UNITED STATES OF AMERICA
WASHINGTON,  D. C.
OPO  16—67244-1 
 
I

\ 
EDICAL INQUIRIES
AND
OBSERVATIONS. 

 
1*
AND
OBSERVATIONS.
         BY BENJAMIN JLUSH, M. D.
PROFESSOR OF THE INSTITUTES AND PRACTICE OF MEDICINE AND OF CLIN1CAI
        PRACTICE, IN THE UNITERSITt OF PENNSYLVANIA.
FOUR VOLUMES IN TWO.
VOL. I.
THE FOURTH EDITION.
PHILADELPHIA:
I-BINTED FOR M. CARET, No. 121, CHESNTJT STBEET.
        Griggs & Dickinsons, Printers.


        iSURGS.-k '•■- .: HUP 0*TiCr.
JUS  '!>1S05  .   I
 
 District of Pennsylvania, to wit:
       BE IT  REMEMBERED, that on the sixteenth day  of
 October, in the thirty fourth yearof the Independence of the United
 states of America, A D- 1809, Mathew Carey, Hopkins and Earle,
 Johnson and Warner, Kimber and Conrad, Bradford and Inskeep,
 Thomas and  William Bradford, Benjamin and Thomas Kite, and
 Bennett and Walton, of the said District, have deposited  in this
 office, the title  of a book,  the right  whereof they claim as pro-
 prietors, in the  words following to wit:

  " Medical Inquiries and Observations.  By Benjamin Rush, M.
 jD. Professor of the Institutes  and Practice  of Medicine  and of
 Clinical Practice, in the  University of Pennsylvania.  In four
volumes.  The  third edition, revised and enlarged by the author*"

  In conformity to the  act of the Congress of the United  States,
entitled, " an  act for the encouragement of learning, by securing
the copies of maps,  charts, and books, to the authors and proprie-
tors of such copies  during the times therein mentioned."  And
also to the act,  entitled " an act supplementary to  an act, entitled,
" an act for the  encouragement of learning, by securing the copies
of maps, charts, and books, to the authors and proprietors of such
 copies  during  the time therein  mentioned," and  extending the
benefits thereof to the arts of designing, engraving, and etching
 historical and other prints."
                                       D. CALDWELL,
                         Clerk of the District of Pennsylvania. 
CONTENTS OF VOLUME I.
                                                 Page
An Inquiry into the Cause of Animal Life             1
An Inquiry into  the  Natural History of Medicine
  among the Indians of North America, and a Compa-
  rative View of their Diseases and Remedies with
  those of Civilized Nations        -                55
An Inquiry into the Influence of Physical Causes upon
  the Moral Faculty      . -       .       .         93
An Account of the Influence of the Military and Po-
  litical events of the American Revolution upon the
  Human Body            -                       125
An Inquiry into the Relation of Tastes and Aliments
  to each other, and into the influence of this relation
  upon Health and Pleasure        -       -        135
The result of Observations made upon the Diseases
  which occurred in  the Military Hospitals  of the
  United States, during the revolutionary war between
  Great Britain and the United States      -       145
An Inquiry into  the Effects of Ardent Spirits upon
  the Human Body and Mind, with an Account of the
  means of Preventing, and the remedies for Curing
  them       --_..     151
Observations upon the Tetanus        -       -     177
An  Account of the Disease occasioned by drinking 
VI
CONTENTS.
   Cold Water in warm  weather,  and of the  means
   of curing it                                    -*-"*
An Account of the Cure of Several Diseases  by the
   Extraction of Decayed Teeth    -       -      1"'
Observations upon Worms>  and upon  Anthelmintic
   Medicines        -                             203
An Account of the External use of Arsenic  in the
   Cure of Cancers         -       -       -      215
An Inquiry into the Cause and Cure of Sore Legs   .223
An Account of the state of the Body and Mind in Old
   Age, with Observations on its Diseases and Reme-
   dies       -       -       -                     233
Observations upon the Duties of a Physician, and the
   Methods of Improving Medicine, accommodated to
   the present state  of manners and society  in the
   United States     -       -'      -       -      251 
PREFACE.
  THE author of the following edition of Medical Inquiries
and observations has changed the  order in which several
of the subjects were arranged in the former editions. He has
given the Lectures upon Animal Life the first place in the
first volume, and has arranged the Histories of Epidemics
in succession to each other.  Some facts have been added to
several of the  Inquiries, particularly to  the Lectures upon
Animal Life, to the History of the Phenomena ol* Fever,
to the Observations upon the Gout, and to the Defence of
Blood-letting; but no alteration has been  made in any of
the  Medical principles of the author. He has preferred the
term of " phenomena" to that of " theory"  of lever, be-
cause he conceives the doctrine he has  aimed to establish
upon that subject, rests upon facts only, obvious not only
to reason, but  in most instances, to the  senses.

  He has omitted  the Lecture  upon Inoculation for the
Small-pox,  from a belief that  the universal practice of
Vaccination has rendered it in a great measure an unneces-
sary part of the education and knowledge of  a physician.

  The Observations upon the Cure of Obstinate Intermit-
ting Fevers by means u. Blood-letting, contained in the 
Vlll                  PREFACE.
            »
former editions, have been incorporated with the defence of
that remedy.
  The author has added to this edition an Account of the
Cure of Several Diseases by the Extraction of Decayed
Teeth, published originally in the New-York Medical Re-
pository.
                             BENJAMIN RUSH.
  October 31, 1809. 
         AN INQUIRY




             INTO THE




CAUSE OF  ANIMAL LIFE.
    IN THREE LECTURES,





DELIVERED IN THE UNIVERSITY OF PENNSYLVANIA
VOL. I.           A 
 
AN  INQUIRY. &c.
                    LECTURE I.

Gentlemen,

      MY business in this chair if^to teach the institutes of
medicine. They have been divided into physiology, patho-
logy, and therapeutics.   The  objects  of the first are, the
laws of the human body in its  healthy  state.  The second
includes the history of the causes and seats of disesses. The
subjects of the third are the remedies for those disciscs. 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
ingenious speculations,  will not leave a reputation behind
them that will outlive them half a  century.  When they
cease from their labours, their labours will be buried along
with them. There never was a man  more followed and ad-
mired in physiology, than Dr. Boeihaave.  I remember the
veneration 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 speculating upon physiological  subjects. Simple ana-
tomony is a mass of dead matter.   It is physiology which
infuses life into it. A knowledge of the structure of the hu-
man body occupies only the memory. Physiology introdu-
ces it to the higher and more noble faculties of the mind.
The component parts of the body may  be compared to the
materials of a house, lying without order in a yard.  It is
Lett, xi 
4                 IN0J7IRY  INTO  THE
physiology, like a skilful architect, which  connects 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 conveniences which they enjoy beyond what are
possessed in the most simple stage of society, belong to the
luxuries of life.  The anatomist who describes the circula-
tion 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 honour to  our sci-
ence; for few men ever explained that subject, and many
others equally physiological, with more perspecuity and elo-
quence, 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 drudgery; and
if in discharging its duties I should meet the fate of my pre-
decessors, in  this branch of medicine,  I shall not perish in
vain. My errors, like the bodies of those who fall in forcing
a breach, will serve to compose a bridge for those who shall
come after me, in our present difficult enterprise. This con-
sideration, aided by just views of the  nature and extent of
moral obligation, will  overbalance 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 forty years,
the memory of his physiological works would perish from
the earth,  I  am satisfied, from the knowledge we have of
his elevated  genius and piety,  he would have treated the
prediction with the same indifference that he would  have
done, had he been told,  that in the same time, his name
should be erased from  a pane of glass,  in a noisy and vulgar
country tavern.
   The subjects of  the lectures I  am about to deliver, you
will find in a syllabus which I have prepared and published,
for the purpose of giving you 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, particu-
larly those which relate to morals, metaphysics, and theolo-
gy.  However  thorny these questions may appear, we must
approach and handle them; for they are intimately connect. 
               CAUSE OF ANIMAL  LIFE.              5

ed with the history of the faculties  and operations of the
human  mind;  and these form  an essential part of the
animal  economy.   Perhaps it is  because physicians  have
hitherto been restrained from investigating,  and deciding
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 important 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 what  it
consists.
   I include in animal life, as applied to the human body,
motion, heat,  sensation,  and thought.   These  four when
united, compose perfect life. It may exist without thought,
sensation, or heat, but none of them 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. Hartley  in
explaining the laws of animal matter; because I conceived
it to be more simple, and better adapted to common appre-
hension.
   In treating  upon this subject,  I shall first consider ani-
mal life as it appears in the  waking and sleeping states in a
healthy adult, and shall afterwards inquire into the modifi-
cation of its causes in the foetal, infant, youthful, and mid-
dle states of life,  in certain diseases,  in different states  of
society, in different climates,  and in different animals.
   Before I proceed any further,  I shall remark,  that there
are certain grades of matter; and that in all its forms it is
necessarily quiescent or in other  words, possesses no self-
moving power.   Every form of it is moved by a  force
external to it, and each form has its appropriate or specific
stimulus, or stimuli, from the waves that are moved by the
wind, and the sand upon the sea shore which is moved by
the waves, up to the human body which is  moved by
the stimuli to be mentioned presently.   From this view  of
matter, I am naturally led to reject the common division of
it into active and  passive, or into substances that possess a
power to move themselves, and into such as require a power
to  move  them.  I believe  that animals, like water,  earth 
6                IN0J7IRY INTO  THE
and air, nay further, that the mind of man are all moved
only by their appropriate stimuli; and that water, earth and
air do not become more certainly quiescent from the ab-
straction of the causes that move them, than motion, heat,
sensation and thought cease from the abstraction of impres-
sions upon the human body.  The only difference between
what is called animated and inanimate matter consists  in
the stimuli which move the former, acting constantly, and
in health, with uniformity; whereas the stimuli which act
upon the  latter, act occasionally and with intermissions.
However diversified the motions and effects of these stimuli
may be, the causes of their motions are exactly the same.
  I shall begin by delivering a few general  propositions.
  I.  Every part of the human  body (the nails and hair
excepted)  is endowed  with  sensibility, or excitability,  or
with both  of them.   By sensibility is meant the power of
having  sensation excited by 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
irritability, contractibility,  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 obvious motion.   It is of no
consequence to our present inquiries, whether this excitabi-
lity be  a quality of animal matter, or a  substance.   The
latter opinion 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 indivisible substance. Its capacity for receiving
motion, and sensation, is variously modified by means of
what are  called the senses.  It is external, and internal.
The impressions which act upon it shall be enumerated in
order.
  III.  Certain motions are voluntary, and  others are per-
formed in an involuntary manner.
   IV.  Different parts of the body possess different decrees
of what has been called excitability, that is, different degrees
of susceptibility  to the action of the same stimuli upon
them.                                              r 
              CAUSE OF ANIMAL LIFE.               V

   V. Life is the effect of certain stimuli acting upon the
sensibility and excitability which are extended, in different
degrees, over every external 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. Cullen in the univer-
sity 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 afterwards deserted it; but it is equally true, I
never did; and the belief of it has been the foundation 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 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 endeavour to establish,  to Dr. Cullen, let
it not be supposed I mean to detract from  the  genius and
merit of Dr. Brown.   To his intrepidity in reviving  and
propagating it, as well as for 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 corrected, by their unsuccessful applica-
tion 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 arteries, the contraction of the mus-
cles, the peristalic motion of the bowels, the absorbing pow-
er 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 stimuli 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 arc food,  drinks, chyle,  the blood, a certain
tension of the glands,  which contain secreted liquors,  and
the exercises of the faculties of the mind  ; each of which  J
shall treat in the order in which they have been  mentioned. 
8
IN Q^L id. x  iniu ijix,
   I. Of external stimuli. Theirs* of these is Air. In sup-
port of this opinion, I shall produce the highest authority,
and that is, the history of the creation of man, as recorded
in the second chapter of the book of Genesis.  For this pur-
pose, I beg you would accompany me in your imaginations
to the garden of Eden, the birth place of the great progeni-
tor of the human race.  In the midst of this garden, behold
a  human  figure!  Let us  approach it: How  exquisitely
formed are its head,  its body, and its  limbs!  All is sym-
metry and beauty!  Let us approach still nearer,  and exa-
mine it by the aid of all our senses. It is motionless as the
earth upon which it stands. Its external surface is cold, but
soft. Its well formed face is pale, and its eyes, mouth, and
nostrils are all closed.   But who is that august figure that
with slow and majestic steps advances towards it ? It is its
Creator in a human shape. Let us retire a little to make
room for him to come nearer to the beautiful workmanship
of his divine hands.  What follows ? Let the inspired his-
torian tell us. "And  the Lord God formed man of the dust
of the ground, and breathed into his nostrils the breath of
life, and man  became a living soul."* The common ex-
planation of this passage  of Scripture is, that God, in this
act, infused a soul into the torpid, or lifeless body of Adam,
and that his soul  became its principle of life, or in other
words,  that he thus changed a dead mass of animalized
matter, into an animated being.   That this was not the case
I infer,  not only from the existence of life in many persons
in whom the soul is  in a dormant  or torpid state from dis-
eases in the brain, but from a more liberal and correct trans-
lation of the above passage of  Scripture,  in  which I am
warranted by several Hebrew scholars in our city, alike emi-
nent for their learning and piety.  It  is as follows. " And
the Lord God breathed into his nostrils, the air of lives, and
he became a living soul."  That is, he dilated his nostrils,
and thereby inflated his lungs with air, and thus excited in
him, animal, intellectual and spiritual life, in consequence
of which he became an animated human creature.  From
this view of the origin of life in Adam,  it appears that his
soul and body were  cast in the same mould,  and at the
same time, and that both were animated by the same act of
Divine power  by means of the  same  stream of air.  The
                       * Verse 7. 
              CAUSE OF  ANIMAL LIFE.              9

resuscitation of  the body after appearing to be dead,  by
means of stimuli, more especially by the stimulus of air,  fa-
vours the explanation I have given of the beginning of life
In man.  The  air thus infused into his lungs, by expanding
and stimulating them, communicated action,  first to the
heart, the heart moved the quiescent blood, the  blood mov-
ed the quiescent brain, the brain moved the quiescent mind,
the eyes and the mouth are now opened, the blood pervades
the capillary vessels of the face, and discharges a part of
the paleness from it;  his skin becomes warm ;  his will, the
great executive  faculty of the  mind,  begins to act; other
stimuli co-operate with the action of the air;  behold!  he
moves, he walks, he is perfectly and universally animated.
Thus gentlemen I believe began the life of man.
   That the  air,  by exciting respiration,  gave the first im-
pulse of life to the body and mind of Adam, and that it is
essential to it, I infer from many passages in the Old and
New  Testaments, besides the one I  have mentioned.   I
shall enumerate a few of them.
   1.  The dry bones seen by Ezekiel in a vision,  when
brought together,  were devoid of life, until the winds are
invoked to inflate their lungs with air.*  Immediately after-
wards they became living and intelligent  beings.
   2.. Job places the life of the whole  human race in their
breath. Hence he says, " In whose hand (meaning the Dei-
ty's) is the soul of every living creature, and the breath of
all mankind."!  Again he says,  " The Spirit of the Lord
hath made me, and the breath of the Almighty hath given
me life.J
   3.  St. Paul in his famous sermon  preached at Athens,
makes life  and breath synonimous ; hence  he  says, " He
(meaning the  Creator  of the world) giveth to all, life and
breath." $
   The intimate and indissoluble connection between breath
or air, and life, is established still further by the connection
which the  scriptures  hold  forth between the  absence  of
breath, or air, and the presence of death.
   4. The son of the  widow of Zarephath is said to die,
when " his sickness was so sore, that there  was no breath
left in him."||

    * Ohap. xxxvii.     f Chap. xiii. 10.      % Chap, xxxiii 4.
    § Acts xvii.  25.      !| 1 Kings xvii 17.
   VOL. I.                 'B 
10               INQUIRY  INTO THE

