sounds of a certain kind in pro- ducing excitement, and thereby increasing life, cannot be denied. Fear produces debility, which is a tendency to death. Sound obviates this debi- lity, and thus restores the system to the natural and healthy grade of life. The school-boy and the clown invigorate their feeble and trembling limbs by whistling or singing as they pass by a country' church-yard, and the soldi«r feels his departing life 382 INQJJIRY INTO THE recalled in the onset of a battle by the noise of the fife, and of the poet's " spirit stirring drum." In- toxication is frequently attended with a higher de- gree of life than is natural. Now sound we know will produce this with a very moderate portion of fermented liquor; hence we find men are more easily and highly excited by it at public entertain- ments where there is music, loud talking, and hal- looing, than in private companies where there is no auxiliary stimulus added to that of the wine. I wish these effects of sound upon animal life to be remembered; for I shall mention it hereafter as a remedy for the weak state of life in many diseases, and shall relate an instance in which a scream sud- denly extorted by grief, proved the means of re- suscitating a person who was supposed to be dead, and who had exhibited the usual recent marks of the extinction of life. I shall conclude this head by remarking, that persons who are destitute of hearing and seeing possess life in a more languid state than other peo, pie ; and hence arise the dulness and want of spi. rits which they discover in their intercourse with the world. 3. Odours have a sensible effect in promoting animal life. The greater healthiness of the conn- CAUSE OF ANIMAL LIFE. 383 try, than cities, is derived in part from the effluvia of odoriferous plants, which float in the atmosphere in the spring and summer months, acting upon the system, through the medium of the sense of smelling. The effects of odours upon animal life appear still more obvious in the sudden revival of it, which they produce in cases of fainting. Here the smell of a few drops of hartshorn, or even of a burnt feather, has frequently in a few minutes restored the system, from a state of weakness bor- dering upon death, to an equable and regular de- gree of excitement. 4. Air acts as a powerful stimulus upon the sys- tem, through the medium of the lungs. The com- ponent parts of this fluid, and its decomposition in the lungs, will be considered in another place*. I shall only remark here, that the circulation of the * It is probable, the first impulse of life was imparted to the body of Adam by the decomposition of air in his lungs. I infer this from the account given by Moses of his creation, in Genesis, chap. ii. v. 7. " And the Lord God formed man of the dust of the ground, and breathed into his nostrils the breath of life," in consequence of which, the verse adds, he became " a living soul." This explanation of the origin of life in the father of the human race, appears to accord more with reason, as well as the order of the words which de- scribe it, than the common opinion of his having been ani- mated by the infusion ©fa living soul into his body. 384, fNqumY INTO THE blood has been ascribed, by Dr. Goodwin, exclu- sively to the action of air upon the lungs and heart. Does the external air act upon any other part of the body besides those which have been mentioned? It is probable it does, and that we lose our sensa- tion and consciousness of it by habit. It is certain children cry, for the most part, as soon as they come into the world. May not this be the effect of the sudden impression of air upon the tender surface of their bodies ? And may not the red co- lour of their skins be occasioned by an irritation excited on them by the stimulus of the air ? It is certain it acts powerfully upon denudated animal fibres ; for who has not observed a sore, and even the skin when deprived of its cuticle, to be affected, when long exposed to the air, with pain and inflam- mation? The stimulus of air, in promoting the natural actions of the alimentary canal, cannot be doubted. A certain portion of it seems to be ne- cessarily present in the bowels in a healthy state. 5. Heat is a uniform and active stimulus in pro- moting life. It is derived, in certain seasons and countries, in part from the sun ; but its principal source is from the lungs, in which it appears to be generated by the decomposition of pure air, and from whence it is conveyed, by means of the circu- lation, to every part of the body. The extensive CAUSE OF ANIMAL LIFE. 38i) influence of heat upon animal life, is evident from its decay and suspension during the winter in cer-r tain animals, and from its revival upon the approach and action of the vernal sun. It is true, life is di- minished much less in man, from the distance and absence of the sun, than in other animals ; but this must be ascribed to his possessing reason in so high a degree, as to enable him to supply the abstraction of heat, by the action of other stimuli upon his system. 6. Exercise acts as a stimulus upon the body in various ways. Its first impression is upon the mus- cles. These act upon the blood-vessels, and they upon the nerves and brain. The necessity of ex- ercise to animal life is indicated, by its being kindly imposed upon man in paradise. The change which the human body underwent by the fall, rendered the same salutary stimulus necessary to its life, in the more active form of labour. But we are not to suppose, that motion is excited in the body by ex- ercise or labour alone. It is constantly stimulated by the positions of standing, sitting, and lying upon the sides ; all of which act more or less upon mus- cular fibres, and by their means, upon every part of the system. VOL. II. 3 c 386 INOJJIR\r INTO THE 7. The pleasures we derive from our senses have a powerful and extensive influence upon human life. The number of these pleasures, and their proximate cause, will form an agreeable subject for two or three future lectures. We proceed next to consider the internal stimuli which produce animal life. These are I. Food. This acts in the following ways. 1. Upon the tongue. Such are the sensibility and excitability of this organ, and so intimate is its con- nection with every other part of the body, that the whole system is invigorated by aliment, as soon as it comes in contact with it. 2. By mastication. This moves a number of muscles and blood-ves- sels situated near the brain and heart, and of course imparts impressions to them. 3. By deglutition, which acts upon similar parts, and with the same effect. 4. By its presence in the stomach, in which it acts by its quantity and quality. Food, by distending the stomach, stimulates the contigu- ous parts of the body. A moderate degree of dis- tention of the stomach and bowels is essential to a healthy excitement of the system. Vegetable ali- ment and drinks, which contain less nourishment than animal food, serve this purpose in the human body. Hay acts in the same manner in a horse. CAUSE OF ANIMAL LIFE. 387 Sixteen pounds of this light food in a day are ne- cessary to keep up such a degree of distension in the stomach and bowrels of this animal, as to impart to him his natural grade of strength and life. The quality of food, when of a stimulating nature, sup- plies the place of its distension from its quantity. A single onion will support a lounging highlander on the hills of Scotland for four and twenty hours. A moderate quantity of salted meat, or a few ounces of sugar, have supplied the place of pounds of less stimulating food. Even indigestible substances, which remain for days, or perhaps weeks in the stomach, exert a stimulus there which has an in- fluence upon animal life. It is in this way the tops of briars, and the twigs of trees, devoid not only of nourishing matter, but of juices, support the camel in his journies through the deserts of the eastern countries. Chips of cedar posts moistened with water have supported horses for two or three weeks, during a long voyage from Boston to Suri- nam ; and the indigestible cover of an old Bible pre- served the life of a dog, accidentally confined in a room at Newcastle upon Tyne, for twenty days. 5. Food stimulates the whole body by means of the process of digestion which goes forward in the sto- mach. This animal function is carried on by a process, in which there is probably an extrication of 388 INOJJIRY INTO THE heat and air. Now both these, it has been re, marked, exert a stimulus in promoting animal life. Drinks, when they consist of fermented or dis- tilled liquors, stimulate from their quality; but when they consist of water, either in its simple state, or impregnated with any sapid substance, they act principally by distention. II. The chyle acts upon the lacteals, mesenteric glands, and thoracic duct, in its passage through them; and it is highly probable, its first mixture with the blood in the subclavian vein, and its first action on the heart, are attended with considerable stimulating effects. III. The blood is a very important internal sti- mulus. It has been disputed whether it acts by its quality, or only by distending the blood-vessels. It appears to act in both w^ays. I believe with Dr. Whytt, that the blood stimulates the heart and ar- teries by a specific action. But if this be not ad- mitted, its influence in extending the blood-vessels in every part of the body, and thereby imparting extensive and uniform impressions to'every animal fibre, cannot be denied. In support of this asser- tion it has been remarked, that in those persons CAUSE OF ANIMAL LIFE. 389 who die of hunger, there is no diminution of the quantity of blood in the large blood-vessels. IV. A certain tension of the glands, and of other parts of the body, contributes to support animal life. This is evident in the vigour which is im- parted to the system, by the fulness of the seminal vesicles and gall bladder, and by the distension of the uterus in pregnancy. This distension is so great, in some instances, as to prevent sleep for many days and even weeks before delivery. It serves the valuable purpose of rendering the female system less liable to death during its continuance, than at any other time. By increasing the quantity of life in the body, it often suspends the fatal issue of pulmonary consumption, and ensures a tempo- rary victory over the plague and other malignant fevers; for death, from those diseases, seldom takes place, until the stimulus, from the distension of the uterus, is removed by parturition. V. The exercises of the faculties of the mind have a wonderful influence in increasing the quan- tity of human life. They all act by reflection only, after having been previously excited into action by impressions made upon the body. This view of the re-action of the mind upon the body accords with the simplicity of other operations in the ana- 390 INQUIRY INTO THE mal economy. It is thus the brain repays the heart for the blood it conveys to it, by re-acting upon its muscular fibres. The influence of the different faculties of the mind is felt in the pulse, in the stomach, and in the liver, and is seen in the face, and other external parts of the body. Those which act most unequivocally in promoting life are the understanding, the imagination, and the passions. Thinking belongs to the understanding, and is at- tended with an obvious influence upon the degree and duration of life. Intense study has often ren- dered the body insensible to the