  5. The author of the 164th Psalm says, w Thou hidcst
thy face, they are troubled; thou takest away their breath;
they die, and return to their dust."*  Again, the author of
the 146th Psalm, in speaking of  the death of man, says,
" His breath goeth forth, he returneth to his earth; in that
very day his thoughts perish, "f
  Exactly in the same way in which I have supposed life
began in the first man in the garden of Eden, does it begin
in every child that comes into the  world.  The first portion
of air that rushes into its lungs, sets them in motion. They
move the heart... .hence they have been called  " cordis fla-
bellum," or " ventilabrum," that is, the bellows of the heart
....the heart moves the brain ;  the brain gradually awakens
and moves the  mind ; and both brain and mind by their
re-action, move every other part of the body. The first im-
pression of air upon the lungs of a new born infant is pain-
ful, and hence it cries give the first notice of the passage of
its head into the world. It is probable the action of air upon
its body likewise excites pain, and that the red colour of its
skin, may be the effect of it.  This sensation of pain is soon
destroyed by habit, and from the operation of a kind law in
the animal economy, it is afterwards followed by a sense
of pleasure.   Respiration for a while in a new born infant
is at first altogether involuntary.   The heart moves in like
manner from the effects of respiration upon it.  After some
time the will acquires, from the influence of habit, a partial
voluntary power over the lungs, but  the heart  continues to
move through every stage of life, only in consequence of
the perpetual impressions which are made upon it.  Its ac-
tion is therefore  very properly said to be altogether invol-
untary.
  That an action originally involuntary may become  vol-
untary, and that actions  originally voluntary may become
involuntary, from habit, is obvious from many facts.  The
former appears not only in respiration, but in the command
which all men acquire over their arms and legs  and over
the spincters of the rectum and bladder, and which some
men acquire over their stomachs and diaphragms, so as to
puke and hiccup at their pleasure, while  the latter appears
in many diseases, and, as I shall  say hereafter, in the last
* Verse 29.
t Verse 4. 
CAUSE OF  ANIMAL  LIFE.
11
hours of life. Convulsions in a limb, or muscle, are a strik-
ing proof of this change of a voluntary into an involuntary
action.  The same things appear in the tremors in the limbs
in old people, and in the fatal consequences which frequent-
ly attend their falling down in walking.  The whole weight
of their heads and bodies generally strikes the ground, and
that from the loss  of the power of their wills over their
arms, which by being protruded, break  the force of a fall
in early and middle life.
   I shall hereafter add a number of facts from  the history
of life in other animals,  which will, I hope, support the im-
portant office I have ascribed to the air in imparting the
first impulse to life in the human species.
   2. Light appears to occupy the next grade to air, in the
production of animal life.   It is remarkable  that the pro-
genitor of the human race was not brought into existence
until all the 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; but it  has
its proportion of force.   Sleep has been said to be a ten-
dency to death; now the absence of light we know invites
to sleep, and the return  of it excites the waking state.  The
late  Mr. Rittenhouse informed me, that for many years he
had constantly awoke with  the first dawn of the morning
light, both in summer and winter.   Its influence 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 inva-
lids, to be intimately connected with the presence or absence
of the rays of the sun.   The well-known pedestrian travel-
ler, 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, uncommon health and spirits,  both of which he
ascribed to the long duration, and invigorating influence of
light.   These facts will surprize 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 direction of their flowers; and all of 
12                INQUIRY INTO  THE
 them discharge their pure air only while they are exposed
 to it.*
   3. Sound has an extensive influence upon human life.
 Its numerous  artificial  and  natural sources need not be
 mentioned.  I shall only take notice,  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 the
 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 bal-
 loon.  They tell us that the silence which prevails in those
 regions of the air is so new and complete,  as to produce
 an awful solemnity in their minds.  It is not necessary 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 ali-
 ment upon the stomach, and of blood upon the heart and
 arteries, probably cease to be felt, only from the influence
 of habit.   The exercise of walking, which was originally
 the result of a deliberate act of the will, is performed from
 habit without the least degree of consciousness.   It is un-
fortunate 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 know-
ledge 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.
  *  Organization,  sensation,  spontaneous motion, and life, exist only at
the surface of the earth, and in places exposed to light.  We might affirm
the flame of Prometheus's torch was the expression of a philosophical
truth that did not escape the ancients. Without light, nature was lifeless,
inanimate, and dead.  A benevolent God, by producing life,  has spread
organization, sensation, and thought over the surface of the earth."—
 Lavoisier. 
CAUSE OF ANIMAL LIFE.            13
  The influence of sounds of a certain kind in producing
excitement, and thereby increasing life, cannot be denied.
Fear  produces debility,  which is a tendency  to  death.
Sound obviates this debility, 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 soldier feels his departing  life recalled in the
onset of  a battle by the noise of the fife, and of the poet's
" spirit stirring drum." Intoxication is frequently attended
with a higher degree 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 entertainments where there is
music, loud talking, and hallooing, than in  private com-
panies 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 suddenly extorted
by grief, proved  the means of resuscitating 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 people; and hence arise the
dulness  and want of spirits which they discover in their
intercourse with the world.
  4. Odours  have a sensible effect  in  promoting  animal
life.  The greater healthiness of the country, 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
bordering upon death, to an equable and regular degree of
excitement.
  5. Heat is a uniform and active stimulus in promoting
life.  It  is derived, in certain seasons and countries, in part 
14                INQUIRY  INTO  THE

from the sun ; but its principal source is from  that cause
whatever it  may be, which  produces animal heat.   The
extensive influence of heat  upon animal  life,  is evident
from its decay and suspension during the winter in certain
animals, and from its revival  upon the  approach and action
of the vernal sun.  It is true, life is diminished  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 muscles.  These
act'upon the blood-vessels, and they upon the nerves and
brain. The necessity of exercise to animal life is indicated,
by its being kindly imposed  upon man in paradise.  The
change which the human body underwent by the fall, render-
ed 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 exercise 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 muscular fibres, and  by their  means, upon
every part of the system.
  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 connection 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 mas-
tication.   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 distention 
               CAUSE OF ANIMAL  LIFE.            15

of the stomach and bowels is essential to a healthy excite-
ment of the system.  Vegetable aliment and drinks, which
contain less nourishment than animal food, serve this pur-
pose in the human body.  Hay acts in the same manner in
a horse.  Sixteen pounds of this light  food in a day are
necessary to  keep up  such  a degree of distention in  the
stomach and  bowels of this animal, as to impart to him his
natural  grade of strength and life.  The  quality of food,
when of a stimulating nature, supplies the place of its dis-
tention 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 influence  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, sup-
port 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 Surinam ; and the indigesti-
ble cover of an old Bible preserved the life of a dog, acci-
dentally confined in a room at Newwcastle 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 heat and air.
Now both these, it has been remarked, exert a stimulus in
promoting animal life.
   Drinks, when they consist of fermented or distilled li-
quors, 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 attend-
ed with considerable stimulating effects.
   III. The blood is a very important internal stimulus. It
has been disputed whether it acts by its  quality, or only
by distending the blood-vessels.   It appears to act in both 
16               INQUIRY INTO THE
 ways. I believe with Dr. Whytt, that the blood stimulates
 the  heart and arteries by a specific action.  But if this be
 not admitted, 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 assertion it has been remarked,
 that in those persons who die of hunger, there is no dimi-
 nution 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 evi-
 dent in the vigour which is imparted to the  system, by the
 fulness of the seminal vesicles and gall bladder, and by the
 distention of the uterus in pregnancy.  This distention is
 so  great, in some instances,  as to  prevent  sleep for many
 days and even weeks before  delivery.  It serves the valu-
 able 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
 temporary victory over  the  plague and other  malignant
 fevers;  for death, from those diseases,  seldom takes place,
 until the stimulus, from the distention  of  the  uterus, is
 removed by parturition.
   V. The  exercises of the  faculties of the mind have a
 wonderful influence  in increasing the quantity 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 animal economy.   It is thus the brain repays the heart
 for the blood it conveys to it, by re-acting upon its muscu-
 lar fibres.   The influence of the different faculties of the
 mmd 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 pas-
 sions.  Thinking  belongs to the  understanding,  and is
 attended  with  an obvious influence upon the degree and
 duration  of life.  Intense study has often rendered the body
 insensible to the debilitating effects of cold and  hunger.
 Men of great and active understandings,  who  blend with
their studies temperance and exercise, are  generally long 
CAUSE OF  ANIMAL LIFE.
17
aved.  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
opinion 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.
  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, ambi-
tion, and avarice; to the latter, fear, hatred, malice, envy,
and the like.   Joy,  anger, and terror, belong to the class
of emotions.  The passions and emotions have been fur-
ther 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 innocence, 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 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 persons
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 over-
   VOL. I.                   C 
18               INQJJIRY INTO  THE
come the fatigue  induced by travelling, by thinking of a
person whom he hated.   The debility induced by disease
is often removed by a sudden change in the temper.  1 nis
is so common,  that even nurses predict a recovery in per-
sons as soon as they become peevish and ill-natured, alter
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 Elwes was a prodigy of  avarice, and. every
court in Europe furnishes instances of men who have attain-
ed 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, I did not find  a single  person
above eighty, who had not possessed an active understand-
ing, or active passions. Those different and opposite facul-
ties of the mind, when in excess, happily supply the place
of each other.  Where they unite their forces, .they extin-
guish the flame of life,  before the oil which feeds it  is
consumed.
  In  another place I shall resume the influence of the facul-
ties of the mind upon human life,  as they discover them-
selves 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 motions of life.  I hope to establish
hereafter the opinion of Mr. Locke, that the mind is always
passive in sound sleep.  It is true it acts  in dreams ; but
these depend upon a morbid state of the brain, and there-
fore 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, indu-
ced by the excess or deficiency of customary stimuli.
   Life is in a languid state in  the morning.   It acquires
vigour by the gradual and successive application of stimuli
in the forenoon.   It is in its most  perfect state about mid-
day,  and remains stationary for some hours.   From the 
              CAUSE OF ANIMAL LIFE.            19

diminution of the sensibility and contractility of the system
to the action of impressions, it lessens in the evening, and
becomes again languid at bed-time. These facts will admit
of an extensive application hereafter in our lectures  upon
the practice of physic.
                    LECTURE II.

Gentlemen,

     THE stimuli  which have been enumerate^, when
they act collectively, and within certain bounds,  produce
a healthy waking state.   But they do not always act col-
lectively, nor in the  determined and  regular manner that
has been described.  There is, in many states of the sys-
tem, a deficiency of some stimuli, and, in some of  its
states, an apparent absence of them all.   To account for
the continuance of animal life under  such circumstances,
two things must be premised, before we proceed to take
notice of the diminution or absence of the stimuli which
support it.
   1. The healthy actions of the body in the  waking state
consist in a proper degree of what has been called excita-
bility and excitement.   The former  is the  medium  on
which stimuli act in producing the  latter.  In an exact
proportion, and a due relation of both, diffused uniformly
throughout every part of the body, consists  good health.
disease is the reverse of this.   It depends in  part upon a
disproportion between excitement and excitability, and in
a partial distribution of each  of them.  In  thus distin-
guishing the different states of excitement and excitability
in health and sickness, you see I dissent from Dr. Brown,
who supposes them to be (though disproportioned to each
other) equably 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 ac- 
20              INQJJIRY INTO THE

tion of others.  This is more certainly the case where a
natural stimulus is abstracted suddenly ; for the excitabi-
lity is thereby so instantly formed and accumulated, as to
furnish a highly sensible and moveable surface for  the
remaining  stimuli 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 rheumatism.   A horse in a cold stable eats more than
a warm one, and  thus counteracts the debility which would
otherwise be induced upon his system, by the abstraction
of the stimulus of warm air.
   These two propositions being admitted, I proceed 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
   1.  Sleep.  This is either natural or artificial.  Natural
sleep is induced by a diminution of the excitement and
excitability of the system, by the continued 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  unusual time, it is
brought on at an earlier hour.  Thus a long walk or ride,
by persons accustomed to a sedentary life, unusual exer-
cise of the understanding, the action of strong passions or
emotions, and the continual application of unusual sounds
seldom fail of inducing  premature sleep.  It is recorded
of pope Gahganelli, 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  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. 
               CAUSE OF ANIMAL LIFE.            21

  Artificial sleep may be induced at any time by certain
stimulating substances, particularly by opium.  They act
by carrying the system beyond the healthy grade of ex-
citement, to a degree  of depression, which Dr. Brown has
happily called the sleeping  point.   The same point may
be induced in the system at any time by the artificial ab-
straction of the usual  stimuli of life.   For example, 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  temperate 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
physician,  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; 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 in-
ducing it.  These belong  to another part of our course.
The short explanation I have given of its cause was neces-
sary in order to render 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  increased  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 heen employed to restore declining
life to the bodies of old people.  Witness  the damsjel who
lay for this purpose in the bosom of the king of Israel.
The advantage of this external heat will appear further,
when we consider how impracticable or  imperfect sleep
is, when we lie under too light covering  in cold weather.
  2. The  air which  applied to the lungs  during sleep
probably acts with more force than in the  waking state.  I 
22               INQUIRY INTO THE
am disposed to believe that more air is phlogisticated in
sleep than at an other time, for the smell of a close room
in which a person has slept one night, we know, is much
more  disagreeable  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  extension
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  fullness 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.
They derive this pre-eminence  from the  protection and
support  they afford to every part of the system.  They
are the perpetual  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 diminution 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 in-
fancy and old age.
   4. Aliment  in the stomach acts more powerfully in
sleep than in the walking state.  This is evident from di-
gestion 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 
CAUSE OF ANIMAL LIFE.             23
is favourable to easy and sound sleep; and the want of it,
in persons who are accustomed to that meal, is often fol-
lowed by a restless night. The absence of its stimulus  is
probably supplied by a full gall-bladder (which always at-
tends an  empty stomach) in persons who are not in the
habit of eating suppers.
   5. The stimulus of the urine, accumulated in the blad-
der 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 acti-
vity  of  the  understanding and passions in  dreams ;  and
hence we dream more in our morning slumbers, when the
bladder is full, than we do in  the beginning or middle of
the night.
   6. The feces exert a constant  stimulus upon  the bow-
els in sleep.  This is so  considerable as to render  it  less
profound when they have been  accumulated for two or
three days, or when they have been deposited in the ex-
tremity of the alimentary canal.
   7. The partial and irregular exercises of the understand-
ing and passions in dreams have an  occasional  influence
in promoting life.  They occur only where there is a defi-
ciency 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, and
putting on a gangrenous appearance in consequence  of the
commotions excited in their bodies by irritating dreams.*
The stimulating passions act through the medium  of the
will; and the exercises of this faculty of the mind  some-
times 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 us with  pleasure or pain, according as
we are disposed to respect or disobey the precepts  of our

  * A fever was excited in Cinna the poet, in consequence of his dream-
ing that he saw Cxsar, 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.  Convulsions, and other diseases, I believe, are often excited in
the night, by terrifying  or distressing dreams.
                             Plutarch's Life of M. Brutul 
24
INQUIRY  1NIO  Itic
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 operation 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 halloo, and by
thus invigorating respiration, overcomes the languid circu-
lation of the blood in the heart and brain. Do not complain
then, gentlemen, when you are bestrode by this midnight
hag. She is 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 commonly 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 present 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 ren-
ders 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 supported.
   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 motion for a
few days is always a sign  of the indisposition 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 mea-
sure deficient in acrimony, and their mental faculties are
too week to exert much influence upon their bodies.  But
the absence of stimulus from those causes is amply sup-
plied.
   1. By the very great  excitability of their systems to

  * " Novum foetum a seminis masculi atimulo vitam concepisse."—•
Elementa Physiologic, vol. viii. p. 177. 
                CAUSE OF ANIMAL LIFE.            25

 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 se>
 veral weeks after  birth.   The capacity of infants to be
 acted upon 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. Umfrevilles'
 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 infants in producing the red colour of their skins.
 It 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 nature.   By a kind law of
 sensation,  impressions, that were originally painful,  be-;
 come pleasurable by repetition or duration.   This is  re,
 markably evident in the impression now under considera-
 tion,  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 fur-r
 ther,  gentlemen, what was said  formerly of  excitability
 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 complain of the injuries they meet
 with from falls, cuts, and even severe surgical operations,
   2. Animal  life is supported in infants by their sucking,
 or feeding,  nearly every hour in the day and  night when
 they are awake.  I explained formerly the manner in which
 food stimulated the system.   The action of sucking sup-
 plies, by the muscles employed in it, the stimulus of mas-
 tication.
   3. Laughing and crying, which are universal in infancy
have a considerable influence in promoting animal life,  by
their action upon respiration, and the  circulation  of  the
blood. Laughing exists under all circumstances, independ-
ently of education or imitation.  The child of the negro slave,
born only to inherit the toils and misery of its parents, re-
ceives its  master with a smile every time  he enters  his
kitchen or a negro-quarter. But laughing exists in infancy
   VOL. I.                   D 
26               INQUIRY INTO THE
under circumstances still more unfavourable to it; an in-
stance 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 solitary 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 perhaps had
never (before the  sight of Mr Bruce) beheld any other hu-
man 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 possi-
ble 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 converting their ideas into words
as fast as they rise, follows them to their beds, where we

  * 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 bo-
dies.  This motion counteracts the diminution of life produced  by the heat
of the climate of Arabia. 
              CAUSE  OF ANIMAL  LIFE            27

often hear them talk themselves  to sleep in a whisper, or
to use less correct, but more striking terms, by thinking
aloud.
   5. Dreams act  at an early period upon the  bodies of
children.  Their smiles, 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 im-
aginary 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 con-
stant succession of new and agreeable impressions.
   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 period the passions
blow a perpetual storm. The most predominating of them
is the love of pleasure.  No sooner  does the system be-
come insensible to this stimulus, than ambition succeeds
it in,
   IV. The middle stage of life.  Here  we behold man in
the most perfect physical state.  The stimuli 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 entire-
ly extinguished.   The pulse becomes slow, and subject
to frequent intermissions, from a decay in the force of the
blood-vessels.  Exercise becomes impracticable, or irk-
some,  and the operations of the understanding are per-
formed with  languor and difficulty.   In this shattered and 
28               INQUIRY INTO THE
declining state of the system, the absence and diminution
of all the stimuli which have been mentioned are supplied,
   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 persons in middle life, and
they bear with pain the usual intervals between meals.
They moreover prefer that kind of food which is  savoury
and stimulating.  The stomach of the celebrated Parr, who
died in the one hundred and  fiftieth year of his age, was
found full of strong, nourishing aliment.
  2.  By the stimulus of the faeces, which are frequently
retained for five or six days in the bowels of old people.
  3.  By the stimulus of fluids rendered preternaturally
acrid by age.  The urine, sweat, and even the tears of old
people, possess a peculiar acrimony. Their blood  likewise
loses  part of the  mildness which  is natural to that fluid;
and hence the difficulty with  which sores  heal in old peo-
ple ; and hence too the reason why cancers are more com-
mon in  the decline, than in any other  period of human
life.
  4.  By  the uncommon activity of  certain  passions.
These are either good or evil.  To the former belong an
increased vigour in the operations of those passions which
have for their objects the Divine Being, or the whole fa-
mily  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 holidays.
Its stimulus is constant, though  varied daily by the  nu-
merous means which it has discovered of increasing, se-
curing,  and perpetuating property. It has been observed
that weak mental impressions produce much greater effects
in old people than persons in middle life.  A trifling indis-
position 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 proba-
bly alludes, when he describes the grasshopper as burden-
some to old people.
   5. By the passion for talking, which is so common, as 
              CAUSE  OF ANIMAL  LIFE.           29

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.
   6.  By their wearing  warmer  clothes, and  preferring
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 find-
ing out at what  degree of heat he found himself comfor-
table  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 contractility of the animal  fi-
bres predominated over their sensibility in that stage of life.
The same thing takes place in old people, and it is in con-
sequence of the  return of this  infantile state of the system,
that all the stimuli which have been  mentioned act upon
them  with  much more force than in middle life.  This
sameness, in the predominance of excitability over sensi-
bility in children and old people, will account for the simi-
larity  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 is from
an ignorance of this change in their constitutions, that ma-
ny 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 gentle
stimulating  employments upon  the  female constitution,
that more women  live  to be old than men, and that they
rarely survive their usefulness in domestic life.
  Hitherto the principles I am endeavouring to establish
have been applied  to explain the cause of life in its  more 
30                INQUIRY INTO THE

common forms.  Let us next  inquire, 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 apparent 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 of sight, hear-
ing, and speech, are sometimes brought  on by diseases.
Here  animal life is deprived of all those numerous stimu-
li, which arise from  light,  colours, sounds, and speech.
But the absence of these stimuli is  supplied,
  1.  By increased sensibility and excitability in their re-
maining 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 walk-
ing 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
celebrated 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 fingers upon them.
One of these persons, mentioned by Mr. Boyle, has left
upon  record an account of the specific quality of each co-
lour as it affected his sense of touch.  He says black im-
parted the most, and blue the  least, perceptible sense of
asperity to his fingers.
  2.  By an increase of vigour in the exercises of the men-
tal faculties. The poems of Homer, Milton, and Blacklock,
and the attainments of Sanderson in mathematical know-
ledge, all  discover  how much the energy of the mind
is increased  by the absence of impressions upon  the or-
gans of vision.
  II.  We sometimes behold life in idiots,  in whom there
is not only an  absence of the stimuli of the understand-
ing and  passions, but frequently from the weakness of 
CAUSE  OF ANIMAL LIFE.             31
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
operations 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,
and of course did not wish to  gratify that appetite in an
unlawful manner.
   III. How is animal life supported in persons who pass
many days,  and even weeks,  without 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 pro-
ducing moral happiness, is  supplied,
   1.  By the stimulus of a  full gall  bladder.  This state
of the  receptacle of  bile has  generally  been found to
accompany an empty stomach.   The bile is sometimes
absorbed, arid imparts a yellow colour to the skin of per-
sons who suffer or die of famine.
   2. By increased acrimony in all the secretions and ex-
cretions of the body.   The saliva becomes  so acrid by
long fasting,  as to excoriate the gums, and the  breath
acquires not only a foetor, but a pungency so active, as tc
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

   * 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 physi-
cians, determined to destroy himself, by abstaining from food and drinks.
He lived sixty days without eating any thing, and the greatest part of that
time without tasting even a drop of water. His disease probably protract-
ed 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. 
32                iNquiit v in iu  i H£
 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 on fasting for six
 weeks, in producing a quickness  and correctness in my
 perceptions of the state of the pulse, which I had  never
 experienced before.
   4. By an  increase  of activity in the understanding 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 pre-
 ternatural  action, the absence of the stimulus of food, is
 scarcely felt.  I shall hereafter mention* the influence of the
 desire of life upon its preservation, under all circumstances.
 It acts with peculiar force when fasting is  accidental.  But
 when it is submitted to as a religious duty, it is accom-
 panied by sentiments and feelings which more than balance
 the abstraction of aliment.   The body of  Moses  was sus-
 tained, 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 no defici-
 ency 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 excessive 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 abstraction of exter-
 nal 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 con-
 sisted in the excitement and excitability of 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
               * Exodus xxxiii.  11. xxxiv. 28. 
CAUSE OF ANIMAL LIFE.             33
some instances, for hours afterwards unimpaired, provided
the accident which produced the loss of excitement 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 exertions 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 gradually into
excitement.  The same  condition of the  system takes
place when apparent  death occurs from freezing, and a
recovery is accomplished  by the same gentle application
of stimuli, provided the organization of  the body be  not
injured,  or its excitability 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  by thought;
and  in these, I  said formerly,  consists perfect life in the
human  body.
   For this explanation of the manner in which life is sus-
pended and revived, in persons apparently dead from cold,
I am indebted to Mr. John Hunter,  who supposes,  if it
were  possible for the body to be suddenly frozen, by an
instantaneous abstraction of its heat,  life might  be con-
tinued for many years in a suspended state, and revived
at pleasure, provided the body were preserved  constantly
in a temperature barely sufficient to prevent re-animation,
and never so great  as to endanger the destruction of any
organic  part. The resuscitation of insects, that have been
in a torpid state  for months, and perhaps years,  in sub-
stances 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 occurs in
acute diseases, and which has sometimes been denominat-
ed a trance, the system is nearly in the  same excitable
state that it is in apparent death from drowning and freez-
ing.   Resuscitation, in these cases, is not the effect, as in
those which have been mentioned, of artificial applications
   VOL. I.                  e 
34               INQUIRE INTO THIS
 made to the body for that purpose. It appears to be spon-
 taneous ;  but it is produced by impressions made upon
 the ears, and by the operations of the mind in dreams.  Of
 the actions of these stimuli upon the body in its apparent-
 ly lifeless state, I  have satisfied myself 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  his death,  he begged that he might not be
 interred until one week  after the usual signs of life had
 left his body, and gave as a reason for  this request, 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 distress.
 ing emotions in his mind, as to diffuse motion throughout
 his body, and finally excited in him all  the usual functions
 of life.  In  Dr. Creighton's  essay upon mental derange-
 ment, there is a history of a case 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 countenance 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 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 speaking and  lamenting her death at the side  of
her coffin.   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 
              CAUSE OF ANIMAL LIFE.            35

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 continually endeavoured
to do so.   The internal anguish  of her mind was at its
utmost height when the funeral 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."
  Where the ears lose their capacity of being acted upon
by stimuli, the mind,  by its operations in dreams, be-
comes a  source of impressions which again sets the wheels
of life in  motion.   There is an account published  by Dr.
Arnold,  in his observations upon insanity,* of  a  certain
John Engelbreght, a German, who  was believed to be
dead, and who was evidently resuscitated by the  exercises
of his mind upon subjects which 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
upwards, insomuch that my whole body became stiff.   J
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
become.   This I heard distinctly, but I had no percep-
tion of their touch. I heard the watchman cry 11 o'clock,
but at 12 my hearing left me." After relatinghis 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 re-
turning  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 conveyed back
fr m the heavenly glory, I began to  hear something  of
                     * Vol. ii. p. 298. 
36               INQUIRY  INTO  THE
 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
 firmness 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 instanta-
 neous recovery."
   The explanation  I have given of the cause of resusci-
 tation in this man will serve to  refute a belief  in a sup-
posed migration of  the soul from the body,  in cases of
apparent death. The imagination, it is true, usually con-
ducts the  whole mind to the abodes of happy or misera-
ble spirits, but it acts here in the  same way that it does
when it transports it, in common dreams, to numerous and
distant parts of the world.
   There is nothing supernatural in Mr. Engelbreght being
invigorated by his  supposed  flight to heaven.  Pleasant
dreams always stimulate and strengthen the body, while
dreams  which are accompanied with distress or labour
debilitate and fatigue it.
                   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 circum-
stances 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 disgusting taciturnity, are the effects of the
want of .action in their brains from a deficiency of ideas;
and their tranquillity under all the common circumstances 
               CAUSE OF ANIMAL  LIFE.            37

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 Rouseau, and several other
writers, who have attempted to prove that man may become
perfect and happy without the aids of civilization and reli-
gion.  This opinion is contradicted by the experience of
all ages, and is rendered ridiculous by the facts which are
well ascertained in the history of the customs and habits of
our  American  savages.  In  a cold climate they are th^
most miserable beings  upon the face of the earth.   Th?
greatest part of their time is spent in sleep, or under 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 diminu-
tion of many of the stimuli of life in these people is supplied
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 labour; for the earth  produces
spontaneously  nearly   all  the  sustenance they require.
Their  understandings  and passions are moreover in a tor-
pid  state.  But the absence of bodily and mental stimuli
in these people is amply supplied by the constant heat of
the sun, by the profuse use of spices in their diet, and by
the  passion for musical sounds which so universally cha-
racterises  the African nations.
   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 nature of the aliment of the Greenlanders, which
consists 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 
 38                INQUIRY INTO THE

 strangers.  I need hardly add, that a diet possessed of such
 diffusible qualities 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 spirituous liquors is universal
 among them.
   IV.  Let us next turn our eyes to the miserable inhabi-
 tants of those eastern countries which compose the Turk-
 ish empire.   Here we behold life in  its most feeble  state,
 not only from the absence of physical, but of other stimuli
   Chich  operate upon  the inhabitants of  other ports of the
   orld.  Among the poor people of Turkey there is a gene-
 ral deficiency of aliment.   Mr. Volney in his Travels tells
 us,  " That the diet of the Bedouins seldom exceeds six
 ounces a day, and that it consists of six or seven  dates
 soaked in buttermilk, and afterwards mixed with a little
 sweet  milk,  or curds."   There  is likewise a  general de-
 ficiency among  them of stimulus from  the  operations
 of the mental faculties;  for  such  is  the  despotism of
 the government in Turkey, 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 al-
 together to  his master.   Fear is the reigning principle of
 his action, and hope and joy seldom add a single pulsation
 to his  heart.   Tyranny even imposes a restraint upon the
 stimulus 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 tra-
veller 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 serocity, that nothing
but the greatest  heat can preserve its fluidity."  The de-
ficiency of aliment, and the absence of mental stimuli in
these people is supplied,
   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.
                   * Niebuhr's Travels. 
CAUSE OF ANIMAL LIFE.            39
  The more debilitated the body is, the more forcibly these
stimuli act upon it.  Hence, according to Mr. Volney, the
Bedouins, whose slender diet has  been mentioned, enjoy
good health; for this consists not in  strength, but in an ex-
act proportion  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 domi-
nions, 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 effi-
ciency of these  stimuli are supplied  by,
   1. The heat  of the  climate in the  southern parts of those
countries.
  2. By a vegetable diet abounding in nourishment, parti-
cularly rice and beans.
  3. By the use of tea in China, and by a stimulating cof-
fee made of the dried and toasted seeds  of the datura  stra-
monium, 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 govern-
ments of the middle and southern parts of Europe, the de-
ficiency of the stimulus of wholesome 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 climate. In cold countries, where the
earth yields its increase with reluctance,  and where vegeta-
ble aliment is scarce, the want of the stimulus of distension
which that species of food is principally calculated to produce
is sought for in that of ardent 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 stimuli
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 
40               INQUIRY INTO  THE
than persons of civilized manners, and cultivated understand-
ings.  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 mentioned, they are constantly under the
invigorating influence of liberty.  There is an indissoluble
union between moral, political, and physical happiness; and
if it be true, that elective and representative governments
are most favourable to individual, as well as national pros-
perity, it follows of course, that they are most favourable to
animal life.  But this opinion  does not rest upon an induc-
tion derived from the relation, which truths upon all sub-
jects bear to each other.  Many facts  prove animal life to
exist in a larger quantity and for a  longer time, in the en-
lightened and  happy state of Connecticut, in which repub-
lican 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 power-
fully in supporting our existence.   It has been  observed
to prolong  life.   Sickly travellers  by sea and  land, often
live under circumstances of the  greatest weakness, till they
reach their  native  country, and then expire in the bosom
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 persons, who were actuated by
opposite passions with respect to life.  Atticus, we are
told, died of voluntary abstinence from food in five days.
In sir William Hamilton's account of the earthquake at Ca-
labria, we read of a girl who  lived eleven days without
food  before she expired.   In  the  former  case, life was
shortened by  an aversion from it; in the latter,  it was pro-
       * Haller's Elementa Physiologix, vol. viii. p. 2. p.  107. 
               CAUSE OF ANIMAL LIFE.             41

tracted by the desire of it.   The late Mr. Brissot, in his
visit to this  city, informed me, that the application of ani-
mal magnetism (in which he was a believer) had in no in-
stance 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 fee-
ble 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 affec-
tions, 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
furnished the most extraordinary proofs of  the stimulus 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.   It excited febrile diseases in
three persons who became 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  deserted, and men of every pro-
fession and  trade were seen  in all our streets hastening to
the coffee-house, where the  agitation of countenance, and
the desultory manners, of all  the persons who were interest-
ed  in this species of gaming, exhibited a truer picture of
a bedlam, than of a place appropriated to the transaction of
mercantile business.   But further, the love of money dis-
covers its stimulus upon 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 suc-
cession at a card table;  and it is related in the life of a noted
gamester  in Ireland, that when he was so ill as to be una-
ble to  rise from his chair, he would suddenly revive when


  * Dr. Mead  relates, upon the authority of Dr. Hales, that more of the
successful speculators in  the South-Sea scheme of  1720 became insane,
tlian of those who had been ruined by it.
vol.. I.
F 
42                INQUIRY INTO THE
brought to the hazard table, by hearing the rattling of the
dice.
  3. Public  amusements  of all kinds, such as a horse
race, a cockpit, a chase, the theatre, the circus, masque-
rades,  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 stimulating
operation to persons in health.  It acts perceptibly in some
cases upon invalids.   I have  heard of a gentleman in South
Carolina,  who always relieved himself of a fit of low spi-
rits by changing his*dress; and I believe there are few peo-
ple, 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, pros-
pects, and situations, with respect to town and country, or
to different countries, that are new, all exert an invigorat-
ing influence upon health and life.
   6. The love of fame acts in various ways; but its stimu-
lus is most sensible and durable in military life.   It coun-
teracts in many instances the debilitating effects of hunger,
cold, and labour.  It has sometimes done more, by remov-
ing  the weakness which is connected with many diseases.
In  several instances,  it  has assisted the  hardships  of a
camp life in curing pulmonary consumption.
   7. The love of country is a deep seated principle of ac-
tion in the  human breast.  Its stimulus is sometimes so
excessive, as to induce disease in persons  who recently
migrate, and settle in foreign countries.   It  appears in va-
rious forms;  but exists most  frequently in the solicitude, la-
bours, attachments, and hatred of party spirit.  All these act
forcibly in supporting animal life.  It is because newspapers
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 vehicles 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. *

   * They have been very happily called by Mr. Green in his poem en-
titled Spleen, " the manna of the day." 
CAUSE OF ANIMAL LIFE.
43
  8. The different religions of the world, by the activity
they excite in the mind, have a sensible influence upon
human  life.  Atheism is the worst of sedatives to the un-
derstanding and passions.  It is the abstraction of thought
from the most sublime, 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 violence
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 necessary 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 fortune, and of human
reason;  and,  in some instances, with ceremonies of  the
most expensive and splendid kind.  Religions are friendly
to animal life, in proportion as they elevate the understand-
ing, and act upon the passions of hope and love.   It will
readily  occur to you, that Christianity, when believed and
obeyed, according to its  original consistency with  itself,
and with the divine attributes,  is more calculated to pro-
duce 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 recom-
mend it to our belief.   How long mankind may continue
to prefer substituted pursuits and pleasures to this invigo-
rating stimulus is uncertain; but the time, we are assured,
will 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 government, have been exhausted to no purpose.
  Thus far,  gentlemen, we  have considered animal life  as
it respects the human species; but  the  principles  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 upon the same causes as in the human
body. 
44               INQUIRY INTO THE
   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 attri-
bute 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.
   L  They all possess either hearts, lungs, brains, nerves,
or muscular fibres.   It is  as yet a controversy among  na-
turalists, whether animal  life can  exist without a brain;
but no one has denied muscular fibres,  and of course con-
tractility, or excitability, 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  co-
vering 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 sup-
porting animal life.
   3.  Many of them possess heat equal  to that of the hu-
man body.   Birds possess several degrees beyond it. Now
heat,  it was said formerly, acts with great force in the pro-
duction of animal life.
   4.  They all feed upon substances more or less stimu-
lating to their bodies.  Even water  itself, chemistry has
taught us, affords an aliment, not only stimulating, but
nourishing to many animals.
   5.  Many of them possess senses more acute and excita-
ble,  than  the same organs in the  human species.   These
expose surfaces  for  the action of external  impressions,
that  supply the absence or deficiency of mental faculties.
   6.  Such of them as are devoid of sensibility possess  an
uncommon portion of contractility, or simple excitability.
This  is evident in the polypus.  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 upon 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 
CAUSE OF ANIMAL LIFE.
45
pleasures, far more powerful than that which is felt by our
species from the same causes.   I shall hereafter mention
some facts from Spalanzani 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 connection
with its female, suffers its limbs to be amputated, without
discovering the least mark of pain, and without relaxing
its hold of the object of its embraces.
   9.  In many animals we behold evident marks of under-
standing 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, exercise,  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 imperceptible.
   2.  By the stimulus of  aliment  in a state of  digestion in
the stomach, or by the stimulus of aliment restrained from
digestion  by means of cold;  for Mr. John Hunter  has
proved, by an, experiment on a frog, that cold below a cer-
tain degree,  checks that animal process.
   3.  By the constant action of air upon their bodies.
   It is possible life may exist in these animals, during their
hybernation, in the total absence of impression and motion
of every kind.   This may be the case, where the torpor
from  cold has been suddenly 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 remark, that heat and cold are relative
terms, and that different animals, according to their orga-
nization, require very different degrees of heat for their ex-
istence.  Thirty-two degrees  of it are probably as stimu-
lating to some of these cold blooded animals,  (as they are
called,) as 70° or 80° are to the human body.
   It might afford additional support to the doctrine of ani- 
46                INQUIRY INTO THE
 mal life which 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 jus-
 tice.   I shall only remark,  that vegetable life is as  much
 the offspring of stimuli as animal, and that skill in agricul-
 ture 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 discovers 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 is
 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
 Cullen, and the vital principle of John Hunter,  as  much
 from the body, as I do an intelligent principle from air, fire,
 and water.
  Upon the opinions  of these different authors, I beg leave
 to add further, that they are all modifications of two errors
 held by Pythagoras and Epicurus.  The former believed
 and taught what is called the transmigration  of souls, that
is, that the principle  of life, rational  and animal, was a
kind of elementary body; that it  never died; and that it
passed from animals that perished, into other animal matter,
and thereby  imparted  to it soul, or  what  is called life.
 This opinion accords  with the vital principle of Mr. Hunter
and Dr. Girtanner, while the anima medica of Stahl accords
with the doctrine taught by Epicurus, of the globe being
animated by a principle  called anima mundi.  Both opinions
substitute an intelligent and self-moving principle to the
agency of a  Supreme Being,  in every part  of his works.
There is a third error  connected with this  subject, which it
may not be improper  to mention upon this occasion, and
that is, that man consists of spirit, soul, and body....that his
spirit resides in his brain, and is concerned only in intellec
                       * Dr. Barton. 
               CAUSE OF ANIMAL LIFE.            47