debilitating effects of cold and hunger. Men of great and active un- derstandings, who blend with their studies tempe- rance and exercise, are generally long lived. In support of this assertion, a hundred names might be added to those of Newton and Franklin. Its truth will be more fully established by attending to the state of human life in persons of an opposite intellectual character. The cretins, a race of idiots in Valais, in Switzerland, travellers tell us, are all short lived. Common language justifies the opi- nion of the stimulus of the understanding upon the brain : hence it is common to say of dull men, that they have scarcely ideas enough to keep themselves awake. CAUSE OF ANIMAL LIFE. 391 The imagination acts with great force upon the body, whether its numerous associations produce pleasure or pain. But the passions pour a constant stream upon the wheels of life. They have been subdivided into emotions and passions properly so called. The former have for their objects present, the latter, future good and evil. All the objects of the passions are accompanied with desire or aversion. To the former belong chiefly, hope, love, ambition, and avarice ; to the latter, fear, ha- tred, malice, envy, and the like. Joy, anger, and terror, belong to the class of emotions. The pas- sions and emotions have been further divided into stimulating and sedative; Our business at present is to consider their first effect only upon the body. In the original constitution of human nature, we were made to be stimulated by such passions and emotions only as have moral good for their objects. Man was designed to be always under the influence of hope, love, and joy. By the loss of his inno- cence, he has subjected himself to the dominion of passions and emotions of a malignant nature ; but they possess, in common with such as are good, a stimulus which renders them subservient to the purpose of promoting animal life. It is true, they are like the stimulus of a dislocated bone in their operation upon the body, compared with the action of antagonist muscles stretched over bones, which 392 FNQJJIRY INTO THE gently move in their natural sockets. The effects of the good passions and emotions, in promoting health and longevity, have been taken notice of by many writers. They produce a flame, gentle and pleasant, like oil perfumed with frankincense in the lamp of life. There are instances likewise of per- sons who have derived strength and long life from the influence of the evil passions and emotions that have been mentioned. Dr. Darwin relates the history of a man, who used to overcome the fa- tigue induced by travelling, by thinking of a per- son whom he hated. The debmty induced by disease is often removed by a sudden change in the temper. This is so common, that even nurses predict a recovery in persons as soon as they be- come peevish and ill-natured, after having been patient during the worst stage of their sickness. This peevishness acts as a gentle stimulus upon the system in its languid state, and thus turns the scale in favour of life and health. The famous Benjamin Lay, of this state, who lived to be eighty years of age, was of a very irascible temper. Old Elwres was a prodigy of avarice, and every court in Europe furnishes instances of men who have at- tained to extreme old age, who have lived constantly under the dominion of ambition. In the course of a long inquiry which I instituted some years ago into the state of the body and mind in old people, GtAUSE OF ANIMAL LIFE. 393 I did not find a single person above eighty, who had not possessed an active understanding, or active passions. Those different and opposite faculties of the mind, when in excess, happily supply the place of each other. Where they unite their forces, they extinguish the flame of life, before the oil which feeds it is consumed. In another place I shall resume the influence of the faculties of the mind upon human life, as they discover themselves in the different pursuits of men. I have only to add here, that I see no occasion to admit, with the followers of Dr. Brown, that the mind is active in sleep, in preserving the mo- tions of life. I hope to establish hereafter the opinion of Mr. Locke, that the mind is always pas- sive in sound sleep. It is true it acts in dreams; but these depend upon a morbid state of the brain, and therefore do not belong to the present stage of our subject, for I am now considering animal life only in the healthy state of the body. I shall say presently, that dreams are intended to supply the absence of some natural stimulus, and hence we find they occur in those persons most commonly, in whom there is a want of healthy action in the system, induced by the excess or deficiency of cu> tomary stimuli. vol. n. 3 © 394 INOJJIRY INTO THE Life is in a languid state in the morning. It ac- quires vigour by the gradual, and successive appli- cation of stimuli in the forenoon. It is in its most perfect state about mid-day, and remains stationary for some hours. From the diminution of the sen- sibility and contractility of the system to the action of impressions, it lessens in the evening, and be- comes again languid at bed-time. These facts w ill admit of an extensive application hereafter in our lectures upon the practice of physic. CAUSE OF ANIMAL LIFE. 395 LECTURE It Gentlemen, THE stimuli which have been enumerated^ when they act collectively, and within certain bounds, produce a healthy waking state. But they do not always act collectively, nor in the determin- ed and regular manner that has been described. There is, in many states of the system, a deficiency of some stimuli, and, in some of its states, an ap- parent absence of them all. To account for the continuance of animal life under such circumstan- ces, two things must be premised, before we pro- ceed to take notice of the diminution or absence of the stimuli which support it. 1. The healthy actions of the body in the wak- ing state consist in a proper degree of what has been called excitability and excitement. The for- mer is the medium on which stimuli act in pro- ducing the latter. In an exact proportion, and a due relation of both, diffused uniformly throughout every part of the body, consists good health. Dis- 396 . INQJIIRY INTO THE ease is the reverse of this. It depends in part up- on a disproportion between excitement and excita- bility, and in a partial distribution of each of them. In thus distinguishing the different states of excite- ment and excitability in health and sickness, you see I dissent from Dr. Brown, who supposes them to be (though disproportioned to each other) equa- bly diffused in the morbid, as well as the healthy state of the body. 2. It is a law of the system, that the absence of one natural stimulus is generally supplied by the increased action of others. This is more certainly the case where a natural stimulus is abstracted sud- denly; for the excitability is thereby so instantly formed and accumulated, as to furnish a highly sen- sible and moveable surface for the remaining sti- muli to act upon. Many proofs might be adduced in support of this proposition. The reduction of the excitement of the blood-vessels, by means of cold, prepares the way for a full meal, or a warm bed, to excite in them the morbid actions which take place in a pleurisy or a rheumatism. A horse in a cold stable eats more than in a warm one, and thus counteracts the debility which would other- wise be induced upon his system, by the abstrac- tion of the stimulus of warm air. CAUSE OF ANIMAL LIFE. 397 These two propositions being admitted, I pro- ceed next to inquire into the different degrees and states of animal life. The first departure from its ordinary and perfect state which strikes us, is in I. Sleep. This is either natural or artificial. Natural sleep is induced by a diminution or' the ex- citement and excitability of the system, by the con- tinued application of the stimuli which act upon the body in its waking state. When these stimuli act in a determined degree, that is, when the same number of stimuli act with the same force, and for the same time, upon the system, sleep will be brought on at the same hour every night. But when they act with uncommon force, or for an un- usual time, it is brought on at an earlier hour. Thus a long walk or ride, by persons accustomed to a sedentary life, unusual exercise of the under- standing, the action of strong passions or emo- tions, and the continual application of unusual sounds seldom fail of inducing premature sleep. It is recorded of pope Ganganelli, that he slept more soundly, and longer than usual, the night after he was raised to the papal chair. The effects of unusual sounds in bringing on premature sleep, is further demonstrated by that constant inclination to retire to bed at an early hour, which country 398 INQJJIRY INTO THE people discover the first and second days they spend in a city, exposed from morning till night to the noise of hammers, files, and looms, or of drays, carts, waggons, and coaches, rattling over pavements of stone. Sleep is further hastened by the absence of light, the cessation of sounds and labour, and the recumbent posture of the body on a soft bed. Artificial sleep may be induced at any time by eertain stimulating substances, particularly by opi- um. They act by carrying the system beyond the healthy grade of excitement, to a degree of indi- rect debility, which Dr. Brown has happily called the sleeping point. The same point may be in- duced in the system at any time by the artificial abstraction of the usual stimuli of life. For exam- ple, let a person shut himself up at mid-day in a dark room, remote from noise of all kinds, let him lie down upon his back upon a soft bed in a tempe- rate state of the atmosphere, and let him cease to think upon interesting subjects, or let him think only upon one subject, and he will soon fall asleep. Dr. Boerhaave relates an instance of a Dutch phy- sician, who, having persuaded himself that waking was a violent state, and sleep the only natural one of the system, contrived, by abstracting every kind of stimulus in the manner that has been mentioned, CAUSE OF ANIMAL LIFE. 399 to sleep away whole days and nights, until at length he impaired his understanding, and finally perished in a public hospital in a state of idiotism. In thus anticipating a view of the cause of sleep, I have said nothing of the effects of diseases of the brain in inducing it. These belong to another part of our course. The short explanation I have given of its cause was necessary in order to ren- der the history of animal life, in that state of the system, more intelligible. At the usual hour of sleep there is an abstraction of the stimuli of light, sound, and muscular motion. The stimuli which remain, and act with an increas- ed force upon the body in sleep, are 1. The heat which is discharged from the body, and confined by means of bed-clothes. It is most perceptible when exhaled from a bed-fellow. Heat obtained in this way has sometimes been employed to restore declining life to the bodies of old people. Witness the damsel who lay for this purpose in the bosom of the king of Israel. The advantage of this external heat will appear further, w hen we con- sider how impracticable or imperfect sleep is, when We lie under too light covering in cold weather. 400 INQJJIRY INTO THE 2. The air which is applied to the lungs during sleep probably acts with more force than in the waking state. I am disposed to believe that more air is phlogisticated in sleep than at any other time, for the smell of a close room in which a person has slept one night, we know, is much more disagree- able than that of a room, under equal circumstances, in which half a dozen people have sat for the same number of hours in the day time. The action of decomposed air on the lungs and heart was spoken of in a former lecture. An increase in its quantity must necessarily have a powerful influence upon animal life during the sleeping state. 3. Respiration is performed with a greater ex- tension and contraction of the muscles of the breast in sleep than in the waking state ; and this cannot fail of increasing the impetus of the blood in its passage through the heart and blood-vessels. The increase of the fulness and force of the pulse in sleep, is probably owing in part to the action of respiration upon it. In another place I hope to elevate the rank of the blood-vessels in the animal economy, by showing that they are the fountains of power in the body. The^" derive this pre-emi- nence from the protection and support they afford to every part of the system. They are the perpe- CAUSE OF ANIMAL LIFE. 401 tual centinels of health and life; for they never partake in the repose which is enjoyed by the mus- cles and nerves. During sleep, their sensibility seems to be converted into contractility, by which means their muscular fibres are more easily moved by the blood than in the waking state. The dimi- nution of sensibility in sleep is proved by many facts to be mentioned hereafter; and the change of sensibility into contractility will appear, when we come to consider the state of animal life in infancy and old age. 4. Aliment in the stomach acts more powerfully in sleep than in the waking state. This is evident from digestion going on more rapidly when we are awake than when we sleep. The more slow the digestion, the greater is the stimulus of the aliment in the stomach. Of this we have many proofs in daily life. Labourers object to milk as a . breakfast, because it digests too soon; and often call for food in a morning, which they can feel all day in their stomachs. Sausages, fat pork, and onions are generally preferred by them for this purpose. A moderate supper is favourable to easy and sound sleep; and the want of it, in persons who are accustomed to that meal, is often followed by a restless night. The absence of its stimulus is probably supplied by a full gall-bladder (which al- vol. n. 3 E 402 INQJJIRY INTO THE ways attends an empty stomach) in persons who are not in the habit of eating suppers. 5. The stimulus of the urine, accumulated in the bladder during sleep, has a perceptible influence. upon animal life. It is often so considerable as to interrupt sleep; and it is one of the causes of our waking at a regular hour in the morning. It is moreover a frequent cause of the activity of the un- derstanding and passions in dreams; and hence we dream more in our morning slumbers, when the bladder is full, than we do in the begining or mid- dle of the night. 6. The fasces exert a constant stimulus upon the bowels in sleep. This is so considerable as to ren- der it less profound when they have been accumu- lated for two or three days, or when they have been »• deposited in the extremity of the alimentary canal. 7. The partial and irregular exercises of the un- derstanding and passions in dreams have an occa- sional influence in promoting life. They occur only where there is a deficiency of other stimuli. Such is the force with which the mind acts upon the body in dreams, that Dr. Brambilla, physician to the emperor of Germany, informs us, that he has seen instances of wounds in soldiers being inflamed, an«l CAUSE OF ANIMAL LIFE. 4@$ putting on a gangrenous appearance in consequence of the commotions excited in their bodies by irri- tating dreams*. The stimulating passions act through the medium of the will; and the exercises of this faculty of the mind sometimes extend so far as to produce actions in the muscles of the limbs, and occasionally in the whole body, as we see in persons who walk in their sleep. The stimulus of lust often awakens u^ with pleasure or pain, accord- ing as we are disposed to respect or disobey the precepts of our Maker. The angry and revengeful passions often deliver us, in like manner, from the imaginary guilt of murder. Even the debilitating passions of grief and fear produce an indirect ope- ration upon the system that is favourable to life in sleep, for they excite that distressing disease called the night mare, which prompts us to speak, or hal- loo, and by thus invigorating respiration, overcomes the languid circulation of the blood in the heart and brain. Do not complain then, gentlemen, when you are bestrode by this midnight hag. She is * A fever was excited in Cinna the poet, in consequence of his dreaming that he saw Caesar, the night after he was assassinated, and was invited to accompany him to a dreary place, to which he pointed, in order to sup with him. Con- vulsions and other diseases, I believe, are often excited in the night, by terrifying or distressing dreams. Plutarch's Life of M. Brutus. 404 INOJ7IRY INTO THE kindly sent to prevent your sudden death. Per- sons who go to bed in good health, and are found dead the succeeding morning, are said most com- monly to die of this disease. I proceed now to inquire into the state of animal life in its different stages. I pass over for the pre- sent its history in generation. It will be sufficient only to remark in this place, that its first motion is produced by the stimulus of the male seed upon the female ovum. This opinion is not originally mine. You will find it in Dr. Haller*. The pungent taste which Mr. John Hunter discovered in the male seed renders it peculiarly fit for this purpose. No sooner is the female ovum thus set in motion, and the foetus formed, than its capacity of life is sup- ported, 1. By the stimulus of the heat which it derives from its connection with its mother in the womb. 2. By the stimulus of its own circulating blood. 3. By its constant motion in the womb after the third month of pregnancy. The absence of this * " Novum foetum a seminis masculi stimulo vitam conce- ptsse."—Elcmcnta Physiologic, vol. viii. p. 177. CAUSE OF ANIMAL LIFE. 405 motion for a few days is always a sign of the indis- position or death of a foetus. Considering how early a child is accustomed to it, it is strange that a cradle should ever have been denied to it after it comes into the world. II. In infants there is an absence of many of the stimuli which support life. Their excretions are in a great measure deficient in acrimony, and their mental faculties are too weak to exert much influ- ence upon their bodies. But the absence of stimu- lus from those causes is amply supplied 1. By the very great excitability of their sys- tems to those of light, sound, heat, and air. So powerfully do light and sound act upon them, that the Author of nature has kindly defended their eyes and ears from an excess of their impressions by imperfect vision and hearing, for several weeks af- ter birth. The capacity of infants to be acted up- on by moderate degrees of heat is evident from their suffering less from cold than grown people. This is so much the case, that we read, in Mr. Umfre- ville's account of Hudson's Bay, of a child that was found alive upon the back of its mother after she was frozen to death. I before hinted at the action of the air upon the bodies of new-born in- fants in producing the red colour of dieir skins. It 406 IN0J7IRY INTO THE is highly probable (from a fact formerly mentioned) that the first impression of the atmosphere which produces this redness is accompanied with pain, and this we know is a stimulus of a very active na- ture. By a kind Lw of sensation, impressions, that were originally painful, become pleasurable by repetition or duration. This is remarkably evident in the impression now under consideration, and hence we find infants at a certain age discover signs of an increase of life by their delightful gestures, when they are carried into the open air. Recollect further, gentlemen, what was said formerly of ex- citability predominating over sensibility in infants. We see it daily, not only in their patience of cold, but in the short time in which they cease to com- plain of the injuries they meet with from falls, cuts, and even severe surgical operations. 2. Animal life is supported in infants by their sacking, or feeding, nearly every hour in the day and night when they are awake. I explained for- merly the manner in which food stimulated the sys- tem. The action of sucking supplies, by the muscles employed in it, the stimulus of mastication. 3. Laughing and crying, which are universal in infancy, have a considerable influence in promoting animal life, by their action upon respiration, and CAUSE OF ANIMAL LIFE. 407 the circulation of the blood. Laughing exists un- der all circumstances, independently of education or imitation. The child of the negro slave, born only to inherit the toils and misery of its parents, receives its master with a smile every time he en- ters his kitchen or a negro-quarter. But laughing exists in infancy under circumstances still more unfavourable to it; an instance of which is related by Mr. Bruce. After a journey of several hundred miles across the sands of Nubia, he came to a spring of water shaded by a few scrubby trees. Here he intended to have rested during the night, but he had not slept long before he was awakened by a noise which he perceived was made by a soli- tary Arab, equally fatigued and half famished with himself, who was preparing to murder and plunder him. Mr. Bruce rushed upon him, and made him his prisoner. The next morning he was joined by a half-starved female companion, with an infant of six months old in her arms. In passing by this child, Mr. Bruce says, it laughed and crowed in his face, and attempted to leap upon him. From this fact it would seem as if laughing was not only characteristic of our species, but that it was early and intimately connected with human life. The child of these Arabs had probably never seen a smile upon the faces of its ferocious parents, and 408 INQJJIRY INTO THE perhaps had never (before the sight of Mr. Bruce) beheld any other human creature. Crying has a considerable influence upon health and life in children. I have seen so many instances of its salutary effects, that I have satisfied myself it is as possible for a child to " cry and be fat," as it is to " laugh and be fat." 4. As children advance in life, the constancy of their appetites for food, and their disposition to laugh and cry, lessen, but the diminution of these stimuli is supplied by exercise. The limbs* and tongues of children are always in motion. They continue likewise to eat oftener than adults. A crust of bread is commonly the last thing they ask for at night, and the first thing they call for in the morning. It is now they begin to feel the energy of their mental faculties. This stimulus is assisted in its force by the disposition to prattle, which is so universal among children. This habit of con- verting their ideas into words as fast as they rise, follows them to their beds, where we often hear * Niebuhr, in his Travels, says the children in Arabia are taught to keep themselves constantly in motion by a^kind of vibratory exercise of their bodies. This motion counteracts the diminution of life produced by the heat of the climate of Arabia. CAUSE OF ANIMAL LIFE. 409 them talk themselves to sleep in a whisper, or to use less correct, but more striking terms, by think- ing aloud. 