tual and spiritual exercises....that his soul is diffused through
every part of his body, and  constitutes  what is called his
"soulish," or animal, life.   This pagan  opinion seems to
have tinctured some of the writings of St. Paul, who, though
inspired by the Spirit of truth upon theological subjects,
was left to  follow the opinions of the world in matters of
human learning. The doctrine I have delivered, obliges us
to consider man as consisting  of two parts  only; these
are, soul, or mind, and body.  This  view of the nature of
man is simple, and accords alike with reason and revelation.
   The speaking figures, which are conducted through our
country as spectacles to amuse the vulgar, afford a striking
illustration of the error of animal life depending upon a self-
moving principle in the body.   The  voice is supposed to
come from within the figure; whereas, it is  certain it is
conveyed there by the reflection of words pronounced by a
person external to it.
   I have often been struck with the similarity of the con-
troversies upon the  origin of  moral  obligation, of power,
and of animal life, and with the similarity of their issue in
a simple elementary truth, obvious  to the most humble
capacities.   They were all believed to depend  upon causes
within themselves;  but they are now rescued from an inter-
nal and placed upon an external basis. The origin of moral
obligation, which was formerly ascribed to utility, to sym-
pathy, and to the fitness of things, is now derived wholly
from the will of God.  The origin  of  power, which was
derived for ages from divine or hereditary right, now rests
exclusively upon the will of the people, while the origin of
animal life, which has been, time immemorial, derived from
a self-moving power,  under the different names  that have
been mentioned,  now reposes,  probably for  ever,  upon
external and internal impressions.  By means of this doc-
trine, revelation and reason embrace each,  others and Moses
and the prophets shake hands with Dr. Brown, and all those
physicians,  who  maintain the .great  and sublime  truth
which he has promulgated.  Think of it, gentlemen, in your
closets, and in your beds, and talk of it in your walks, and
by your fire-sides.   It is  the active and wide-spreading
seminal principle of all truth in medicine.
   It is no uncommon thing for the simplicity of causes to
 be lost in the magnitude of their effects.  By contemplating 
48                INQUIRY  INTO THE
  the wonderful functions of life, we have strangely overlook-
  ed 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 governments.
  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 pur-
  pose to know the fact. It is immaterial, moreover, whether this
  matter derives its power of being acted upon wholly from the
  brain,  or whether  it be inpart 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  water from the  impulse of winds
i  and  tide.
    The infinity of effects, from similar causes, has often 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
  believed to contain  a principle of fire. The  heat and flame
  they emit are  derived from an agent altogether 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 only in their  effects.  The former produces
  the destruction of the bodies upon which it acts, while the
  latter excites the more  gentle and durable motions of life.
  Common language  in expressing 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
  exhibiting the phenomena of life.  It is brought on,
    1. By the abstraction of all  the  stimuli which  support
  life.   Death from this cause is produced  by the same me-
  chanical 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 
               CAUSE OF ANIMAL LIFE.             49

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 texture of the
matter which composes  the human body. No more occurs
here, than is  observed in the  extinction 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 solid  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 occurs in death from
this  cause, than takes place when the emission of sound
from a violin is prevented 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 incapa-
ble of receiving and emitting the motions of life. No more
occurs here,  than would  happen if  a stick or pipe-stem
were placed, in the room of catgut, upon  the bridges of
the violin.  But death may take place in  old age, without 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 produce its  usual effects upon the
body.
   Should it be asked, what is  that peculiar organization of
matter, which enables it to emit life, when acted upon by
stimuli, I answer,  I do not know.  It is true,  the votaries
of chemistry have lately attempted to imitate  it; but no
arrangements of matter  by their hands have ever produced
a single living fibre, nor have any of their compounds produ-
ced a substance endowed with the properties of dead animal
matter. Lavoisser laboured in vain to produce that simple
animal substance we call bile.   That the human body is
composed of certain matters which  belong to the objects of
   vol. i.                    c 
50               INQUIRY INTO THE
  chemistry, there can be no doubt;  but their proportions,
  and manner of aggregation, are unknown to us;  nor  are
  the products, when obtained  by fire,  the same in form,
  number, or proportion, which existed in the body in its
  living  state.   But admitting this medico-chemical theory
  of animal life to be demonstrated, it does not in the least
  degree militate against the doctrine which I  have taught.
  Let us suppose a chemist to have discovered  all the mat-
  ters which compose an animal body, and to have arranged
  them in their exact order and  proportions, they cannot in
  this situation assume the properties of life, without the im-
  pression of some agent upon them.  A stimulus of some
♦  kind must give them activity.   Even the matter of phos-
  phorus torpid, when confined  in a phial.   It requires  the
  stimulus of air to impart to it its blazing life. It is remarka-
  ble, that some of the ancient philosophers had more correct
  ideas of the origin of animal life than some of our  modern
  chemists.   This is elegantly illustrated in the fable of Pro-
  metheus.  He was unable, by any chemical  combination,
  to animate his image of clay,  until he stole fire, or an
  external stimulus from heaven, for that purpose.   As well
  might  we suppose thinking to be a chemical process, as
  motion  and sensation.  They are all  alike the  effects of
  impression.   We think by force, as well  as live by force.
  If any man doubt  the  truth of this assertion, let him sus-
  pend, for a moment, the operations of his mind, or, in other
  words, let him cease to think.   As well might he  attempt
  to stop the pulsation of his heart, by the action of his will,
  or to arrest the planets in their course, by holding up  his
  finger.  Here then let us limit our inquiries, and remain
  satisfied with facts which are obvious,  and capable of  ap-
  plication to all the  useful purposes of medicine.
     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 ex-
  ercises of our reason.  Mahomet 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
  singular properties, which enable it, under certain  circum-
  stances, to exhibit the appearances of life.
     I cannot conclude this subject, without taking notice of 
CAUSE OF ANIMAL LIFE.            51
its extensive application to medicine, metaphysics, theolo-
gy, and morals.
  The doctrine of animal life which has been  taught ex-
hibits, in the
  First place, a new view of the nervous system, by disco-
vering its origin in the extremities of the nerves on which
impressions are made,  and  its termination 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 promoting health
and longevity, by proportioning the number and force of
stimuli to the age, climate, situation, habits, and tempera-
ment of the human body.
  3. It leads u« to a knowledge of the causes of all dis-
eases.   These  consist in excessive or preternatural excite-
ment  in certain parts,  of the  human body, accompanied
generally with  irregular motions, and  induced by natural
or artificial stimuli.  The latter have been called, very pro-
perly,  by Mr.  Hunter, irritants.   The occasional absence
of motion in acute diseases is  the effect only of the excess
of impetus in their remote causes.
  4.  It discovers to us that the cure of all diseases depends
simply $pon the abstraction of stimuli from the whole,  or
from a jifrt, 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 purpose, 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 im-
pressions acting upon an innate capacity 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 know-
ledge 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 fur-
nishes a striking illustration of the origin of human actions,
■)':  the  impression  of motives upon  the  will.   As  well 
P2               INQUIRY INTO THE
might we admit an inherent principle of life in animal mat-
ter, as a self-determining power in this faculty of the mind.
Motives are. necessary,  not only to constitute its freedom,
but its essence ; for, without them, there could be no more
a will, than there could be vision without light, or hearing
without sound.   It is true,  they are often so obscure as
not to be perceived, 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 ac-
count deny their agency in producing animal life.   In thus
deciding in favour of the necessity of  motives to produce
actions, I cannot help bearing a testimony against the gloomy
misapplication of this doctrine  by some modern writers.
When properly 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 some-
times obtain a currency, from being disguised by innocent
names.  The  doctrine of animal life that has been deliver-
ed is  directly opposed to an error of this kind, which has
had the most baneful influence upon morals and religion.
To suppose a  principle  to reside necessarily and constant-
ly in the human body, which acted independently  of  ex-
ternal circumstances,  is to ascribe to it an attribute, 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 the Divine Be-
ing, and humble views of ourselves.  The doctrine of animal
life which has  been delivered is calculated to produce these
effects in an eminent degree ; for
   8.  It does homage to the Supreme  Being,  as the  go-
vernor of the universe, and establishes the certainty  of  his
universal and particular  providence.   Admit a principle of
life in the human bod}',  and we open a door for .the  restor-
ation  of the old Epicurean or atheistical philosophy which
has been mentioned.  The doctrine I have taught cuts the
sinews of that error ;  for by rendering the continuance of
animal life, no less than  its commencement,  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.  It leads  us further to distinguish  be- 
CAUSE OF  ANIMAL LIFE.             53
tween the works  of die Creator  of the  universe, and the
works of a common architect.   It has been supposed by
some men, that the author of our world formed all its won-
derful machinery as a man  makes a clock, and,  having
wound it up, threw it out of his  hands,  and afterwards re-
tired to rest, or employed himself in other acts of creating
power; or if this were not the case, that he committed the
care of his works to certain deputies,  called nature in the
inanimate, and vital principle in  the animated  parts of the
globe.  This idea is contrary to  the whole tenor cf revela-
tion.   The Being  that created our world never  takes his
hand,  nor his eye,  for  a single  moment,  from any part 6f
it.   He  constantly

       " Warms in the sun, refreshes in each lv ■-/",
       " Glows in the stars, blossoms in the tr*.>
       "  Lives through all life, extends through all extent,
       " Spreads undivided, operates unspent."

His providence is  one continued  act of creating  power.
The sun  rises (to use the words of a late elegant writer*)
only because he says every morning,  "  let there be light."
The moon and  the stars supply the absence  of the sin;
only because he says every evening, " let there  be lights
in the firmament of  heaven, to  divide  the day  from the
night."   The seasons of spring and autumn return, only
because he says, " let the earth bring forth grass, the herb
yielding seed, and the fruit tree yielding fruit according to
its kind ;"  and even man exists, only because he breathes
into his nostrils the breath, or air,  of life, not only at his
birth,  but every moment  of his existence.
   9.  The view that has been given of the dependent state
of man for the blessing of life leads us to contemplate, with
very opposite and  inexpressible feeling, 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
God.  This appears from the following declaration.   " For
as the Father hath life in himself, so hath he given  to the
Son to have life  within himself."*  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
          »  Mf Fawcett.          f John v. verse 26. 
54            INQUIRY  into'THE,  &c.
New Testament.  These divine epithets, which  arc vei)
properly founded upon the  manner of our  Saviour's exis-
tence, exalt  him infinitely above simple  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 pro-
duce animal life, are derived from the  moral and physical
evils of our world.  From  beholding 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 teaching 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 flutters in the air, or the humblest plant that
grows upon the earth.  WThat an inspired writer says  of
the innumerable animals which inhabit the ocean, may with
equal propriety be said of the whole human race.  " Thou
sendest forth thy spirit, and they are created.  Thou takest
away their breath,—they die, and return to their dust." Let
us not complain of this tenure  of our lives.  By taking
their capital out of our hands, and dealing it out to us ac-
cording to our necessities, our benevolent Creator prevents
our squandering it away without judgment or prudence, and
thus becoming bankrupts  in  life as  soon as  we began  to
exist.
   12. Melancholy indeed would have been the issue of all
our inquiries, did we take a final leave of the human body
in its state of decomposition in the grave.  Revelation fur-
nishes us with an elevating and comfortable assurance that
this  will not be the case.  The precise manner of its re-or-
ganization, and the new means of its  future existence, are
unknown to us.  It is  sufficient  to believe the event will
take place, and that, after it, the soul and body of man will
be exhalted, 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 opposite shore with my head
clean, or covered with mud and  weeds, I leave wholly  to
vour determination. 
               AN INQUIRY

                   INTO THE

  NATURAL HISTORY OF MEDICINE!

                   AMONG THE

        INDIANS OF NORTH AMERICA:
                     AND A          /

           COMPARATIVE VIEW
                   OF THEIR
DISEASES AND REMEDIES WITH THOSE OF CIVILIZED NATIONS.
READ BEFORE THE AMERICAN PHILOSOPHICAL SOCIETY, HELD AT
     PHILADELPHIA , ON THE FOURTH OF FEBRUARY, 1774. 
 
AN  INQUIRY,  &c.
Gentlemen,*

     I RISE with peculiar diffidence to address you upon
this occasion, when I reflect upon the entertainment you
proposed to yourselves from the eloquence of that learned
member, Mr. Charles Thompson, whom your suffra-
ges appointed to this honour, after the delivery of the last
anniversary oration. Unhappily for the interests of science,
his want of health has not permitted him to comply with
your appointment.  I beg, therefore, that you would for-
get, for a  while, the abilities necessary to  execute this
task with propriety, and listen  with candour to the efforts
of a member, whose attachment  to  the society was the
only qualification that entitled him to the honour of  your
choice.
   The subject  I have chosen for this evening's entertain-
ment is, " An  inquiry into the natural history of medicine
among the Indians in North America, and a comparative
view of their diseases and rejriedies with those of civiliz-
ed nations." You will readrly anticipate the difficulty of
doing justice to this subject.   How  shall  we distinguish
between the original diseases of the Indians and those con-
tracted from their intercourse with the Europeans ? By
what arts shall we persuade them to discover their reme-
dies ? And, lastly, how shall we come at the  knowledge of
facts, in that cloud of errors in which .the credulity of the
Europeans, and  the  superstition of  the Indians,  have
involved both their diseases and remedies ?   These  diffi-
culties serve to increase the importance of our  subject.

  * This  Inquiry was the subject of an Anniversary Oration. The style
of an oration is therefore preserved in many parts of it.
   VOL. I.                   H 
58
NATURAL  HISTORY OF  MED1C1NK
If I should not be able to solve them, perhaps I may lead
the way to more successful  endeavours for that purpose.
   I shall first limit the tribes of Indians,  who  are to be
the objt cts of this inquiry, to those who inhabit that part
of North-America which extends from the 30th to-the 60th
degree of  latitude.   When  we  exclude the  Esquimaux,
who inhabit the shores oi" Hudson's bay, we shall  find a
general resemblance in the  colour, manners, and state of
society, among all the tribes of Indians, who inhabit the
extensive  tract  of  country above-mentioned.
   Civilians have divided nations into  savage, barbarous,
and civilized.   The  savage  live by fishing and  hunting;
the barbarous,  by  pasturage or cattle; and the  civilized,
by agriculture.  Each of these is connected together in
such a manner, that the whole appear to form  different
parts of a circle.   Even  the manners of the most civilized
nations partake of those of the savage.  It would seem as
if liberty and indolence were the highest pursuits of man;
and these  are enjoyed in their greatest perfection by sava-
ges,  or in the  practice of customs which resemble those
of savages.
   The Indians of North America partake- chiefly  of the
manner of savages.  In  the earliest accounts we have of
them,  we find  them cultivating a spot of ground.   The
maize  is  an original grain  among them.  The different
dishes of it which are in  use among the white people still
retain Indian names.
   It will be unnecessary to  show  that the Indians live in
a state of  society adapted to all the exigencies of their
mode of  life.   Those who  look  for the' simplicity and
perfection ol  the state  of nature must seek it in  systems,
as absurd  in philosophy, as  they are delighful in poetry.
   Before we attempt to ascertain the number or history of
the diseases of  the Indians, it will  be necessary to inquire
into, those customs among them, \\ hich we know influence
diseases.   For  this purpose  I shall,
   First, Mention a few facts which relate to the birth and
treatment  of their children.
   Secondly, I  shall speak of their  diet.
   Thirdly,  Of the  customs  which are peculiar to the
sexes, and, 
AMONG THE INDIANS.
59
   Fourthly, Of those customs which are common to them
both.*
   1.  Of the birth and treatment of their  children.
   Much of the future health of the  body depends upon
its original stamina.   A child born of healthy parents al-
ways brings into the world a system formed by nature to
resist the causes of diseases'.   The treatment of  children
among the Indians tends to  secure this  hereditary firm-
ness of constitution.  Their first food is their  mother's
milk.   To harden  them against the action of heat and
cold  (the natural enemies of"  health  and  life  among the
Indians) they are plunged every day into cold water.  In
order to facilitate their being moved from place  to place,
and at the same time to preserve their shape, they are tied
to a board, where they lie on their backs for six, ten, or
eighteen months.   A child generally sucks its mother till
it is two years old, and sometimes longer.  It is easy to
conceive  how much vigour  their bodies must acquire
from this simple, but wholesome nourishment.   The ap-
petite we sometimes observe in children  for flesh is alto-
gether artificial.  The peculiar irritability of the system
in infancy forbids stimulating aliment of all kinds. Nature
never calls for animal food, till she has provided  the child
with those teetli which are  necessary to divide it. I shall
not undertake to determine how far the wholesome quali-
 ty of the mother's milk is  increased, by her  refusing the
 embraces of her husband during the time of giving  suck.
   II. The diet of the Indians is of a mixed nature,  being
 partly animal,  and partly vegetable.  Their animals are
 wild, and therefore easy of digestion.  As the Indians are
 naturally more disposed to the indolent employment of
 fishing than hunting,  in summer, so we find them living
 more upon fish than land animals, in that season of the
 year.  Their  vegetables consist of roots and fruits,  mild