5. Dreams act at an early period upon the bodies of children. Their smtfes, startings, and occasional screams in their sleep appear to arise from them. After the third or fourth year of their lives, they sometimes confound them with things that are real. From observing the effects of this mistake upon the memory, a sensible woman whom I once knew, forbad her children to tell their dreams, lest they should contract habits of lying, by confounding imaginary with real events. 6. New objects, whether natural or artificial, are never seen by children without emotions of pleasure which act upon their capacity of life. The effects of novelty upon the tender bodies of children may easily be conceived, by its friendly influence upon the health of invalids who visit foreign countries, and who pass months or years in a constant succession of new and agreeable im- pressions. III. From the combination of all the stimuli that have been enumerated, human life is generally in excess from fifteen to thirty-five. It is during this vol. n. 3 F 410 INQUIRY INTO THE period the passions blow a perpetual storm. The most predominating of them is the love of pleasure. No sooner does the system become insensible to this stimulus, than ambition succeeds it in, IV. The middle stage jfc life. Here wre behold man in his most perfect physical state. The sti- muli which now act upon him are so far regulated by prudence, that they are seldom excessive in their force. The habits of order the system acquires in this period, continue to produce good health for many years afterwards; and hence bills of mor- tality prove that fewer persons die between forty and fifty-seven, than in any other seventeen years of human life. V. In old age, the senses of seeing, hearing, and touch are impaired. The venereal appetite is weakened, or entirely extinguished. The pulse becomes slow, and subject to frequent intermis- sions, from a decay in the force of the blood-ves- sels. Exercise becomes impracticable, or irksome, and the operations of the understanding are per- formed with languor and difficulty. In this shat- tered and declining state of the system, the absence and diminution of all the stimuli which have been mentioned are supplied, CAUSE OF ANIMAL LIFE. 411 1. By an increase in the quantity, and by the peculiar quality of the food which is taken by old people. They generally eat twice as much as per- sons in middle life, and they bear with pain the usual intervals between meals. They moreover prefer that kind of food which is savoury and sti- mulating. The stomach of the celebrated Parr, who died in the one hundred and fiftieth year of his age, was found full of strong, nourishing ali- ment. 2. By the stimulus of the faeces, which are fre- quently retained for five or six days in the bowels of old people. 3. By the stimulus of fluids rendered preterna- turally acrid by age. The urine, sweat, and even the tears of old people, possess a peculiar acrimo- ny. Their blood likewise loses part of the mild- ness which is natural to that fluid; and hence the difficulty with which sores heal in old people ; and hence too the reason why cancers are more com- mon in the decline, than in any other period of hu- man life. 4. By the uncommon activity of certain passions. These are either good or evil. To the former be- long an increased vigour in the operations of those 412 INQUIRY INTO THE passions which have for their objects the Divine Being, or the whole family of mankind, or their own offspring, particularly their grand-children. To the latter passions belong malice, a hatred of the manners and fashions of the rising generation, and, above all, avarice. This passion knows no holi- days. Its stimulus is constant, though varied daily by the numerous' means which it has discovered of increasing, securing, and perpetuating property. It has been observed that weak mental impressions produce much greater effects in old people than in persons in middle life. A trifling indisposition in a grand-child, an inadvertent act of unkindness from a friend, or the fear of losing a few shillings, have, in many instances, produced in them a degree of wakefulness that has continued for two or three nights. It is to this highly excitable state of the system that Solomon probably alludes, when he describes the grasshopper as burdensome to old people. 5. By the passion for talking, which is so com- mon, as to be one of the characteristics of old age. I mentioned formerly the influence of this stimulus upon animal life. Perhaps it is more necessary in the female constitution than in the male ; for it has long ago been remarked, that women who are very taciturn, are generally unhealthy. CAUSE OF ANIMAL LIFE. 413 6. By their wearing warmer clothes, and prefer- ring warmer rooms, than in the former periods of their lives. This practice is so uniform, that it would not be difficult, in many cases, to tell a man's age by his dress, or by finding out at what degree of heat he found himself comfortable in a close room. 7. By dreams. These are universal among old people. They arise from their short and imperfect sleep. 8. It has been often said, that " We are once men, and twice children." In speaking of the state. of animal life in infancy, I remarked^ that the con- tractility of the animal fibres predominated over their sensibility in that stage of life. The same thing takes place in old people, and it is in conse- quence of the return of this infantile state of the system, that all the stimuli which have been men- tioned act upon them with much more force than in middle life. This sameness, in the predominance of excitability over sensibility in children and old people, will account for the similarity of their habits with respect to eating, sleep, exercise, and the use of fermented and distilled liquors. It is from the increase of excitability in old people, that so small a quantity of strong drink intoxicates them; and it 414 INQUIRY INTO THE is from an ignorance of this change in their consti- tutions, that many of them become drunkards, after passing the early and middle stages of life with sober characters. Life is continued in a less imperfect state in old age in women than in men. The former sew, and knit, and spin, after they lose the use of their ears and eyes; whereas the latter, after losing the use of those senses, frequently pass the evening of their lives in a torpid state in a chimney corner. It is from the influence of moderate and gently sti- mulating employments, upon the female constitu- tion, that more women live to be old than men, and that they rarely survive their usefulness in do- mestic life. Hitherto the principles I am endeavouring to establish have been applied to explain the cause of life in its more common forms. Let us next in- quire, how far they will enable us to explain its continuance in certain morbid states of the body, in which there is a diminution of some, and an appa- rent abstraction of all the stimuli, which have been supposed to produce animal life. I. We observe some people to be blind, or deaf and dumb from their birth. The same defects CAUSE OF ANIMAL LIFE. 41S of sight, hearing, and speech,, are sometimes brought on by diseases. Here animal life is de- prived of all those numerous stimuli, which arise from light, colours, sounds, and speech. But the absence of these stimuli is supplied, 1. By increased sensibility and excitability in their remaining senses. The ears, the nose, and the fingers, afford a surface for impressions in blind people, which frequently overbalances the loss of their eye-sight. There are two blind young men, brothers, in this city, of the name of Dutton, who can tell when they approach a post in walking across a street, by a peculiar sound which the ground under their feet emits in the neighbourhood of the post. Their sense of hearing is still more exquisite to sounds of another kind. They can tell the names of a number of tame pigeons, with which they amuse themselves in a little garden, by only hearing them fly over their heads. The cele- brated blind philosopher, Dr. Moyse, can distinguish a black dress on his friends, by its smell; and we read of many instances of blind persons who have been able to perceive colours by rubbing their fin- gers upon them. One of these persons, mentioned by Mr. Boyle, has left upon record an account of the specific quality of each colour as it affected his sense of touch. He says black imparted the most, 416 INOJ7IRY INTO fHI and blue the least perceptible sense of asperity to his fingers. 2. By an increase of vigour in the exercises of the mental faculties. The poems of Homer, Mil- ton, and Blacklock, and the attainments of Sander- son in mathematical knowledge, all discover how much the energy of the mind is increased by the absence of impressions upon the organs of vision. II. We sometimes behold life in idiots, in whom there is not only an absence of the stimuli of the understanding and passions, but frequently, from the weakness of their bodies, a deficiency of the loco-motive powers. Here an inordinate appetite for food, or venereal pleasures, or a constant habit of laughing, or talking, or playing with their hands and feet, supply the place of the stimulating opera- tions of the mind, and of general bodily exercise. Of the inordinate force of the venereal appetite in idiots we have many proofs. The cretins are much addicted to venery ; and Dr. Michaelis tells us that the idiot whom he saw at the Passaic falls in New- Jersey, who had passed six and twenty years in a cradle, acknowledged that he had venereal desires, and wished to be married, for, the doctor adds, he had a sense of religion upon his fragment of mind, J CAUSE OF ANIMAL LIFE. 417 and of course did not wish to gratify that appetite in an unlawful manner. III. How is animal life supported in persons w^ho pass many days, and even weeks w ithout food, and in some instances without drinks ? Long fasting is usually the effect of disease, of necessity, or of a principle of religion. When it arises from the first cause, the actions of life are kept up by the stimulus of disease*. The absence of food when accidental, or submitted to as a means of producing moral happiness, is supplied, 1. By the stimulus of a full gall bladder. This state of the receptacle of bile has generally been bile found to accompany an empty stomach. The -is sometimes absorbed, and imparts a yellow colour to the skin of persons who suffer or die of famine. * The stimulus of a disease sometimes supplies the place of food in prolonging life. Mr. C. S----, a gentleman well known in Virginia, who was afflicted with a palsy, which had resisted the skill of several physicians, determined to destroy himself, by abstaining from food and drinks. He lived sixty days without eating any tiling, and the greatest part of that time without tasting even a drop of water. His disease probably protracted his life thus long beyond the usual time in which death is induced by fasting. See a particular account of this case, in the first number of the second volume of Dr. Coxe's Medical Museum, VOL. II. 3 G 418 INQJJIRY INTO THE 2. By increased acrimony in all the secretions and excretions of the body. The saliva becomes so acrid by long fasting, as to excoriate the gums, and the breath acquires not only a fcetor, but a pungency so active, as to draw tears from the eyes of persons who are exposed to it. 3. By increased sensibility and excitability in the sense of touch. The blind man mentioned by Mr. Boyle, who could distinguish colours by his fingers, possessed this talent only after fasting. Even a draught of any kind of liquor deprived him of it. I have taken notice, in my account of the yellow fever in Philadelphia, in the year 1793, of the effects of a diet bordering upon fasting for six weeks, in producing a quickness and correctness in my perceptions of the state of the pulse, whicla I had never experienced before. 4. By an increase of activity in the understand- ing and passions. Gamesters often improve the exercises of their minds, when they are about to play for a large sum of money, by living for a day or two upon roasted apples and cold water. Where the passions are excited into preternatural action, the absence of the stimulus of food is scarcely felt. I shall hereafter mention the influence of the desire CAUSE OF ANIMAL LIFE. 419 of life upon its preservation, under all circum*. stances. It acts with peculiar force when fasting is accidental. But when it is submitted to as a religious duty, it is accompanied by sentiments and feelings which more than balance the abstraction of aliment. The body of Moses was sustained, probably without a miracle, during an abstinence of forty days and forty nights, by the pleasure he derived from conversing with his Maker " face to face, as a man speaking with his friend*." I remarked formerly, that the veins discover noj\ deficiency of blood in persons who die of famine. Death from this cause seems to be less the effect of the want of food, than of the combined and ex- cessive operation of the stimuli, which supply its place in the system. IV. We come now to a difficult inquiry, and that is, how is life supported during the total ab- * straction of external and internal stimuli which takes place in asphyxia, or in apparent death, from all its numerous causes ? I took notice, in a former lecture, that ordinary life consisted in the excitement and excitability of * Exodus xxxiii, 11. xxxiv, 28. 420 INQJJIRY INTO THE the different parts of the body, and that they were occasionally changed into each other. In apparent death from violent emotions of the mind, from the sudden impression of miasmata, or from drowning, there is a loss of excitement; but the excitability of the system remains for minutes, and, in some instances, for hours afterwards unimpaired, pro- vided the accident which produced the loss of ex- citement has not been attended with such exertions as are calculated to waste it. If, for example, a person should fall suddenly into the water, without bruising his body, and sink before his fears or ex- ertions had time to dissipate his excitability; his recovery from apparent death might be effected by the gentle action of heat or frictions upon his body, so as to convert his accumulated excitability gra- dually into excitement. The same condition of the system takes place w hen apparent death occurs from freezing, and a recovery is accomplished by 9 the same gentle application of stimuli, provided the organization of the body be not injured, or its ex- citability wasted, by violent exertions previously to its freezing. This excitability is the vehicle of motion, and motion, when continued long enough, produces sensation, which is soon followed be- thought ; and in these, I said formerly, consists perfect life in the human body. CAUSE OF ANIMAL LIFE. 421 For this explanation of the manner in which life is suspended and revived, in persons apparendy dead from cold, I am indebted to Mr. Join Hun- ter, who supposes, if it were possible for .he body to be suddenly frozen, by an instantaneous abstrac- tion of its heat, life might be continued br many years in a suspended state, and revived at pleasure, provided .the body were preserved constintiy in a temperature barely sufficient to prevent re-anima- tion, and never so great as to endanger the de- struction of any organic part. The resuscitation of insects, that have been in a torpid state for months, and perhaps years, in substances that have preserved their organization, should at least defend this bold proposition from being treated as chimerical. The effusions even of the imagination of such men as Mr. Hunter, are entitled to respect. They often become the germs of future discoveries. In that state of suspended animation which oc- curs in acute diseases, and which has sometimes been denominated a trance, the system is nearly in the same excitable state that it is in apparent death from drowning and freezing. Resuscitation, in these cases, is not the effect, as in those which have been mentioned, of artificial applications made to the body for that purpose. It appears to be spon- taneous ; but it is produced by impressions made 422 INQJJIRY INTO THE upon the ears, and by the operations of the mind in dreams. Of the actions of these stimuli upon the body in its apparently lifeless state, I have sa- tisfied nvseif by many facts. I once attended a citizen of Philadelphia, who died of a pulmonary disease, in the 80th year of his age. A few days before hij> death, he begged that he might not be in- terred until one week after the usual signs of life had left his body, and gave as a reason for this re- quest, that he had, when a young man, died to all appearance of the yellow fever, in one of the West- India islands. In this situation he distinctly heard the persons who attended him, fix upon the time and place of burying him. The horror of being put under ground alive, produced such distressing emotions in his mind, as to diffuse motion through- out his body, and finally excited in him all the usu- al functions of life. In Dr. Creighton's essay upon mental derangement, there is a history of a case 0 nearly of a similar nature. " A young lady (says the doctor), an attendant on the princess of-----, after having been confined to her bed for a great length of time, with a violent nervous disorder, was at last, to all appearance, deprived of life. Her lips were quite pale, her face resembled the coun- tenance of a dead person, and her body grew cold. She was removed from the room in which she died, was laid in a coffin, and the day for her funeral was CAUSE OF ANIMAL LIFE. 423 fixed on. The day arrived, and according to the custom of the country, funeral songs and hymns were sung before the door. Just as the people were about to nail on the lid of the coffin, a kind of per- spiration was observed on the surface of her body. She recovered. The following is the account she gave of her sensations: she said, " It seemed to her as if in a dream, that she was really dead ; yet she was perfectly conscious of all that happened around her. She distinctly heard her friends speak* ing and lamenting her death at the side of her cof- fin. She felt them pull on the dead clothes, and lay her in it. This feeling produced a mental anxiety which she could not describe. She tried to cry out, but her mind was without power, and could not act on her body. She had the contradictory feeling as if she were in her own body, and not in it, at the same time. It was equally impossible for her to stretch out her arm or open her eyes, as to cry, although she continu- ally endeavoured to do so. The internal anguish of her mind was at its u most height when the fu- neral hymns began to be sung, and when the lid of the coffin was about to be nailed on. The thought that she was to be buried alive was the first which gave activity to her mind, and enabled it to ope- rate on her corporeal frame. 424 INQJJIRY INTO THE Where the ears lose their capacity of being act- ed upon by stimuli, the mind, by its operations in dreams, becomes a source of impressions which again sets the wheels of life in motion. There is an account published by Dr. Arnold, in his obser- vations upon insanity*, of a certain John Engel- breght, a German, who was believed to be dead, and who was evidently resuscitated by the exer- cises of his mind upon subjects w-hich were of a delightful or stimulating nature. This history shall be taken from Mr. Engelbreght's words. " It was on Thursday noon (says he), about twelve o'clock, when I perceived that death was making his approaches upon me from the lower parts up- wards, insomuch that my whole body became stiff. I had no feeling left in my hands and feet, neither in any other part of my whole body, nor was I at last able to speak or see, for my mouth now becoming very stiff, I was no longer able to open it, nor did I feel it any longer. My eyes also broke in my head in such a manner that I distinctly felt it. For all that, I understood what they said, when they were praying by me, and I distinctly heard them say, feel his legs, how stiff and cold they have be- come. This I heard distinctly, but I had no per- ception of their touch. I heard the watchman cry * Vol. ii. p. 298. CAUSE OF ANIMAL LIFE. 425 11 o'clock, but at 12 o'clock my hearing left me." After relating his passage from the body to heaven with the velocity of an arrow shot from a cross bow, he proceeds, and says, that as he was twelve hours in dying, so he was twelve hours in returning to life. " As I died (says he) from beneath up- wards, so I revived again the contrary way, from above to beneath, or from top to toe. Being con- veyed back from the heavenly glory, I began to hear something of what they were praying for me, in the same room with me. Thus was my hearing the first sense I recovered. After this I began to have a perception of my eyes, so that, by little and little, my whole body became strong and sprightly, and no sooner did I get a feeling of my legs and feet, than I arose and stood firm upon them with a firm- ness I had never enjoyed before. The heavenly joy I had experienced, invigorated me to such a degree, that people were astonished at my rapid, and almost instantaneous recovery." The explanation I have given of the cause of re- suscitation in this man will serve to refute a belief in a supposed migration of the soul from the body, in cases of apparent death. The imagination, it is true, usually conducts the w hole mind to the abodes of happy or miserable spirits, but it acts here in the same way that it does when it transports it, in com- VOL. II. 3 h 426 INQJ7IRY INTO THE mon dreams, to numerous and distant parts of the world. There is nothing supernatural in Mr. Engel- breght being invigorated by his supposed flight to heaven. Pleasant dreams always stimulate and strengthen the body, while dreams which are ac- companied with distress or labour debilitate and fatigue it, CAUSE OP ANIMAL LIFE. LECTURE III. Gentlemen, LET us next take a view of the state of animal life in the different inhabitants of our globe, as varied by the circumstances of civilization, diet, situation, and climate. I. In the Indians of the northern latitudes of America there is often a defect of the stimulus of aliment, and of the understanding and passions. Their vacant countenances, and their long and dis- gusting taciturnity, are the effects of the want of action in their brains from a deficiency of ideas; and their tranquillity under all the common cir- cumstances of irritation, pleasure, or grief, are the result of an absence of passion ; for they hold it to be disgraceful to show any outward signs of anger, joy, or even of domestic affection. This account of the Indian character, I know, is contrary to that which is given of it by Rousseau, and several other writers, who have attempted to