   * Many of the facts contained in the Natural History of Medicine among
 the liulians, in this Inquiry, are taken from La Hontan and Charlevoix s
 histories of  Canada; but the most material ot them are taken trom per-
 sons who had lived or travelled among the Indians.  The author acknow-
 ledges himself indebted in a particular manner to Mr. Edward  Hand,
 surgeon in the 18th regiment, afterwards brigadier-general in the army
 of the United States, who,  during several years' residence at Fort Pitt,
 directed his inquiries into their customs, diseases, and remedies, With a
 success that does equal honour to his ingenuity and  diligence. 
60       natural history of medicine.
in themselves, or capable of being made so by the action
of fire.   Although  the  interior  parts  of  our continent
abound  with salt springs, yet I cannot find that the Indians
used salt in their diet, till they were instructed to do so
by the Europeans.   The small  quantity of fixed  alkali
contained in the ashes, on which they roasted their meat,
could ne>t add much  to  its stimulating quality.   They
preserve their meat  from putrefaction,  by cutting it into
small pieces, and exposing it in summer to the sun, and
in winter to the  frost. In the  one case its moisture is dis-
sipated, and in the other so frozen, that it cannot undergo
the putrefactive process.   In dressing their meat, they are
careful to preserve its juices.   They generally prefer it in
the form of soups.   Hence we find, that among them the
use of the spoon  preceded that of the knife and fork.  They
take  the same pains to preserve  the  juice of  their  meat
when they roast it,  by turning it often.  The efficacy of
this animal juice, in dissolving meat in the stomach, has
not been equalled by any of those sauces or liquors, which
modern luxury has  mixed with it for that purpose.
   The Indians have no set time for eating, but obey the
gentle appetites of nature as  often as they are called by
them.   After  whole days spent  in  the chase, or in war,
they often commit those excesses in eating, to which long
abstinence cannot fail of prompting them.   It is common
to see them spend three or four hours  in satisfying their
hunger.  This is occasioned, not more by the quantity
they eat, than by the pains they take  in  masticating it.
They carefully avoid drinking water in their marches, from
an opinion that it lessens their ability to bear fatigue.
   III. We now come to  speak  of those  customs which
are peculiar to the sexes.  And, first, of those which be-
long  to  the women.  They are doomed by their  hus-
bands to such domestic labour as gives a firmness to their
bodies,  bordering  upon the  masculine.  Their menses
seldom begin to flow before they are eighteen or twenty
years of age,  and generally cease  before  they are  forty.
They have them in small quantities, but at regular inter-
vals. They seldom marry till they are about twenty. The
constitution has now acquired a vigour, which enables it
the  better  to  support the convulsions  of child-bearing. 
AMONG THE INDIANS'.
61
This custom likewise guards against a premature old age.
Doctor Bancroft  ascribes the haggard  looks, the loose
hanging breasts, and the prominent bellies of the Indian
women at Guiana, entirely to their bearing  children too
early.*  Where marriages are unfruitful  (which is seldom
the case) a separation is obtained by means of an easy di-
vorce ;  so that they are unacquainted with  the  disquie-
tudes which  sometimes arise from barrenness.  During
pregnancy,  the women are exempted from  the  more la-
borious parts of their duty: hence miscarriages rarely
happen among them.  Nature is their only midwife.  Their
labours are short, and accompanied with little pain. Each
woman is delivered in a private cabin,  without so much
as one of her own sex to attend her.  After  washing her-
self in cold water, she returns  in a few days to her usual
employments ; so that she knows nothing of those acci-
dents, which proceed from the carelessness or ill manage-
ment  of midwives; or those weaknesses, which arise
from  a month's confinement in a warm room.   It is re-
markable that there  is hardly a period in the interval be-
tween the eruption and the ceasing of the menses,  in which
they are not pregnant, or giving suck.   This is the most
natural state of the constitution during that interval; and
hence we often find it connected with the  best state of
health  in the women of civilized nations.
   The customs peculiar to the Indian men consist chiefly
 in those employments which  are  necessary to  preserve
 animal life,  and to defend their nation.   These  employ-
 ments are hunting and war, each of which is conducted
 in a manner that tends to call forth every fibre into ex-
 ercise, and to ensure them the possession of the utmost
 possible health.  In  times  of  plenty and peace,  we  see
 them sometimes rising from their beloved indolence, and
 shaking off its influence by the salutary exercises of  dan-
 cing and swimming.  The Indian men  seldom marry be-
 fore they are thirty years of age  (they no  doubt derive
 considerable vigour from this custom;  for while they are
 secured by  it from the enervating effects of the premature
 dalliance of love, theyr may insure more certain fruitfulness
 to their wives, and  entail more certain health upon  their
                 * Natural History of Guiana. 
62        NATURAL HISTORY OF MEDICINE
children.   Tacitus describes the same custom among the
Germans,  and attributes to it the same good effects.
" Sera juvenum venus, eoque  inexhausta pubertas;  nee
" virgines festinantur ; eadem juventa, similis proceritas,
" pares validique  miscentur; ac robora parentum liberi
" referunt."*
  Among the Indian men,  it is deemed a mark of hero-
ism to bear the most exquisite  pain without complaining;
upon  this account they early inure themselves to burning
part of their bodies with fire, or cutting them with sharp
instruments.   No young man can be admitted  to the ho-
nours of manhood or war, who has not acquitted himself
well in these trials of  patience and  fortitude.  It is easy
to conceive how much this  contributes to give a tone to
the  nervous system, which  renders  it less subject to the
occasional causes of diseases.
  IV. We come now to speak of those customs which
are  common to  both sexes: these  are  painting,  and
the  use of  the cold bath.  The  practice of anointing
the  body with oil is common to  the savages of all coun-
tries ; in warm climates it  is said to promote  longevity,
by  checking  excessive  perspiration.   The Indians ge-
nerally use bear's grease, mixed with a clay which bears
the  greatest resemblance to the colour of their  skins.
This  pigment serves to lessen the  sensibility of the ex-
tremities of the nerves; it moreover fortifies them against
the  action of those exhalations, which we  shall  mention
hereafter as a considerable source of their diseases.  The
cold bath likewise fortifies the body, and renders it less
subject to those diseases,  which  arise  from the extremes
and vicissitudes of heat and  cold.   We  shall speak here-
after of the Indian manner of using it.
  It is a practice among the Indians never to drink be-
fore dinner, when they work  or travel. Experience teaches,
that filling  the  stomach with cold water in  the forenoon
weakens the appetite,  and makes the system more sensi-
ble  of heat and fatigue.

  * Cxsar, in his history of the Gallic war,  gives the same account of
the ancient Germans. His words are,  " Qui diutissimi impuberes per-
" manserunt, maximam inter suos  ferunt laudem; hoc  ali  staturam ah'
" vires, nervasque confirmari putant." Lib. vi. xxi. 
AMONG THE INDIANS.              63
  The state  of society among the Indians excludes the
influence of  most of those passions which disorder the
body.  The  turbulent effects of anger are concealed in
deep and lasting resentments.  Envy and ambition are
excluded by their equality of power and property. Nor is
it necessary that  the perfections of the whole sex should
be  ascribed to one, to  induce them to marry.   " The
weakness of love (says Dr. Adam Smith)  which is so
much  indulged  in ages of humanity and politeness, is
regarded among savages as the most unpardonable effemi-
nacy.  A young man would think himself disgraced for
ever, if  he showed the least  preference of one  woman
above another, or did not express  the most complete in-
difference, both about the  time when, and the person to
whom, he was to be married."* Thus are  they exempted
from those violent or  lasting diseases, which accompany
the several stages of such  passions in both sexes among
civilized nations.
   It is  remarkable that there are no deformed  Indians.
Some have suspected, from this circumstance, that they
put their deformed children to death;  but nature  here
acts the  part of an unnatural mother.  The severity of the
Indian manners destroys them.f
   From a review of the customs of the Indians,  we need
not be surprized at the stateliness, regularity of  features,
 and dignity of  aspect, by which  they are characterized.
 Where we observe these among ourselves, there is always
 a presumption  of  their being  accompanied with health,
 and a strong constitution.  The circulation of the  blood is
 more languid in the Indians,  than in persons who are in
 the constant exercise of the habits of civilized life.   Out
 of eight Indian  men, whose pulses I once examined at the
 wrists, I did not meet  with one, in whom the artery beat
 more than sixty strokes in a minute.
    The marks of old  age  appear  more  early among  In-
 dian,  than among civilized, nations.
    Having finished our  inquiry into the  physical  customs

   * Theory of Moral Sentiments.
   t Since the intercourse of the white people with the Indians, we find
 some of them deformed in their limbs. This deformity, upon inquiry,
 appears to be produced by those accidents,  quarrels, &c. which have been
 introduced among them by spirituous liquors. 
64-       NATURAL  HisrORY OF MtJJlClNE
of the Indians, we shall now proceed to inquire into their
diseases.
  A celebrated professor of anatomy  has asserted,  that
we could not tell, by reasoning a priori, that the body was
mortal, so intimately woven  with its texture are the prin-
ciples of life.   Lord Bacon  declares that the only cause
of death, which is natural to man, is that from old age;
and complains of the imperfection of physic, in not being
able to guard the principle of life until the whole of the
oil that feeds it is consumed.  We cannot as yet admit
this proposition of our noble philosopher.  In the inven-
tory of the grave, in every  country, we find more of the
spoils of youth and  manhood than of age.   This must
be attributed to moral as well as physical causes.
  We need only recollect the custom among the Indians,
of sleeping in the open air in a variable climate ; the alter-
nate action of heat and  cold upon their bodies, to which
the warmth  of their cabins exposes  them;  their long
marches ; their excessive exercise; their intemperance in
eating, to which their long fasting and their publick feasts
naturally prompt them;  and,  lastly, the vicinity of their
habitations to the banks of rivers; in order to discover
the empire of diseases among them, in every stage of their
lives.   They have in vain attempted to elude the general
laws of  mortality, while their mode of life subjects them
to these remote, but certain, causes of diseases.
  From what we know of the action of these powers upon
the human body, it will  hardly be necessary to appeal to
facts, to determine that fevers constitute the only diseases
among the Indians.  These fevers are  occasioned by the
insensible qualities of the air.  Those which are produced
by cold and heat are of the inflammatory kind, such as
pleurisies,  peripneumonies,  and  rheumatisms.   Those
which are produced by the insensible  qualities of the air,
or by putrid exhalations, are intermitting, remitting inflam-
matory, and malignant, according as the  exhalations are
combined with more or less heat  or cold.  The dysen-
tery (which is an Indian disease) comes under the class
of fevers.  It appears  to be the  febris  introversa of Dr.
Sydenham.
  The Indians are subject to animal and vegetable 
               AMONG THE  INDIANS.            65

poisons.   The effects of these  upon the body are, in
some degree, analogous to the exhalations we have men-
tioned.  When they do not bring on sudden  death, they
produce, according to their force, either a common inflam-
matory, or a malignant, fever.
  The small pox and the venereal disease  were
communicated  to the  Indians of North America  by the
Europeans.  Nor can  I find that they were ever subject
to the scurvy.  Whether this was obviated by their me-
thod of preserving their flesh, or by their mixing it at all
times with vegetables,  I shall not undertake to determine.
Their peculiar customs and manners seem to have exempt-
ed them from this, as well as from the  common diseases
of the  skin.
  I have heard of two or three cases of the gout among
the Indians, but it was only among those who  had learned
die use of  rum from the white people.   A question na-
turally occurs here, and  that is,  why does not the gout
appear more frequently among that class of people, who
consume the greatest quantity of rum among ourselves ?
To this I answer, that the effects of this liquor upon those
enfeebled people are too sudden, and violent, to admit of
their being thrown upon the extremities; as wc  know
them to be among the  Indians.  They  appear only in
visceral obstructions, and a complicated train of chronic
diseases. Thus putrid miasmata are sometimes too strong
to bring on a fever, but produce instant debility and death.
The gout  is seldom  heard of in Russia, Denmark, or
Poland.  Is this occasioned by the vigour of constitution
peculiar to  the inhabitants of those northern countries ? or
is it caused by their excessive use of  spirituous liquors,
which produce the same chronic complaints among them,
which  we said  were common among the lower class of
people in this country ?  The similarity of their diseases
makes the  last of these suppositions the most probable.
The effects of wine, like tyranny in a well formed govern-
ment, are felt first in the extremities: while spirits, like a bold
invader, seize at once upon the vitals of the constitution.
  After much inquiry, I have not been able to find a single
instance of fatuity among the Indians, and but few in-
stances of melancholly and madness ; nor can I find
   vol. i.                  T 
66        NATURAL HISTORY OF MEDICINE
any  accounts  of  diseases  from  worms  among  them.
Worms are common to most animals;  they produce dis-
eases only in weak, or increase them in strong, constitu-
tions.*  Hence they have no place in the nosological sys-
tems of  physic.  Nor  is  dentition accompanied by
disease among the Indians.  The facility with which the
healthy children of healthy parents cut  their teeth, among
civilized nations,  gives us reason to conclude that the In-
dian children never suffer from this quarter.
  The Indians appear moreover to be strangers to diseases
and pains in the teeth.
  The employments of the Indians subject them to many
accidents; hence  we sometimes read of wounds, frac-
tures, and luxations, among them.
  Having thus pointed out the natural  diseases of the In-
dians, and shown  what diseases are foreign to them, we may
venture to conclude, that fevers, old age, casual-
ties, and war, are the only natural  outlets of human
life.   War is  nothing  but a disease; it is founded  in the
imperfection of political bodies, just as fevers are founded
on the weakness of the  animal body. Providence in these
diseases seems to act like a mild legislature, which  miti-
gates the severity of death, by inflicting it in a manner the
least painful,  upon the whole, to  the patient and the sur-
vivors.
  Let us now inquire into the remedies of the Indians.
These, like their  diseases, are simple, and few in number.
Among the first  of them, we shall mention the powers
of  nature.   Fevers,  we said formerly, constituted the
chief of the diseases among  the  Indians; they are like-
wise, in  the hands of nature, the principal  instruments to
remove the evils  which threaten her dissolution ; but the
event of these efforts of nature, no doubt, soon convinced
the Indians of the danger of trusting her in all cases; and
hence, in the earliest accounts we have of their manners,
we read  of persons who were intrusted with the office of
physicians.
   It will be difficult to find out the exact order in which
  * Indian children are not exempted from worms.  It is common with
the Indians, when a fever in their children is ascribed by the white peo-
ple to worms (from their being discharged occasionally in their stools) to
say, " the fever makes the worms come, and not the worms the fever." 
AMONG THE INDIANS.             67
the Indian remedies were suggested by nature, or disco-
vered by art;  nor will it be easy to arrange them in  pro-
per order. I shall, however, attempt it, by reducing them
to natural and artificial.
   To the class  of  natural  remedies belongs  the
Indian practice,  of  abstracting from their  patients  all
kinds of stimulating aliment.  The compliance of the In-
dians with  the dictates of nature, in the  early stage of a
disease, no doubt, prevents,  in many cases, their being
obliged to  use any other remedy.   They  follow nature
still closer, in allowing their  patients to drink plentifully
of cold water; this being the only liquor a patient calls
for in a fever.
   Sweating is likewise a natural remedy.  It was probably
suggested by observing fevers to be terminated by it.   I
shall not inquire how far these sweats are essential to the
crisis of a fever.  The Indian mode of procuring this eva-
cuation is as follows:  the patient  is confined in a close
tent,  or wigwam, over a hole in  the earth,  in which a
red  hot stone is placed;  a  quantity of water is thrown
upon this stone, which instantly involves the patient in
a cloud of vapour and sweat; in this  situation he rushes
out, and plunges himself into a river,  from whence he
retires to his  bed.   If the remedy has  been used  with
success, he rises from his bed in four and  twenty hours,
perfectly recovered from his indisposition.  This remedy
is used not  only to cure  fevers,  but remove that uneasi-
ness which arises from fatigue of body.
   A third natural remedy among  the Indians is, purging.
The fruits of the earth, the  flesh of birds, and other ani-
mals feeding upon  particular vegetables, and, above all,
the spontaneous  efforts of nature, early led the Indians to
perceive the necessity and advantages of this evacuation.
   Vomits constitute their fourth natural  remedy. They
were probably, like the former, suggested by nature, and
accident.  The ipecacuanha is one of the  many roots they
employ for that  purpose.
   The  artificial remedies made use of by the In-
dians are,   bleeding,  caustics, and astringent
medicines.   They confine bleeding entirely  to  the part
affected.  To know that opening a vein in the  arm,  or 
68        natural history of medicine
foot, would relieve a pain in the head or side, supposes
some knowledge of the animal economy, and  therefore
marks an advanced period in the history of medicine.
   Sharp stones and thorns are the instruments they use to
procure a discharge of blood.
   We have an account of the Indians  using something
like a potential caustic, in obstinate pains.  It con-
sists of a piece of rotten wood, called punk, which they
place upon  the part affected, and afterwards set it on fire:
the fire gradually consumes the wood, and its ashes burn
a hole in the flesh
   The undue efforts of nature, in those fevers which are
connected with a diarrhoea, or a dysentery, together with
those hemorrhages to which their  mode of  life exposed
them, necessarily led them to an early discovery of some
astringent  vegetables.   I am uncertain  whether
the Indians rely upon astringent, or any other vegetables,
for the cure of the intermitting fever. This disease among
them probably requires no other remedies than the cold
bath, or cold air.   Its greater obstinacy, as well as fre-
quency,  among ourselves, must be sought for in the
greater feebleness of our constitutions, and in that change
which our country has undergone,  from  meadows,  mill-
dams, and the cutting down of woods;  whereby morbid
exhalations have been multiplied, and their  passage ren-
dered more free, through every part of the country.
  This is a short account of the remedies of the Indians.
If they are  simple, they are, like their eloquence, full of
strength; if they are few in number, they are accommo-
dated,  as their  languages are to their ideas,  to the whole
of their diseases.
  We said, formerly, that the Indians  were subject to
accidents, such as wounds, fractures, and the  like. In
these cases, nature performs the office of a surgeon.  We
may judge of her qualifications for this office, by observ-
ing the marks of wounds and fractures which are some-
times discovered on wild animals.   But further, what is
the practice of our modern surgeons in these  cases ?  Is it
not to lay aside plaisters and ointments, and trust the whole
to nature ?  Those ulcers,  which require the  assistance of
mercury, bark, and a particular regimen, are unknown to
the Indians. 
AMONG THE INDIANS.             69
  The  hemorrhages which sometimes  follow their
wounds are  restrained,  by plunging themselves into cold
water,  and  thereby  producing a  constriction  upon  the
bleeding vessels.
  Their practice of attempting to recover drowned peo-
ple is irrational and unsuccessful.  It consists in suspend-
ing the patient by the heels, in order that the water  may
flow from his mouth.   This practice  is founded on a be-
lief, that  the patient dies from swallowing an  excessive
quantity of  water.   But modern  observations teach us,
that drowned people die from another cause.  This dis-
covery has suggested a method of cure, directly opposite
to that in use among the Indians;  and has shown us that
the practice of suspending by the heels is hurtful.
  I do not find that the Indians ever suffer in their limbs
from the action of cold upon them.   Their rnokasons,*
by  allowing their feet to move  freely, and thereby pro-
moting the circulation of the blood, defend their lower ex-
tremities  in the daytime, and their practice of sleeping
with their feet near a fire defends them from the morbid
effects of cold at night.  In those cases, where the motion
of their feet in  their  rnokasons  is  not sufficient to keep
them warm, they break the  ice, and restore their warmth,
by  exposing them for a short time to the action of cold
water.f
  We have heard much of  their specific antidotes to the
venereal disease.   In  the accounts of these anti-ve-
nereal medicines, some abatement should be made for that
love of the marvellous, and of novelty, which are apt to
creep into the writings of travellers and physicians. How
many medicines, which were once thought infallible in this
disease, are now rejected from the materia medica!  I have
found upon inquiry that the  Indians always assist their
medicines in this disease, by  a regimen  which promotes
perspiration.  Should we allow that mercury acts  as a
specific in destroying this disease,  it  does not follow that