prove that man may become perfect and happy without the aids of'civi- lization and religion., This opinion is contradicted 428 INQUIRY INTO THE by the experience of all ages, and is rendered ridi- culous by the facts which are well ascertained in the history of the customs and habits of our Ame- rican savages. In a cold climate they are the most miserable beings upon the face of the earth. The greatest part of their time is spent in sleep, or un- der the alternate influence of hunger and gluttony. They moreover indulge in vices which are alike contrary to moral and physical happiness. It is in consequence of these habits that they discover so early the marks of old age, and that so few of them are long-lived. The absence and diminution of many of the stimuli of life in these people is sup- plied in part by the violent exertions with which they hunt and carry on war, and by the extravagant manner with which they afterwards celebrate their exploits, in their savage dances and songs. II. In the inhabitants of the torrid regions of Africa there is a deficiency of labouf; for the earth produces spontaneously nearly all the sustenance they require. Their understandings and passions are moreover in a torpid state. But the absence of bodily and mental stimuli in these people is am- ply supplied by the constant heat of the sun, by the profuse use of spices in their diet, and by the pas- sion for musical sounds which so universally cha- racterises the African nations. CAUSE OF ANIMAL LIFE. 429 III. In Greenland the body is exposed during a long winter to such a degree of cold as to reduce the pulse to 40 or 50 strokes in a minute. But the effects of this cold in lessening the quantity of life are obviated in part by the heat of close stove rooms, by warm clothing, and by the peculiar na- ture of the aliment of the Greenlanders, which con- sists chiefly of animal food, of dried fish, and of whale oil. They prefer the last of those articles in so rancid a state, that it imparts a fcetor to their perspiration, which, Mr. Crantz says, renders even their churches offensive to strangers. I need hardly add, that a diet possessed of such diffusible quali- ties cannot fail of being highly stimulating. It is remarkable that the food of all the northern nations of Europe is composed of stimulating animal or vegetable matters, and that the use of spiritous li- quors is universal among them. IV. Let us next turn our eyes to the, miserable inhabitants of those eastern countries which com- pose the Turkish empire. Here we behold life in its most feeble state, not only from the absence of physical, but of other stimuli which operate upon the inhabitants of other parts of the world. Among the poor people of Turkey there is a general defi- ciency of aliment. Mr. Volney in his Travels tells us, " That the diet of the Bedouins seldom exceeds 430 INQJJIRY INTO THE six ounces a day, and that it consists of six or seven dates soaked in butter-milk, and afterwards mixed with a little sweet milk, or curds." There is like- wise a general deficiency among them of stimulus from the operations of the mental faculties; for such is the despotism of the government in Tur- key, that it weakens not only the understanding, but it annihilates all that immense source of stimuli which arises from the exercise of the domestic and public affections. A Turk lives wholly to himself. In point of time he occupies only the moment in which he exists; for his futurity, as to life and property, belongs altogether to his master. Fear is the reigning principle of his actions/ and hope and joy seldom add a single pulsation to his heart. Tyranny even imposes a restraint upon the stimu- lus which arises from conversation, for " They speak (says Mr. Volney) with a slow feeble voice, as if the lungs wanted strength to propel air enough through the glottis to form distinct articulate sounds." The same traveller adds, that " They are slow in all their motions, that their bodies are small, that they have small evacuations, and that their blood is so destitute of serosity, that nothing but the greatest heat can preserve its fluidity." The deficiency of aliment, and the absence of meri- tal stimuli in these people is supplied, CAUSE OF ANIMAL LIFE. 431 1. By the heat of their climate. , 2. By their passion for musical sounds and fine clothes. And 3. By their general use of coffee, garlic*, and opium. The more debilitated the body is, the more forcibly these stimuli act upon it. Hence, accord- ing to Mr. Volney, the Bedouins, whose slender diet has been mentioned, enjoy good health; for this consists not in strength, but in an exact propor- tion being kept up between the excitability of the body, and the number and force of the stimuli which act upon it. V. Many of the observations which have been made upon the inhabitants of Africa, and of the Turkish dominions, apply to the inhabitants of China and the East-Indies. They want, in many instances, the stimulus of animal food. Their minds are, moreover, in a state too languid to act with much force upon their bodies. The absence and deficiency of these stimuli are supplied by, * Niebuhr's Travels, 432 INOJJIRY INTO THE 1. The heat of the climate in the southern parts of those countries. 2. By a vegetable diet abounding in nourish- ment, particularly rice and beans. 3. By the use of tea in China, and by a stimu- lating coffee made of the dried and toasted seeds of the datura stramonium, in the neighbourhood of the Indian coast. Some of these nations likewise chew stimulating substances, as too many of our citizens do tobacco. Among the poor and depressed subjects of the governments of the middle and southern parts of Europe, the deficiency of the stimulus of whole- some food, of clothing, of fuel, and of liberty, is supplied, in some countries, by the invigorating influence of the christian religion upon animal life, and in others by the general use of tea, coffee, garlic, onions, opium, tobacco, malt liquors, and ardent spirits. The use of each of these stimuli seems to be regulated by the circumstances of cli- mate. In cold countries, where the earth yields its increase with reluctance, and where vegetable ali- ment is scarce, the want of the stimulus of disten- sion which that species of food is principally calcu- lated to produce is sought for in that of ardent CAUSE OF ANIMAL LIFE. 433 spirits. To the southward of 40°, a substitute for the distension from mild vegetable food is sought for in onions, garlic, and tobacco. But further, a uniform climate calls for more of these artificial sti- muli than a climate that is exposed to the alternate action of heat and cold, winds and calms* and of wet and dry weather. Savages and ignorant people likewise require more of them than persons of civilized manners, and cultivated understandings. It would seem from these facts that man cannot ex- ist without sensation of some kind, and that when it is not derived from natural means, it will always be sought for in such as are artificial. In no part of the human species, is animal life in a more perfect state than in the inhabitants of Great Britain*, and the United States of America. With all the natural stimuli that have been men- tioned, they are constantly under the invigorat- ing influence of liberty. There is an indissoluble union between moral, political, and physical happi- ness ; and if it be true, that elective and represen- tative governments are most favourable to indivi- dual, as well as national prosperity, it follows of course, that they are most favourable to animal life. But this opinion does not rest upon an induc- * Haller's Elementa Physiologic, vol. viii. p. 2. p. 107. VOL. II. ^ l 434 INQJ7IRY INTO THE tion derived from the relation, which truths up- on all subjects bear to each other. Many facts prove animal life to exist in a larger quantity and for a longer time, in the enlightened and happy state of Connecticut, in which republican liberty has existed above one hundred and fifty years, than in any other country upon the surface of the globe. It remains now to mention certain mental stimuli which act nearly alike in the production of animal life, upon the individuals of all the nations in the world. They are, 1. The desire of life. This principle, so deeply and universally implanted in human nature, acts very powerfully in supporting our existence. It has been observed to prolong life. Sickly tra- vellers by sea and land, often live under circum- stances of the greatest weakness, till they reach their native country, and then expire in the bo- som of their friends. This desire of life often turns the scale in favour of a recovery in acute diseases. Its influence will appear, from the difference in the periods in which death was induced in two per- sons, who were actuated by opposite passions with respect to life. Atticus, we are told, died of volun- tary abstinence from food in five days. In sir Wil- liam Hamilton's account of the earthquake at Cala- CAUSE OF ANIMAL LIFE. 435 bria, we read of a girl who lived eleven days with- out food before she expired. In the former case, life was shortened by an aversion from it; in the latter, it was protracted by the desire of it. The late Mr. Brissot, in his visit to this city, informed me, that the application of animal magnetism (in which he was a believer) had in no instance cured a disease in a West-India slave. Perhaps it was rendered inert by its not being accompanied by a strong desire of life ; for this principle exists in a more feeble state in slaves than in freemen. It is possible likewise the wills and imaginations of these degraded people may have become so paralytic by slavery, as to be incapable of being excited by the impression of this fanciful remedy. 2. The love of money sets the whole animal machine in motion. Hearts which are insensible to the stimuli of religion, patriotism, love, and even of the domestic affections, are excited into action by this passion. The city of Philadelphia, between the 10th and 15th of August, 1791, will long be remembered by contemplative men, for having fur- nished the most extraordinary proofs of the stimu- lus of the love of money upon the human body. A new scene of speculation was produced at that time by the scrip of the bank of the United States. 436 INQJ7IRY INTO THE It excited febrile diseases in three persons who ber came my patients. In one of them, the acquisition of twelve thousand dollars in a few minutes by a lucky sale, brought on madness which terminated in death in a few days*. The whole city felt the impulse of this paroxysm of avarice. The slow and ordinary means of earning money were desert- ed, and men of every profession and trade were seen in all our streets hastening to the coffee-house, where the agitation of countenance, and the desul- tory manners, of all the persons who were interest- ed in this species of gaming, exhibited a truer pic- ture of a bedlam, than of a place appropriated to the transaction of mercantile business. But fur- ther, the love of money discovers its stimulus up- on the body in a peculiar manner in the games of cards and dice. I have heard of a gentleman in Virginia who passed two whole days and nights in succession at a card table, and it is related in the life of a noted gamester in Ireland, that when he wras so ill as to be unable to rise from his chair, he would suddenly revive when brought to the hazard table, by hearing the rattling of the dice. * Dr. Mead relates, upon the authority of Dr. Hales, that more of the successful speculators in the South-Sea scheme of 1720 became insane, than of those who had been ruined by it, CAUSE OF ANIMAL LIFE. 437 3. Public amusements of all kinds, such as a horse race, a cockpit, a chase, the theatre, the cir- cus, masquerades, public dinners, and tea parties, all exert an artificial stimulus upon the system, and thus supply the defect of the rational exercises of the mind. 4. The love of dress is not confined in its sti- mulating operation to persons in health. It acts perceptibly in some cases upon invalids. I have heard of a gentleman in South-Carolina, who al- ways relieved himself of a fit of low spirits by chang- ing his dress; and I believe there are few people who do not feel themselves enlivened, by putting on a new suit of clothes. 