  *  Indian shoes.
  f  It was remarked in Canada, in the winter  of the year 1759, during
the war before last, that none of those soldiers who wore rnokasons were
frost-bitten, while few of those escaped that were much exposed to the
cold who wore shoes. 
70        natural  history of medicine
it is proof against the efficacy of medicines, which act
more mechanically upon the body.*
  There cannot be a stronger mark of the imperfect state
of knowledge in medicine among the Indians,  than their
method of treating the small-pox.   We  are told that
they plunge themselves in cold water in the beginning of
the disease, and that it often proves fatal to them.
  Travellers speak  in  high  terms of the Indian  anti-
dotes to poisons.   We  must remember that many
things have been thought poisonous, which later experi-
ence  hath  proved to possess no unwholesome quality.
Moreover, the uncertainty and  variety,  in the  operation
of poisons, renders it extremely difficult to fix the certainty
of the antidotes to them.   How  many specifics have de-
rived their credit for preventing the hydrophobia, from
persons being wounded  by animals,  who were  not  in a
situation to produce that disease ! If we may judge of all
the Indian antidotes to poisons,  by those which have fal-
len into our hands, we have  little reason to ascribe much
to them in any cases whatever.
   I have  heard  of  their performing several remarkable
cures upon stiff joints, by an infusion of certain herbs
in water.  The mixture of several herbs together in this in-
fusion calls in question the specific efficacy of each of them.
I cannot help attributing the  whole success of this remedy
to the great heat of the water  in which the  herbs were boil-
ed, and to its being applied for a long time to the part affect-
ed.   We find the same medicine to vary frequently in its
success, according to its strength, or to  the continuance
of  its application.   De Haen attributes the good effects
of electricity entirely to its being used for several months.
   I have met with one  case  upon record,  of their aiding
nature in  parturition.    Captain Carver gives us an
account of an Indian woman in a difficult labour being
suddenly delivered,  in consequence of a general convul-
sion induced upon her  system  by stopping, for  a short

  * I cannot help suspecting the anti-venereal qualities of the lobelia,
ceanothus and ranunculus, spoken of by Mr Kalm, in the Memoirs of the
Swedish Academy.  Mr. Hand informed me, that the Indians rely chiefly
upon a plentiful use of the decoctions of the pine-trees for the cure of the
venereal disease. He added, moreover, that he had often known this dis-
ease prove fatal to them. 
AMONG THE  INDIANS.              71
time, her mouth and nose, so as to obstruct her breathing.
  We are sometimes amused with accounts of Indian re-
medies for the dropsy, EPILEPSY, COLIC, GRAVEL, and
gout.  If,  with all the advantages which modern physi-
cians derive from their knowledge in anatomy,  chemistry,
botany, and philosophy ; if, with the benefit of discoveries
communicated from abroad, as well as handed down from
our ancestors, by more certain methods than tradition, we
are still ignorant of certain remedies for these diseases;
what can we expect from the Indians, who are not only de-
prived of these advantages, but want our chief motive, the
sense of the pain and danger of those diseases,  to prompt
them to seek for  such remedies  to relieve them!  There
cannot be a stronger proof of their ignorance of proper re-
medies for  a new or difficult diseases, than their having re-
course to enchantment.  But to be more particular ; I have
taken pains to inquire into the success  of some of  these
Indian specifics, and have never heard of one well attested
case of their efficacy.  I believe they derive all their credit
from our being ignorant of their composition.   The  influ-
ence of secrecy is well known in establishing the credit of
a medicine.   The sal seignette was supposed to an infalli-
ble medicine for the intermitting fever, while the manufac-
tory of it was confined  to an apothecary at Rochelle; but
it lost  its virtues, as soon as it was found to be composed
of the acid of tartar and the fossil alkali. Dr. Ward's famous
pill and drop ceased to  do wonders in scrophulous cases,
as soon as  he bequeathed to the world his receipts for  mak-
ing them.
   I foresee an objection to what has been said concerning
the remedies of the Indians, drawn from that knowledge
which experience gives to a mind intent upon one subject.
We have heard much of the perfection of their senses of
seeing and hearing.   An Indian, we are told, will discover,
not  only a particular tribe  of Indians by their footsteps,
but the distance of time in which they were made. In those
branches of knowledge which relate to  hunting and war,
the Indians have acquired a degree of perfection, that nas
not been equalled by civilized nations.  But we must re-
member,  that medicine among them does not possess the
like advantages with the arts of war and hunting, of being
the chief object of their attention.   The physician and the 
72        NATURAL HISTORY OF  MEDICINE
warrior are united in one character;  to render him as able
in the former as he is in the latter profession would require
an entire abstraction from every other employment, and a
familiarity with external objects, which are incompatible
with the wandering life of savages.
   Thus have we finished our inquiry into the diseases and
remeoies of the Indians in North America.  We come now
to inquire into the diseases and remedies of civilized nations.
   Nations differ in their degrees of civilization.  We shall
select one for the subject of our inquiries, which, is most
familiar to us; I  mean  the British nation.   Here we be-
hold subordination and classes of mankind established, by
government, commerce, manufactures, and certain customs,
common to most of the civilized nations of Europe.   We
shall trace the origin of  their  diseases through their cus-
toms, in the same manner as we did those  of the Indians.
   I. It will be sufficient to name the degrees of heat, the
improper aliment,  the tight dresses,  and the  premature
studies, children are exposed to, in order to show the ample
scope for diseases,  which is added to the original defect of
stamina they derive from their ancestors.
   II. Civilization rises in its demands upon the health of
women.   Their fashions; their dress and diet;  their eager
pursuits and ardent enjoyment of pleasure ;  their indolence,
and undue evacuations in pregnancy; their cordials, hot
regimen, and neglect, or use of art,  in child-birth;  are all
so many inlets to disease.
  Humanity would fain be silent,  while philosophy calls
upon us to mention the effects of interested marriages, and
of disappointments in love, increased by that concealment,
which the tyranny of custom has imposed upon the sex.*
Each of these exaggerates the natural,  and increases the
number of artificial, diseases among  women.
  III. The diseases introduced by civilization extend them-
selves  through every class  and profession  among  men.
How fatal are the effects of idleness and intemperance among
  * " Married women are more healthy and long-lived  than single wo-
" men.  The registers, examined by Mr. Muret, confirm this observation;
" and show, particularly, that of equal numbers of single and married wo-
" men, between fifteen and twenty-five years of age, more of the former
" died than of the latter, in the proportion of two to one:  the consequence,
" therefore, of following nature must be favourable to health among the
" female sex."  Supplement to Price's Observations on Reversionarv Pay-
ments, p. 357. 
AMONG THE INDIANS.

the rich* and of hard labour and penury among the poor!
What pallid looks are contracted by the votaries of science,
from hanging over the  " sickly taper!"   How many dis-
eases are entailed upon manufacturers)  by the materials in
which they work, and the posture of their bor^ies!   What
monkish diseases do we observe, from  monkish continence
and monkish vices!  We pass over the  increase of acci-
dents, from building, sailings riding, and the like.   War,
as if too slow in destroying the human species,  calls in a
train of diseases peculiar to civilized nations. What havoc
have the corruption and monopoly of  provisions, a damp
soil, and an unwholesome sky, made,  in a few days, in an
army!   The achievements of British  valour,  at the Ha-
vannah,  in the last war*  were obtained at the ex^c.icc of
9,000 men, 7,000 of whom perished with the  West India
fever.*  Even our modern discoveries in geography,  by
extending the empire of commerce, have likewise extended
the empire of diseases.  What  desolation have the East
and West Indies made of British subjects!   It  has been
found, upon a nice calculation, that  only ten of a hundred
Europeans live  above  seven years after they arrive in  the
island of Jamaica.
   IV. It would take  up too much of our time to  point
out all the customs, both physical and moral, which influ-
ence diseases among both  sexes.   The  former have  en-
gendered the seeds of diseases in the  human body itself;
hence the  origin of catarrhs, jail and military  fevers, with
a long train of  other  diseases, which  compose so great a
part of our books of medicine.   The  latter  likewise have
a large share in producing diseases.  I  am not one of those
modern philosophers, who derive the vices of mankind from
the  influence of civilization; but I am  safe in  asserting,
that; their number and malignity increase with the  refine-
ments of polished life.  To prove this, we need only sur-

  * The modern writers upon the diseases of  armies  wonder that the
Greek and Roman physicians have left us nothing upon that subject.  But
may not most of the diseases of armies be produced  by the different man-
ner in which wars are carried on by the modem nations ? The discoveries
in geography, by extending the field of war, expose soldiers to many  dis-
eases, from long voyages, and a sudden change of climate, which were
unknown to the armies of former ages.  Moreover, the form of the wea-
pons,  and the variety in the military exercises, of  the Grecian and Ro-
man armies gave a vigour to the constitution, which can never be acquir-
ed by the use of muskets and artillery.
   VOL. I.                   K 
 74        NATURAL HISTORY OF MEDICINE

 vey a scene too familiar to affect us: it is a bedlam ; which
 injustice, inhumanity, avarice, pride, vanity, and ambition,
 have filled with inhabitants.
   Thus have I briefly pointed out the customs, which in-
 fluence the diseases of civilized nations.  It remains now
 that we take notice of their diseases.   Without naming
 the many new fevers, fluxes, hemorrhages, swellings from
 Water,  wind, flesh, fat, pus, and  blood; foulness on the
 skin, from cancers, leprosy, yawes, poxes, and itch; and,
 lastly, the gout, the hysteria, and the hypocondriasis, in all
 their variety  of known and unknown  shapes; I shall sum
 tip all  that is necessary upon this  subject, by adding, that
 the number  of diseases which belong to civilized nations,
 according to Doctor Cullen's nosology, amounts to 1687;
 the single class  of nervous diseases  from 612 of this
 number.
   Before we proceed to speak of the remedies of civilized
 nations, we shall  examine into  the abilities of nature in
 curing their diseases.   We found her  active and successful
 in curing the diseases of the Indians.   Are her strength,
 wisdom, or benignity equal to the increase of those dangers,
 which threaten her dissolution among  civilized nations ? In
 order to answer this question, it will be necessary to explain
 the meaning of the term nature.
   By nature, in the present case, I understand nothing but
physical necessity.  This at once excludes every thing like
 intelligence from  her operations; these are all performed in
 obedience to the  same laws, which. govern  vegetation in
 plants, and the intestine motions of fossils.  They are  as
 truly  mechanical as the  laws of gravitation,  electricity,
 or magnetism.  A  ship, when laid on her  broadside by a
 wave, or a sudden blast of wind, rises by the simple laws
 of her  mechanism ; but suppose this ship to be attacked
 by fire, or a water-spout, we are not to call in question the
 skill of the ship-builder,  if she  be consumed by the one,
 or sunk by the other.  In like manner, the Author of na-
 ture hath furnished the body with powers to preserve itself
 from its natural enemies ; but when it is attacked by those
 civil foes, which  are bred by the peculiar customs of civil-
 ization, it resembles a company of Indians, armed with
 bows and arrows, against the complicated and deadly ma-
 chinery of fire-arms.   To place this  subject in a proper 
AMONG THE INDIANS.               75
light, I shall deliver a history of the operations of nature in
a few of the diseases of civilized nations.
   I.  There are cases, in which nature is still successful in
curing diseases.
   In fevers, she still deprives us of our appetite for animal
food, and imparts to us a desire for cool air and cold water.
   In hemorrhages, she produces a faintness, which occa-
sions a coagulum in the open vessels ;  so that the further
passage of blood through them is obstructed.
   In wounds of flesh and bones she discharges  foreign
matter, by exciting an  inflammation, and supplies the waste
of both with new flesh and bone.
   II. There are  cases, where the efforts of nature are too
feeble to do service, as in malignant and chronic fevers.
   III. There are cases, where the efforts of nature are over-
proportioned to the strength of the disease, as in the cholera
morbus and dysentery.
   IV. There are cases, where nature is idle, as in the atonic
stages of the gout, the cancer, the epilepsy, the mania, the
venereal disease,  the apoplexy, and the tetanus.*
   V. There are  cases, in which nature does mischief. She
wastes herself with an unnecessary fever in a dropsy and
consumption.  She throws a plethora upon the brain and
lungs in the apoplexy and peripneumonia notha.   She ends
a pleurisy and peripneumony in a vomica, or empyema.
She creates  an unnatural  appetite for food in  the hypo-
chondriac disease.  And, lastly, she drives the melancholy
patient to solitude, where, by brooding over the subject of
his insanity, he increases his disease. ""
   We are accustomed to hear of the  salutary kindness of
nature in alarming  us  with  pain, to prompt us to seek for
a remedy.  But,
  VI. There are cases, in which she refuses to send this
harbinger, of the evils which threaten her, as  in the aneu-
rism, scirrhus, and  stone in the bladder.
  VII.  There are cases, where the pain is not proportioned
to the danger, as  in the tetanus, consumption, and  dropsy
of the head.  And,
  VIII. There are cases, where the pain is over-proportion-
ed to the danger,  as in the paronychia and tooth-ache.
  This is a short account of the. operations of nature in the
# Hoffman de hypothesium medicarum damno, sect. xv. 
 76        NATURAL HISTORY OF MEDICINE

 diseases of civilized nations.  A lunatic  might  as  well
 plead against the sequestration of his estate, because he
 once employed the full exercise of his reason, or  because
 he still had lucid intervals, as nature be exempted from the
 charges we have brought against her.
   But this subject will receive strength from considering
 the remedies of civilized nations.  All the products of
 the vegetable, fossil, and animal  kingdoms,  tortured, by
 heat and mixture, into an almost infinite variety of forms ?>
 bleeding, cupping,  artificial drains by setons, issues, and
 blisters; exercise,  active and passive; voyages and jour-
nies; baths warm  and cold; waters, saline, aerial,  and
mineral; food, by weight and measures ; the royal touch;
enchantment; miracles; in  a word, the combined discove-
ries of natural history and philosophy united into a system
of materia  medica all  show, that although physicians  are
in speculation the servants, yet in practice they are the mas-
ters, of  nature.  The whole of their  remedies seem con-
trived on purpose  to arouse, assist, restrain,  and controul
her operations.
   There are some truths, like certain liquors, which require
strong heads to bear them.   I feel myself protected from
the prejudices of vulgar minds, when I reflect  that I am
delivering these sentiments  in a society of philosophers.
   Let us now take a  comparative view of the  dis-
eases and remedies of  the Indians with those of  civilized
nations.  We shall begin with their diseases.
   In our account of the diseases of the Indians we beheld
death executing his. commission, it is true ; but  then  his
 dart was hid in a mantle,  under which he concealed  his
 shape.  But among civilized nations we behold him mul-
tiplying his weapons, in proportion to the number of organs
 and functions in the body;  and pointing each of them in
 such a manner, as  to render his messengers more terrible
 than himself.
   We said formerly that fevers constituted the chief dis-
eases of  the Indians.   According  to  Doctor Sydenham's
 computation, above 66,000 out of 100,000 died of fevers,
 in London, about 100 years ago ; but fevers now consti-
 tute but a little more than one-tenth part of the diseases of
 that city.  Out of 21,780  persons who died in  London,
 between December,  1770,  and December,  1771, only 
AMONG THE INDIANS.              77
2273 died of simple fevers.   I have more than once heard
Doctor Huck complain, that he could find no marks of
epidemic fevers in London, as described by Dr.  Syden-
ham.  London has undergone a revolution in its manners
and customs since  Doctor Sydenham's time.  New dis-
eases, the offspring  of luxury, have supplanted fevers; and
the few that are left are so complicated with other diseases,
that their connection can no longer  be discovered with an
epidemic constitution of the year. The pleurisy and perip-
neumony, those inflammatory fevers  of strong  constitu-
tions, are now lost  in catarrhs, or colds, which, instead of
challenging the powers of nature or art to a fair combat,
insensibly undermine the constitution, and bring on an in-
curable consumption.   Out of 22,434 who died in LonT
don, between December, 1769, and  the same month in
1770, 4594 perished with that British  disease.  Our coun-
tryman, Doctor Maclurg, has ventured to foretell that the
gout will be lost in a few years, in a train of hypochondriac,
hysteric, and bilious diseases.   In like manner, may we
not look for a season, when fevers, the natural diseases of
the human  body,  will be lost in an inundation of artificial
diseases, brought on by the  modish practices of civiliza-
tion ?
   It may not be improper to compare the prognosis of
the Indians, in diseases, with that of civilized nations, be-
fore we take a comparative view of their remedies.
   The Indians are  said to be successful in predicting the
c vents of diseases.   While diseases are simple; the marks
which distinguish them, or characterize their  several stages,
are generally uniform, and obvious to the most indifferent
observer.   These marks afford so much certainty, that the
Indians sometimes kill their physicians for a false progno- *
sis, charging the death of the patient  to their carelessness,
or ignorance.  They estimate the danger of  their  patients
by the degrees of appetite ; while an Indian  is able to eat,
he is  looked upon  as free from danger.  But when we
consider the number and variety in the signs of diseases
among  civilized  nations,  together  with the  shortness of
life, the fallacy of memory, and the uncertainty of observa-
tion, where shall we find a physician willing to risk his
reputation,  much less his  life, upon the prediction of the
event of our acute diseases ?  We can  derive no advantage 
 /8         NATURAL HISTORY OF MEDICINE