5. Novelty is an immense source of agreeable stimuli. Companions, studies, pleasures, modes of business, prospects, and situations, with respect to town and country, or to different countries, that are new, all exert an invigorating influence upon health and life. 6 The love of fame acts in various ways; but its stimulus is most sensible and durable in military life. ' It counteracts in many instances the debilitat- ing effects of hunger, cold, and labour. It has some- times done more, by removing the weakness which 438 iNqurny into the is connected with many diseases. In several in- stances it has assisted the hardships of a camp life, in curing pulmonary consumption. 7. The love of country is a deep seated principle of action in the human breast. Its stimulus is some- times so excessive, as to induce disease in persons who recently migrate, and settle in foreign coun- tries. It appears in various forms; but exists most frequently in the solicitude, labours, attachments, and hatred of party spirit. All these act forcibly in supporting animal life. It is because newspa- pers are supposed to contain the measure of the happiness or misery of our country, that they are so interesting to all classes of people. Those vehi- cles of intelligence, and of public pleasure or pain, are frequently desired with the impatience of a meal, and they often produce the same stimulating effects upon the body*. 8. The different religions of the world, by the activity they excite in the mind, have a sensible in- fluence upon human life. Atheism is the worst of sedatives to the understanding and passions. It is the abstraction of thought from the most sublime, * They have been very happily called by Mr. Green, in his poem entitled Spleen, " the manna of the day." CAUSE OF ANIMAL LIFE. 439 and of love from the most perfect of all possible objects. Man is as naturally a religious, as he is a social and domestic animal; and the same vio- lence is done to his mental faculties, by robbing him of a belief in a God, that is done by dooming him to live in a cell, deprived of the objects and pleasures of social and domestic life. The neces- sary and immutable connection between the texture of the human mind, and the worship of an object of some kind, has lately been demonstrated by the atheists of Europe, who, after rejecting the true God, have instituted the worship of nature, of for- tune, and of human reason ; and, in some instances, with ceremonies of the most expensive and splen- did kind. Religions are friendly to animal life, in proportion as they elevate the understanding, and act upon the passions of hope and love. It will readily occur to you, that Christianity, when believ- ed and obeyed, according to its original consis- tency with itself, and with the divine attributes, is more calculated to produce those effects than any other religion in the world. Such is the salutary operation of its doctrines and precepts upon health and life, that if its divine authority rested upon no other argument, this alone would be sufficient to recommend it to our belief. How long mankind may continue to prefer substituted pursuits and pleasures to this invigorating stimulus, is uncer- 440 INQJJIRY INTO THE • tain; but the time, we are assured, wall come, when the understanding shall be elevated from its present inferior objects, and the luxated passions be reduced to their original order. This change in the mind of man, I believe, will be effected only by the influence of the christian religion, after all the efforts of human reason to produce it, by means of civilization, philosophy, liberty, and govern- ment, have been exhausted to no purpose. Thus far, gentlemen, we have considered animal life as it respects the human species ; but the prin- ciples I am endeavouring to establish require that we should take a view of it in animals of every species, in all of which we shall find it depends up- on the same causes as in the human body. And here I shall begin by remarking, that if we should discover the stimuli which support life in certain animals to be fewer in number, or weaker in force than those which support it in our species, we must resolve it into that attribute of the Deity which seems to have delighted in variety in all his works. The following observations apply more or less to all the animals upon our globe. CAUSE OF ANIMAL LIFE. 441 1. They all possess either hearts, lungs, brains, nerves, or muscular fibres. It is as yet a contro- versy among naturalists whether animal life can ex- ist without a brain ; but no one has denied muscu- lar fibres, and of course contractility, or excitabi- lity, to belong to animal life in all its shapes. 2. They all require more or less air for their existence. Even the snail inhales it for seven months under ground, through a pellicle which it weaves out of slime, as a covering for its body. If this pellicle at any time become too thick to admit the air, the snail opens a passage in-it for that purpose. Now air we know acts powerfully in supporting animal life. 3. Many of them possess heat equal to that of the human body. Birds possess several degrees beyond it. Now heat, it was said formerly, acts with great force in the production of animal life. 4. They all feed upon substances more or less stimulating to their bodies. Even water itself, che- mistry has taught us, affords an aliment, not only stimulating, but nourishing to many animals. 5. Many of them possess senses, more acute and excitable, than the same organs in the human VOL. II. ** K 442 INQUIRY INTO THE species. These expose surfaces for the action of external impressions, that supply the absence or de- ficiency of mental faculties. 6. Such of them as are devoid of sensibility, pos- sess an uncommon portion of contractility, or sim- ple excitability. This is most evident in the poly- pus. When cut to pieces, it appears to feel little or no pain. 7. They all possess loco-motive powers in a greater or less degree, and of course are acted up- on by the stimulus of muscular motion. 8. Most of them appear to feel a stimulus, from the gratification of their appetites for food, and for venereal pleasures, far more powerful than that which is felt by our species from the same causes. I shall hereafter mention some facts from Spalan- zani upon the subject of generation, that will prove the stimulus, from venery, to be strongest in those animals, in which other stimuli act with the least force. Thus the male frog during its long connec- tion widi its female, suffers its limbs to be ampu- tated, without discovering the least mark of pain, and without relaxing its hold of the object of its embraces. G-AUSE OF ANIMAL LIFE. 44S 9. Ill many animals we behold evident marks of understanding and passion. The elephant, the fox, and the ant exhibit strong proofs of thought; and where is the school boy that cannot bear testimony to the anger of the bee and the wasp ? 10. But what shall we say of those animals, which pass long winters in a state in which there is an apparent absence of the stimuli of heat, exer- cise, and the motion of the blood. Life in these animals is probably supported, 1. By such an accumulation of excitability, as to yield to impressions, which to us are impercep.- tible. 2. By the stimulus of aliment in a state of di- gestion in the stomach, or by the stimulus of ali- ment restrained from digestion by means of cold; for Mr. John Hunter has proved by an experiment on a frog, that cold below a certain degree, checks that animal process. 3. By the constant action of air upon their bo- dies. ' It is possible life may exist in these animals, du- ring their hybernation, in the total absence of im- 444 INQUIRY INTO THE pression and motion of every kind. This may be the case where the torpor from cold has been sud- denly brought upon their bodies. Excitability here is in an accumulated, but quiescent state. 11. It remains only under this head to inquire, in what manner is life supported in those animals which live in a cold element, and whose blood is sometimes but a little above the freezing point? It will be a sufficient answer to this question to re- mark, that heat and cold are relative terms, and that different animals, according to their organization^ require very different degrees of heat for their ex- istence. Thirty-two degrees of it are probably as stimulating to some of these cold blooded animals (as they are called), as 70° or 80° are to the hu- man body. It might afford additional support to the doctrine of animal life, w hich I have delivered, to point out the manner in which life and growth are produced in vegetables of all kinds. But this subject belongs to the professor of botany and natural history*, who is amply qualified to do it justice. I shall only remark, that vegetable life is as much the off- spring of stimuli as animal, and that skill in agri- * Dr. Barton. CAUSE OF ANIMAL LIFE. 445 culture consists chiefly in the proper application of them. The seed of a plant, like an animal body, has no principle of life within itself. If preserved for many years in a drawer, or in earth below the stimulating influence of heat, air, and water, it dis- covers no sign of vegetation. It grows, like an animal, only in consequence of stimuli acting upon its capacity of life. From a review of what has been said of animal life in all its numerous forms and modifications, we see that it as much an effect of impressions upon a peculiar species of matter, as sound is of the stroke of a hammer upon a bell, or music of the motion of the bow upon the strings of a violin. I exclude therefore the intelligent principle of Whytt, the medical mind of Stahl, the healing powers of Cul- len, and the vital principle of John Hunter, as much from the body, as I do an intelligent principle from air, fire, and water. It is no uncommon thing for the simplicity of' causes to be lost in the magnitude of their effects. By contemplating the wonderful functions of life we have strangely overlooked the numerous and obscure circumstances which produce it. Thus the humble but true origin of power in the people is often forgotten in the splendour and pride of go- 446 INQJJTRY INTO THE vernments. It is not necessary to be acquainted with the precise nature of that form of matter, which is capable of producing life from impressions made upon it. It is sufficient for our purpose to know the fact. It is immaterial, moreover, whe- ther this matter derives its power of being acted upon wholly from the brain, or whether it be in part inherent in animal fibres. The inferences are the same in favour of life being the effect of stimuli, and of its being as truly mechanical as the move- ments of a clock from the pressure of its weights, or the passage of a ship in the w ater from the im- pulse of winds and tide. The infinity of effects from similar causes, has ofte*n been taken notice of in the works of the Creator. It would seem as if they had all been made after one pattern. The late discovery of the cause of combustion has thrown great light upon our subject. Wood and coal are no longer believ- ed to contain a principle of fire. The heat and flame they emit are derived from an agent altoge- ther external to them. They are produced by a matter which is absorbed from the air, by means of its decomposition. This matter acts upon the predisposition of the fuel to receive it, in the same way that stimuli act upon the human body. The two agents differ ouly in their effects. The former CAUSE OF ANIMAL LIFE. 447 produces the destruction of the bodies upon which it acts, while the latter excite the more gentle and durable motions of life. Common language in ex- pressing these effects is correct, as far as it relates to their cause. We speak of a coal of fire being alive, and of the flame of life. The causes of life which I have delivered will receive considerable support by contrasting them with the causes of death. This catastrophe of the body consists in such a change induced on it by disease or old age, as to prevent its exhibitmg the phenomena of life. It is brought on, 1. By the abstraction of all the stimuli wrhich support life. Death from this cause is produced by the same mechanical means that the emission of sound from a violin is prevented by the abstraction of the bow from its strings. 