from the simple sign,  by which the Indians estimate  the
danger of their patients; for we daily see a want of appetite
for food  in diseases which  are attended with no danger;
and we sometimes observe an unusual degree of this appe-
tite to precede the agonies of death.   I honour the name of
Hippocrates :  but forgive me, ye votaries of antiquity,
If I attempt to pluck  a few gray hairs from his venerable
head.   I was once an  idolater  at his altar,  nor did I turn
apostate from his worship, till I was taught, that not a tenth
part of his  prognostics  corresponded with modern experi-
ence, or observation.  The pulse,* urine, and sweats, from
which the principal signs of life and death have been taken,
are so variable, in most of the acute diseases of civilized
nations, that the wisest  physicians have in  some measure
excluded the  prognosis from  being a part of their pro-
fession.
   I  am here insensibly led to make an  apology for the
instability  of  the theories and practice of physic.  The
theory of physic is founded  upon the laws of the animal
economy. These  (unlike the laws of  the mind,  or the com-
mon laws of matter) do not appear at once, but are gradu-
ally  brought to light by the phenomena of diseases.  The
success of  nature in curing the simple diseases of Saxony
laid  the foundation  for  the  anima  medic a of Doctor
Stahl.  The endemics of Hollandf  led  Doctor Boer-
h a ave  to seek for the causes of all diseases in the fluids.
And the universal prevalence of diseases of the nerves,
in Great Britain, led  Doctor  Cullen to  discover their
peculiar laws, and to found a system  upon them; a system,
which will probably last till some new diseases are let loose

  * Doctor Cullen used to inform his pupils, that, after forty years' expe-
rience he could find  no relation between ais  own observations made on
the pulse, and those made by Doctor Solano.  The climate and  customs
of the people in bpa.n being  so different from the climate and customs of
the present inhab.tants of Britain  may account for the diversity of the*
observations.  Doctor Heberden's remarks upon the pulse, i^  L Lcond
volume of the  Med.cal Transactions, are calculated to^show how HtUe the
issue of diseases can be learned from it.                         l
  + " The  scurvey is very frequent in  Holland; and draws it- nri™
partly from their strong f„od, sea-hsh, and smoked flesh, anTpa,tlV75
£S£^'r' t0gCther Wkh thdr bad wateV.^SL^n
  " We are now in North Holland; and I have never sppi,  am™» *„ r ,,
people, so many infected with the leprosy as he?e T fe} saHhl risen
is, because they eat so much fish."  Howell's Familiar fitters. 
AMONG THE  INDIANS.               79
upon the human species,  which shall unfold  other laws of
the animal economy.
   It is in consequence of this fluctuation in the principles
and practice of physic being so necessarily connected with
the changes in the  customs of civilized nations,  that  old
and young physicians so  often disagree in their  opinions
and practices.   And it  is by attending  to the  constant
changes  in these customs of civilized  nations,  that those
physicians have generally become the most eminent, who
have  soonest emancipated  themselves from the  tyranny of
the schools of physic;  and have occasionally accommodat-
ed their principles and practice to the changes in diseases.*
This variety in diseases, which is  produced by the changes
in the customs of  civilized nations, will  enable us to  ac-
count for many of the contradictions which are to be found
in authors of equal  candour and abilities, who have written
upon the materia medica.
   In forming  a comparative view of the remedies of
the Indians, widi those of civilized nations, we  shall  re-
mark, that the want of success in a medicine is occasioned
by one of the following causes:
   First, our ignorance of the disease.   Secondly,  an igno-
rance of a suitable remedy.  Thirdly, a want of efficacy in
the remedy.
   Considering the  violence of the diseases of the  Indians,
it is probable their want of success is always occasioned by
a want of efficacy in their medicines.  But the case is very
different  among the civilized nations.   Dissections daily
convince us of our ignorance of the seats of diseases, and
cause us to blush at our prescriptions.   How often are we
disappointed in our expectation from the most certain and
powerful of our remedies,  by the negligence or obstinacy
of our patients I What mischief have we done under  the
belief of  false facts (if I may be  allowed the  expression)
  * We may learn, from these observations, the great impropriety of those
Egyptian laws, which oblige physicians to adopt, in all cases, the prescrip-
tions which had been collected, and approved of,  by the  physicians of
former ages.  Eve»- ch^ §e in ihecust-.nis of civilized nations  products a
change in  their diseases, which calls for a change in their remedies.
What havoc would plentiful bleeding, purging, and small  beer, formerly
used with so much success by Dr. Sydenham in the cure of fevers,  now
make  upon the enfeebled citizens of London! The fevers of the same, and
of more southern latitudes, still admit of such antiphlogistic remedies. In
the room of these, bark, wine, and other cordial medicines, are prescribed
in London in almost everv kind of fever. 
 SO        natural history of medicine

 and false theories!  We have assisted in multiplying dis-
 eases.   We  have done more—we have  increased their
 mortality.
   I shall not  pause to beg pardon of the faculty, for ac-
 knowledging, in this public manner, the weaknesses of our
 profession.   I am pursuing Truth,  and while I can keep
 my eye fixed  upon  my guide, I am indifferent whither I
 am led, provided she is my leader.
   But further,  the Indian submits to his disease, without
 one fearful emotion from his doubtfulness of its event; and
 at last meets his fate, without an anxious wish for futurity:
 except it is of being admitted to an " equal sky," where
     " His faithful dog shall bear him company."
 But among civilized nations, the influence of a false religion
 in good, and of a true religion in bad, men has converted
even the fear of death into a disease.   It is this original
 distemper of the  imagination  which renders the  plague
 most fatal, upon its first appearance in a country.
   Under all these disadvantages in the  state of medicine,
 among civilized nations, do more in proportion die of the
 diseases peculiar to them, than of fevers,  casualties,  and
 old age, among the Indians ? If we take our account from
the city of London, we shall find this to be the case. Near
a twentieth part of its inhabitants  perish  one year with
 another.  Nor does the natural increase of inhabitants sup-
ply this yearly waste.  If we judge from the bills of mor-
tality, the city of London contains fewer inhabitants,  by
 several thousands, than it did forty years ago.  It appears
from this fact,  and  many others of a  like nature, which
 might be adduced, that although the  difficulty of support-
ing children, together with  some  peculiar customs of the
 Indians, which  we mentioned, limit their number, yet they
 multiply faster, and die in a smaller proportion, than civil-
ized nations, under the circumstances we have described.
The Indians, we are told, were  numerous in this country,
before  the  Europeans  settled among  them.   Travellers
agree likewise  in describing numbers of both sexes, who
exhibited all the marks of extreme old age.  It is remark-
able that age seldom  impairs the faculties of their minds.
   The mortality peculiar to thoselndian tribes who have min-
gled with the white people must be ascribed to the extensive
mischief of spirituous liquors. When these have not acted, 
AMONG  THE INDIANS.               81
 they have suffered from having accommodated themselves
 too  suddenly  to the European diet, dress and manners. It
 does not become us to pry too much into futurity; but if we
 may judge from the fate of the original natives of Hispani-
 ola.  Jamaica,  and the provinces on the continent, we may
 venture  to foretell, that, in proportion as the white people
 multiply, the Indians will diminish; so that in a few centu-
 ries they will probably be entirely extirpated.*
    It may be said, that health among the Indians, like  in-
 sensibility to cold and hunger, is proportioned to their need
 of it; and that the less  degrees, or entire want of health,
 are no  interruption  to the  ordinary business  of civilized
 life.
    To obviate  this supposition, we shall first attend to the
 effects of a single disease  in  those people, who are the
 principal wheels in the machine of civil  society.  Justice
 has stopt its current, victories  have been lost, wars have
 been prolonged,  and embassies delayed, by the principal
 actors in these departments of government being suddenly
 laid up by a fit of the gout.   How many offences are daily
 committed  against the rules of good breeding,  by the te-
 dious histories of our diseases, which compose so great a
 part of modern conversation! What sums of money have
 been lavished in foreign countries in pursuit of health !f Fa-
 milies have been ruined by the unavoidable expenses  of
 medicines and  watering-places.  In a word, the swarms  of
 beggars, which infest so  many of the European countries,
 urge their petitions for charity chiefly by arguments deriv-


  • Even the influence of christian principles has not been able to put
 a stop to the mortality introduced among the Indians, by their intercourse
 with the Europeans.   Dr. Cotton Mather, in a letter to sir William As-
 hurst, printed in Boston, in the year 1705, says, " that about five years be-
 fore there  were about thirty Indian congregations in the southern parts of
 the  province of Massachusetts-Bay."  The  same author, in his history of
 New-England, says, " That in  the islands  of Nantucket and Martha's
 Vineyard there were 3000 adult Indians, 1600 of wlv m professed the chris-
 tian religion." At present there is but one Indian congregation in the whole
 Massachusetts province.
  It may serve to extend our knowledge of diseases, to remark, that epide-
 mics were often observed to prevail among the Indians in Nantucket, with-
out affecting the white people.

  f  It is said there are seldom less than 20,000 British subjects in France
and Italy; one half of whom reside or travel in those countries upon the
account of their health.
   VOL. I.                     I.
  / 
82        NATURAL HISTORY OF MEDICINE
 ed from  real or counterfeit diseases, which render them
 incapable of supporting themselves.*
   But may not civilization, while it abates the violence of
 natural diseases, increase the lenity of those that are artifi-
 cial, in the same manner that it lessens the strength of na-
 tural vices by multiplying them ? To answer this question,
 it will only be necessary to ask another: Who would ex-
 change the heat, thirst,  and uneasiness of a fever, for one
 fit of the colic or stone ?
   The history of the number, combination, and fashions
 of the remedies we have given, may serve to humble the
 pride  of  philosophy;  and to convince  us,  that with all
 the advantages of the whole circle of sciences, we are still
 ignorant of antidotes to many of the diseases of civilized
 nations.  We sometimes sooth our ignorance, by reproach-
 ing our idleness  in not investigating  the remedies peculiar
 to this country.  We are taught to believe that every herb
 that grows in our woods is possessed  of some medicinal
 virtue, and that Heaven  would be wanting  in l>enignity, it'
 our  country did not  produce remedies for all the different
 diseases of its  inhabitants.   It would be arrogating too
 cnuch, to suppose that man was the only creature  in  our
 world for whom vegetables  grow.   The beasts, birds,  and
 insects, derive their  sustenance'either directly or indirectly
 from them; while many of them were  probably intended,
 from their variety in figure, foliage, and colour,  only to
 serve as ornaments for our globe.   It would seem strange
 that the Author of nature  should furnish every  spot of
 ground with medicines adapted to the diseases of its inha-
 bitants, and at  the same time deny it the more necessary
 articles of food and clothing.  I know not whether Heaven
 has provided every country with antidotes even to the natu-
 ral diseases of its inhabitants.  The intermitting  fever is
 common in almost e\ay corner of the globe; but a sove-
 reign remedy for it  has been discovered  only in  South
 America.  The combination of bitter and astringent sub-
 stances, which  serve as a succedaneum  to the Peruvian
 bark, is as much a preparation of art, as calomel or tartar

,«^T!?mJ>le!nan comPutes» that Scotland contains 1,500,000 inhabitants-
300,000 of whom, according to Mr. Fletcher, are supported at the S^
S!nFrancI, Sl?5p!°n   P°°r pe°ple iS '"UCh grcater in EnS,a»d-I,e 
AMONG THE  INDIANS.
83
emetic.   Societies stand in need of each other as much as
individuals i and the goodness of the Deity remains unim-
pcached, when we suppose that he intended medicines to
serve (with other articles) to promote that  knowledge, hu-
manity and politeness, among the inhabitants of the earth,
which have been so justly attributed to commerce.
   We have no discoveries in the materia medica to hope
for from die Indians of North America.  It would be a re-
proach to our schools of physic, if modern physicians were
not more successful than the Indians, even in the treatment
of their own diseases.
   Do the blessings of civilization compensate for the  sac-
rifice we make of natural health, as well as of natural liber-
ty ?  This question must be answered under some  limita-
tions.   When natural liberty is given up  for laws  which
enslave instead of protecting us, we are immense losers by
the exchange. Thus, if we arm the whole elements against
our health, and render every pore in  the body an avenue
for a disease,  we pay too high a price for  the blessings of
civilization.
   In governments which have departed entirely from their
simplicity, partial evils are to be  cured by nothing  but an
entire  renovation of their constitution.   Let the world bear
with the professions of law,  physic,  and divinity; and let
the lawyer, physician,  and  divine, yet learn to bear with
each other.   They are  all  necessary, in the present state
of society.   In like manner, let the woman of fashion for-
get the delicacy of her sex, and submit to be delivered by
a man-mid wife.*   Let her snatch her offspring from  her
breast, and send  it  to repair the weakness of its stamina,
with the milk of  a  ruddy cottager.f   Let  art  supply the
  *  Li the enervated age of Athens a law was  passed, which confined
the practice of midwifery only to the men.  It was,  however, repealed,
upon a woman's dying in child-birth, rather than be delivered by a man-
midwife.  It appears from the bills of mortality in London and  Dub-
Sin,  that alxmt one in seventy of those women die in child-birth, who are
in the hands of midwives; but from the accounts of the lying-in hospitals
in those cities, wliich are under the care of mau-midwives,  only  one in a
hundred and forty perishes in child-birth.
  f  There has been much common-place declamation against the custom
among the great, of not suckling their children. Nurses were common
in Rome, in the declension of the empire: hence we find Cornelia com-
mended as a rare example of maternal virtue, as much for suckling her
sons, as for teaching tlum eloquence. That nurses were common in Egypt,
is probable from the contract which Pharoah's  daughter made with the
unknown mother of Moses, to allow her wages for suckling her own child. 
84         natural history of medicine
place  of nature in the preparation and digestion of all our
aliment.   Let our fine ladies keep up their  colour with
carrnine, and their spirits with ratifia: and let our fine gen-
tlemen defend themselves  from the excesses of heat  and
cold with lavender and hartshorn.   These customs have
become necessary in the corrupt stages  of society.  We
must  imitate, in these  cases,  the practice of physicians,
who consult the appetite only in diseases which do not ad-
mit of a remedy.
   The state of a country,  in point of population,  temper-
ance, and industry, is so connected with its diseases,  that
a tolerable idea may be formed of  it, by looking  over its
bills of mortality.  Hospitals, with all their boasted ad-
vantages, exhibit at the same time monuments of the cha-
rity and depravity of a people.*   The opulence of physi-
cians, and the divisions of their offices,  into those of sur-
gery, pharmacy, and midwifery,  are likewise proofs of the
declining state of a country.   In the infancy of the Roman
empire, the priest  performed the office of a physician; so
simple were the principles and practice of physic.    It was
only in the declension of the empire, that physicians vied
                                                            •
The same degrees of civilization require the same customs.  A woman,
■whose times for eating and sleeping are constantly interrupted by the calis
of enervating pleasures, must always afford milk of an unwholesome na-
ture. It may truly be said of a child doomed to live on this aliment, that,
as soon  as it receive its
                                       ------'* breath.
              It sucks in " the lurking principles of death."
  • " Aurengezebe, emperor of Persia, being asked, Why he did not build
hospitals? said, / will make my empire so rich, that there shall be no need
of hospitals. He ought to have said, I will begin by rendering my subjects
rich, and then I will build hospitals.
  " At Rome, the hospitals place every one at his ease, except those who
labour,  those who are industrious,  those who have lands, and those who
are engaged in trade.
  •« I have observed, that wealthy nations have need of hospitals, because
fortune subjects them to a thousand accidents; but it is plain, that tran-
sient assistances are better than perpetual foundations. The evil is mo-
mentary ;  it is necessary, therefore, that the succour should be of the
same nature, and that it be applied  to particular accidents."  Spirit of
Laws, b. xxiii. ch. 29.
  It was reserved for the present generation to substitute in the room of
public hospitals private dispensaries for the relief of the  sick.  Philo-
sophy and Christianity  alike concur in deriving praise and  benefit from
these excellent institutions.  They exhibit something like an application
of the mechanical powers to the purposes of benevolence; for what other
charitable institutions do we perceive  so great a quantity of distress re-
lieved by so small an expence ? 
AMONG THE INDIANS.               85
with the emperors of Rome in  magnificence and splen-
dour.*
   I  am sorry to  add, in this  place,  that  the number of
patients in the  hospital, and incurables in the alms-
house of this city, show that we are treading in the ener-
vated steps of our fellew subjects in Britain.   Our bills of *
mortality likewise show the encroachments of British dis-
eases upon us.   The nervous fever  has become so
familiar to us,  that we  look upon it as a natural disease.
Dr. Sydenham, so faithful in his history of fevers, takes no
notice of it.   Dr. Cadwallader informed me,  that it made
its first appearance in this city about five and twenty years
ago.   It will be impossible to name the consumption,
without recalling to our minds the memory of some friend
or relation, who has perished within these few years by that
disease.  Its rapid progress among us has been unjustly
attributed to the  growing resemblance of our climate to
that of Great Britain.   The  hysteric and  hypochon-
driac  diseases, once peculiar to the chambers of the
great, are now to be found in our kitchens and workshops.
All these diseases have  been produced by our having de-
serted the simple diet and manners of our ancestors.
   The blessings of literature, commerce, and religion, were
not originally purchased at the  expense of health.   The
complete enjoyment of  health is as compatible with civili-
zation, as the  enjoyment of civil liberty.   We read of
countries, rich in  every  thing that can form national happi-
ness and national  grandeur, the diseases of which are nearly
as few and simple as those of the Indians.   We hear of no
diseases among the Jews,  while  they were  under  their
democratical form  of  government, except such as were
  * The first regular practioners of physic in Rome were women and
slaves.  The profession was  confined to them  above six hundred years.
The Romans, during this period, lived chiefly upon vegetables, particularly
upon pulse ; and hence  they were called, by their neighbours, pulti-
fagi.  They were likewise early inured to the healthy employments of
war and husbandry. Their diseases, of course, were t<K> few and simple,
to render the cure  of  them an object of  liberal profession.  When their
diseases became more numerous and complicated, their investigation and
cure required the aids of philosophy. The profession from this time became
liberal; and maintained a rank with the other professions which are found-
ed upon the imperfection and depravity of human institutions.  Physicians
are as necessary in the advanced  stages of society as surgeons, although
their office is less ancient and certain. There are many artificial diseases,
in which they give certain relief; and even where their art fails,  their
prescriptions are still necessary, in order to smooth the avenues of death. 
86         NATURAL  HISTORY  OF  MEDICINE
inflicted by a supernatural power.* We should be tempted
to doubt the accounts given of the populousness of  that
people, did we not see the practice of their simple customs
producing nearly the same populousness in Egypt, Rome,
and other countries of antiquity.   The empire of China, it
is said, contains more inhabitants than the whole of Europe.
The political institutions of that country have exempted its
inhabitants from a  large share of the diseases  of other civil-
ized nations.   The inhabitants of Swisserland,  Denmark,
Norway,! and Sweden, enjoy the chief advantages of civil-
ization^ without having surrendered for them the blessings
of natural health.  But it is unnecessary to appeal to ancient
or remote nations,  to prove that health is not incompatible
with civilization.   The inhabitants of many  parts of New
England, particularly of the province of Connecticut, are
but little affected by  artificial diseases.   Some of you may
remember the time,  and our fathers have  told those of us
who do not, when the diseases of Pennsylvania were
as few and as simple  as those of the  Indians.   The food of
the  inhabitants was   then  simple;  their  only drink  was
water ; their appetites were restrained  by labour ; religion
excluded the influence of sickening passions  ; private hos-
pitality supplied the want of a public hospital; nature  was
their only nurse, and temperance their principal physician.