2. By the excessive force of stimuli of all kinds. No more occurs here than happens from too much pressure upon the strings of a violin preventing its emitting musical tones. 3. By too much relaxation, or too weak a tex- ture of the matter which composes the human body. No more occurs here tiian is observed in the ex- 448 INQUIRY INTO THE tinction of sound by the total relaxation, or slender combination of the strings of a violin. 4. By an error in the place of certain fluid or so- lid parts of the body. No more occurs here than would happen from fixing the strings of a violin upon its body, instead of elevating them upon its bridge. 5. By the action of poisonous exhalations, or of certain fluids vitiated in the body, upon parts which emit most forcibly the motions of life. No more happens here than occurs from enveloping the strings of a violin in a piece of wax. 6. By the solution of continuity by means of wounds in solid parts of the body. No more oc- curs in death from this cause than takes place when the emission of sound from a violin is pre- vented by a rupture of its strings. 7. Death is produced by a preternatural rigidity, and in some instances by an ossification of the solid parts of the body in old age, in consequence of which they are incapable of receiving and emitting the motions of life. No more occurs here, dian would happen if a stick or pipe-stem were placed in the room of catgut, upon the bridges of the CAUSE OF ANIMAL LIFE. violin. But death may take place in old age with- out a change in the texture of animal matter, from the stimuli of life losing their effect by repetition, just as opium, from the same cause, ceases to pro- duce its usual effects upon the body. Should it be asked, what is that peculiar organi- zation of matter, which enables it to emit life, when acted upon by stimuli, I answer, I do not know. The great Creator has kindly established a witness of his unsearchable wisdom in every part of his works, in order to prevent our forgetting him, in the successful exercises of our reason. Mohammed once said, " that he should believe himself to be a God, if he could bring down rain from the clouds, or give life to an animal." It belongs exclusively to the true God to endow matter with those singu- lar properties, which enable it, under certain circum- stances, to exhibit the appearances of life. I cannot conclude this subject, without taking notice of its extensive application to medicine, me- taphysics, theology, and morals. The doctrine of animal life which has been taught, exhibits in the VOL. II. .3 L 450 INQUIRY INTO THE First place, a new view of the nervous system, by discovering its origin in the extremities of the nerves, on which impressions are made, and its ter- mination in the brain. This idea is extended in an ingenious manner by Mr. Valli, in his treatise upon animal electricity. 2. It discovers to us the true means of promot- ing health and longevity, by proportioning the num- ber and force of stimuli to the age, climate, situa- tion, habits, and temperament of the human body. 3. It leads us to a knowledge of the causes of all diseases. These consist in excessive or preterna- tural excitement in the whole, or a part of the hu- man body, accompanied generally with irregular motions, and induced by natural or artificial stimuli. The latter have been called, very properly, by Mr. Hunter, irritants. The occasional absence of'mo- tion in acute diseases is the effect only of the ex- cess of impetus in their remote causes. 4. It discovers to us that the cure of all diseases depends simply upon the abstraction of stimuli from the whole, or from a part of the body, when the motions excited by them are in excess ; and in the increase of their number and force, when motions are of a moderate nature. For the former pur- CAUSE OF ANIMAL LIFE. 451 pose, we employ a class of medicines known by the name of sedatives. For the latter, we make use of stimulants. Under these two extensive heads, are included all the numerous articles of the materia medica. 5. It enables us to reject the doctrine of innate ideas, and to ascribe all our knowledge of sensible objects to impressions acting upon an innate capa- city to receive ideas. Were it possible for a child to grow up to manhood without the use of any of its senses, it would not possess a single idea of a material object; and as all human knowledge is compounded of simple ideas, this person would be as destitute of knowledge of every kind, as the grossest portion of vegetable or fossil matter. 6. The account which has been given of animal life, furnishes a striking illustration of the origin of human actions, by the impression of motives upon the will. As well might we admit an inherent principle of life in animal matter, as a self-deter- mining power in this faculty of the mind. Mo- tives are necessary, not only to constitute its free- dom, but its essence; for, without them, there could be no more a will, than there could be vision with- out light, or hearing without sound. It is true, they are often so obscure as not to be perceived, 452 INQJJIRY INTO THE and they sometimes become insensible from habit; but the-same things have been remarked in the operation of stimuli, and yet we do not upon this account deny their agency in producing animal life. In thus deciding in favour of the necessity of mo- tives, to produce actions, I cannot help bearing a testimony against the gloomy misapplication of this doctrine by some modern writers. When proper- ly understood, it is calculated to produce the most comfortable views of the divine government, and the most beneficial effects upon morals and human happiness. 7. There are errors of an impious nature, which sometimes obtain a currency, from being disguised by innocent names. The doctrine of animal life that has been delivered is directly opposed to an error of this kind, which has had the most bane- ful influence upon morals and religion. To sup- pose a principle to reside necessarily and constant- ly in the human body, which acted independently of external circumstances, is to ascribe to it an at- tribute, which I shall not connect, even in language, with the creature man. Self-existence belongs only to God. The best criterion of the truth of a philosophical opinion, is its tendency to produce exalted ideas of CAUSE OF ANIMAL LIFE. 453 the Divine Being, and humble views of ourselves. The doctrine of animal life which has been deli- vered is calculated to produce these effects in an eminent degree, for *, 8. It does homage to the Supreme Being, as the governor of the universe, and establishes the cer- tainty of his universal and particular providence. Admit a principle of life in the human body, and we open a door for the restoration of the old Epi- curean or atheistical philosophy, which supposed the world to be governed by a principle called na- ture, and which was believed to be inherent in every kind of matter. The doctrine I have taught, cuts the sinews of this error ; for by rendering the continuance of animal life, no less than its com- mencement, the effect of the constant operation of divine power and goodness, it leads us to believe that the whole creation is supported in the same manner. 9. The view that has been given of the depen- dent state of man for the blessing of life, leads us to contemplate, with very opposite and inexpressi- ble feelings, the sublime idea which is given of the Deity in the scriptures, as possessing life " within himself." This divine prerogative has never been imparted but to one being, and that is the Son of 454 INOJJIRY INTO THE God. This appears from the following declara- tion. " For as the Father hath life in himself, so hath he given to the Son to have life within him- self."* To this plenitude of independent life, we are to ascribe his being called the " life of the world," " the prince of life," and " life" itself, in the New Testament. These divine epithets which are very properly founded upon the manner of our Saviour's existence, exalt him infinitely above sim- ple humanity, and establish his divine nature upon the basis of reason, as well as revelation. 10. We have heard that some of the stimuli which produce animal life, are derived from the moral and physical evils of our world. From be- holding these instruments of death thus converted by divine skill into the means of life, we are led to believe goodness to be the supreme attribute of the Deity, and that it will appear finally to predominate in all his works. 11. The doctrine which has been delivered, is calculated to humble the pride of man by teach- ing him his constant dependence upon his Maker for his existence, and that he has no pre-eminence in his tenure of it, over the meanest insect that flut- * John v. verse 26. CAUSE OF ANIMAL LIFE. 455 ters in the air, or the humblest plant that grows upon the earth. What an inspired writer says of the innumerable animals which inhabit the ocean, may with equal propriety be said of the whole hu- man race. " Thou sendest forth thy spirit, and they are created. Thou takest away their breath —they die, and return to their dust." 12. Melancholy indeed would have been the is- sue of all our inquiries, did wre take a final leave of the human body in its state of decomposition in the grave. Revelation furnishes us with an elevating, and comfortable assurance that this will not be the case. The precise manner of its re-organization, and the new means of its future existence, are un- known to us. It is sufficient to believe, the event will take place, and that after it, the soul and body of man will be exalted in one respect, to an equality with their Creator. They will be immortal. Here, gentlemen, we close the history of animal life. I feel as if I had waded across a rapid and dangerous stream. Whether I have gained the op- posite shore with my head clean, or covered with mud and weeds, I leave wholly to your determi- nation. i:XD OF VOL. II. Med. Hist. Wz 7399