  * The principal employments of the Jews; like those of the Romans in
their simple ages, consisted in war  and husbandry. Their diet was plain,
consisting chiefly of vegetables.  Their only remedies were plaisters and
ointments; which were calculated for those diseases which are produced
by accidents.  In  proportion as they receded from their simple customs,
we  find artificial  diseases prevail among them.  The leprosy made its
appearance in their journey through the wildnerness.  King Asa's pains
in his feet were prolxibly brought on by a fit of the gout.  Saul and Nebu-
chadnezzar were  afflicted  with a melancholy. In the time of our Saviour,
we  find an account of all those diseases in Juriea which mark the declen-
sion of the  people ; such as, the palsy, epilepsy, mania, blindness, hemorr-
hagia uterina, £cc.  It is unnecessary to suppose that they were let  loose
at this juncture, on purpose to give  our Saviour  an opportunity of making
them the chief subject of his miracles. They had been produced  from
natural  causes, by the gradual depravity of their manners. It is remark-
able, that our Saviour chose those artificial diseases for  the subject of his
miracles, in preference to natural diseases.  The efforts of  nature, and
the operation of medicines, are too slow and uncertain  in these cases to
detract in the least from the validity of the  miracle.  He cured Peter's
mother-in-law, it is true, of a fever; but to show that the cure was
miraculous, the sacred historian adds (contrary to what is common  after
a fever) " that she arose  immediately, and ministered unto them."
•  f I" t'1^ c!ty °f Bergen, which consists of 30,000 inhabitants,  there is
but one  physician; who is supported at the expense of the public.   Pen*
toppidan s Nat. Hist.-of Norway. 
AMONG THE INDIANS.               87
But I must  not dwell upon  this  retrospect of primaeval
manners; and I am too strongly impressed with a hope of
a revival of such happy days, to pronounce them the golden
age of our province.
   Our esteem for  the customs of  our savage neighbours
will be  lessened, when we add,  that civilization does  not
preclude the  honours, of old age.   The proportion of  old
people is much greater among civilized, than among savage
nations.   It would be easy to decide this  assertion in  our
favour,  by  appealing to facts in  the natural  histories oi"
Britain, Norway, Sweden, North America,* and several of
the West India islands.
   The laws of decency and nature  are not necessarily abol-
ished  by  the customs of civilized  nations.   In many of
these wTe read of women,  among whom nature alone  still
performs the office of a midwife,t and who feel the obliga-
tions of suckling their children to be equally binding with
the common  obligations of morality.
    Civilization does not render us less fit for the necessary
hardships of war.   We read of armies of civilized nations,
who have endured degrees  of cold, hunger, and  fatigue,
which have  not been exceeded by the  savages  of  any
country. |

  * It has been urged against the state of longevity in America, that the
Europeans, who settle among us,  generally arrive to a greater age  than
the Americans.  This is not occasioned so much by a peculiar firmness in
their stamina, as by an increase of vigour which the constitution acquires by a
' change of climate.  A Frenchman (cxteris paribus) outlives an Englishman
in  England  A Hollander prolongs his  life by removing to the Cape of
Good Hope.  A  Portuguese gains fifteen or twenty years by removing to
 Brazil.  And  there are good reasons to believe that a North  American
would derive the same advantages, in point of health and longevity, by re-
moving to Europe,  which a European derives from coming to this country.
   From a calculation made by an  ingenious foreigner, it appears, that a
greater proportion of old people are to be found in Connecticut, than in
any colony in North America.   This colony contains 180,000 inhabitants.
They have no public hospitals or poor-houses; nor is a beggar to be seen
among them. There cannot bu more striking proofs man these facts of the
simplicity of their manners.
   f Parturition, in  the simple ages of all countries, is performed  by nature.
The Israelitish women were delivered even without the help of the Egyp-
tian mid wives.  We read of but two women  who died  in child birth, in the
whole history of the Jews. Dr. Bancroft says, that child-bearing is attended
with so little pain in Guiana, that die women seem to be exempted  from
the curse inflicted upon Eve. These easy births are  not confined to warm
climates. They are equally safe and easy in Norway and Iceland, according
to  l\mtoppidan and Anderson's histories of those countries.
   X Civilized nations have, in the end, always conquered savages as  much
by their ability to bear hardships, as by thd: superior military skill.  Sol- 
88         NATURAL HISTORY OF  MEDICINE
   Civilization does not always  multiply  the avenues of
 death.  It appears from the bills of mortality, of many coun-
 tries, that fewer  in  proportion  die  among civilized, than
 among savage nations.
   Even the charms of beauty are heightened  by civiliza-
 tion.  We read of  stateliness, proportion, fine teeth,* and
 complexions, in both sexes, forming the principal outlines
 of national characters.
   The danger of many diseases is not proportioned to their
 violence, but to their duration.  America has advanced but
 a few paces in luxury and effeminacy. There is yet strength
 enough  in her vitals to  give life to those parts which are
 decayed. She may tread back her steps.  For this purpose,
   I.  Let our children be educated in a manner more agree-
 able to nature.
   II.  Let the common people  (who constitute the  wealth
 and  strength of our country)  be preserved from the effects
 of ardent spirits.   Had I a double  portion of all that elo-
 quence, which has been employed in describing the political
 evils that lately threatened our country,  it would be too
 little to set  forth the  numerous and complicated physical
 and moral evils, which these liquors have introduced among
 us.  To encounter this hydra  requires an arm accustomed,
 like  that of Hercules, to vanquish monsters.  Sir William
 Temple tells  us, that formerly in Spain no man could be
 admitted as  an evidence in a court, who had once  been con-
 victed of drunkenness.   I do not call for so severe a law
 in this country.  Let us first  try the force of severe man-
 dicrs  are not to be chosen indiscriminately.   The greatest generals have
 looked upon sound constitutions to be  as essential to soldiers, as bravery or
 military discipline.  Count Saxe refused soldiers born and bred in large
 cities; and sought for such only as were bred in mountainous countries.
 The king of Prussia calls young soldiers only to the dangers  and honours
 of  the field, in his elegant poem, Sur l'Art de la Guerre, chant  1.  Old
 soldiers generally lose the advantages of their veteranism, by their habits
of  idleness and debauchery.  An able general, and experienced  officers,
 will always supply the defects of ago in young soldiers.
  * Bad teeth are observed chiefly in middle latitudes, which are subject
to alternate heats and colds. The inhabitants of Norway and Russia are
 as remarkable for their fine teeth as the inhabitants of Africa.  We observe
 fine teeth to be universal likewise among the inhabitants of France, who
live in a variable climate.  These have been ascribed to their protecting
their  heads from the action of the night air  by means of woollen night-
caps, and  to the  extraordinary attention to  the  teeth of their children.
These precautions secure good teeth; and are absolutely necessary in all
 variable climates, where, people do not adopt all the customs of the'savage
 life. 
AM0NC THE INDIANS.             89
ners.  Lycurgus governed more by these, than by his laws.
" Boni mores, non bonae leges,"  according to Tacitus,
were  the bulwarks of virtue among the ancient Germans.
   III. I despair of being able to call the votaries of Bac-
chus from their bottle, and shall therefore  leave them to be
roused by the more eloquent twinges of the gout.
   IV. Let us be cautious what kind of manufactures we
admit among us.   The rickets made their first appearance
in the manufacturing towns in  England.  Dr. Fothergill
informed me, that he had often observed, when a pupil,
that the greatest part of the chronic patients in the London
Hospital were Spittal-field weavers.  I would not  be un-
derstood, from these facts, to discourage those manufactures
which employ women  and children: these suffer few in-
conveniences from a sedentary life ;  nor do I mean to offer
the least restraint to those manufactories among men, which
admit of free air,  and the exercise of all their limbs.  Per-
haps  a pure air,  and the abstraction  of spirituous liquors,
might render sedentary  employments less  unhealthy in
America, even among men, than in the populous towns of
Great Britain.
   The population of a country is not to be  accomplished
by rewards and punishments.  And it is happy for Ameri-
ca, that the universal prevalence of the protestant religion,
the checks lately given to negro slavery, the general unwil-
lingness among us to acknowledge  the usurpations of pri-
mogeniture, the universal practice  of inoculation  for the
small-pox, and absence of the plague, render the interpo-
sition of government for that purpose unnecessary.
   These advantages can only be secured to our country by
agriculture.   This is the true basis of national health,
riches, and populousness.  Nations, like individuals, never
rise higher than when they are ignorant  whither they are
tending.   It is impossible to tell, from history,  what will
be the effects of agriculture, industry, temperance, and com-
merce, urged on by the competition of colonies united in the
same general pursuits, in a country, which, for extent, varie-
ty of  soil, climate, and number of navigable rivers, has never
been  equalled in any quarter of the globe.  America is
the theatre, where human nature will probably receive her
last and principal literary, moral, and political honours.
     VOL. I-                 M 
90        NATURAL  HISTORY OF MEDICINE

  But I recall myself from the ages of futurity.  The pro-
vince of Pennslyvania has already shown,  to her sister co-
lonies, the influence of agriculture and commerce upon the
number and happiness of  a  people.  It is scarcely a hun-
dred years since our illustrious legislator, with a handful of
men, landed upon these shores.  Although  the perfection
of our government, the healthiness of our climate,  and the
fertility of our  soil, seemed to ensure  a rapid settlement
of the province;  yet it would have  required  a prescience
bordering upon  divine to  have  foretold,  that in such a
short space of time the province would contain above 300,
000 inhabitants;  and  that nearly 30,000  of this number
should compose  a city, which should be the third, if not
the  second,  in commerce  in the British empire.   The
pursuits of literature require leisure,  and a total recess
from clearing forests, planting, building, and all the com-
mon toils of settling  a new country ;  but before these ar-
duous "works Mere accomplished, the sciences, ever fond
of the company of liberty and industry, chose this spot for
the seat of their empire in this new world. Our college,
so catholic in its foundation, and extensive in its objects,
already sees her sons  executing offices in the highest de-
partments of society.   I have now the honour of speaking
in the presence of a most respectable  number of philoso-
phers,  physicians, astronomers,  botanists, patriots,  and
legislators; many of whom have already seized the prizes
of honour, which their ancestors had alotted to a much later
posterity.  Our  first offering had scarcely found its way
into the temple of fame, when the oldest societies in Europe
turned their eyes upon us, expecting with impatience to see
the mighty fabric of science, which,  like a well-built arch,
can only rest upon the whole of its materials, completely fin-
ished  from the treasures of  this unexplored quarter of the
globe.
   It reflects equal honour upon our society and the hon-
ourable assembly of our province,  to acknowledge,  that
we have always  found the latter willing to encourage by
their  patronage,  and reward by  their liberality, all our
 schemes for promoting useful knowledge.   What may we
 not expect from this harmony between the  sciences and
 government!  Methinks I see canals cut, rivers once im- 
                AMONG THE INDIANS.              91

passable rendered  navigable, bridges erected,  and roads
improved, to facilitate the exportation of grain.  I see the
banks of our rivers vying in fruitfulness with the banks of
the river of Egypt.   I behold our farmers nobles;  our
merchants  princes.  But I forbear—imagination cannot
swell with the subject.
   I beg leave to conclude,  by deriving an argument from
our connection with the legislature, to remind my auditors
of the duty they owe to the society.  Patriotism and litera-
ture are here connected together;  and a man cannot ne-
glect the one, without being destitute of the other.  Nature
and our ancestors have completed their works  among  us;
and have left us nothing to do, but to enlarge and perpetu-
ate our own happiness. 
V 
AN INQUIRY
                  INTO THE







INFLUENCE OF PHYSICAL CAUSES






                   UPON






         THE MORAL FACULTY.
DELIVERED BEFORE THE AMERICAN PHILOSOPHICAL SOCIETY, HELD AT




    PHILADELPHIA, ON THE TWENTY-SEVENTH OF FEBRUARY, 1786. 
 
AN  INQUIRY,  &c
Gentlemen,

     IT was for the laudible purpose of exciting a spirit
of emulation and inquiry among the members of our body,
that the founders of our society instituted an annual ora-
tion. The task of preparing, and delivering this exercise,
hath devolved, once more,  upon me.  I have submitted
to it, not because I thought myself capable of  fulfiling
your intentions, but because I wished, by a testimony of
my obedience to your requests,  to atone for my long ab-
sence from the temple of science.
  The subject, upon which I am to have the honour of
addressing you this evening, is on the influence of physi-
cal causes upon the moral faculty.
  By the moral faculty I mean a capacity in the human
mind of distinguishing and choosing good and evil, or, in
other words, virtue and vice.  It is a native principle, and
though  it be capable of improvement 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 la\V, 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 ac-
cusing, or else excusing, another."*
   The words of Cicero are as follow: " Est igitur hsec,
judices, non scripta, sed nata lex,  quam non didicimus,
accepimus, legimus, verum ex natura ipsa  arripuimus,
                     * Rom. i. 14, 1J. 
96        INFLUENCE  OF PHYSICAL CAUSES

hausimus, expressimus, ad quam non docti, sed facti, non
instituti, sed imputi sumus."*  This faculty is  often con-
founded 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 accuses or ex-
cuses us, of a breach of  the law written in our hearts.
The moral faculty  is what the schoolmen call the  " regula
regulans;"  the conscience is  their "regula regulata;"
or, to speak in more modern terms, the moral faculty per-
forms 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 Marius, 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  con-
science  in its full vigour, with a diminished tone, or total
absence of moral faculty.
  It has long  been a  question  among  metaphysicians,
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 of the moral faculty, and
the understanding  to be the seat of the conscience.   The
mysterious nature  of the union of those two moral princi-
ples 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 con-
                   *  Oratio pro Milone, 
             UPON  THE MORAL FACULTY.           97

seience, 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. Hutchi-
son ;  "  the sympathy" of Dr. Adam Smith ; the " moral
instinct" of Rousseau; and " the light that lighteth every
man that  cometh into the world"  of St.  John.   I have
adopted the  term of moral faculty from Dr. Beattie,  be-
cause I  conceive  it  conveys,  with the  most perspicuity,
the idea of a capacity in the mind of choosing good  and
evil.
   Our  books of medicine contain  many  records  of the
effects of physical causes upon the memory, the imagina-
tion,  and  the  judgment.   In  some instances we behold
their operation only on one,  in others  on two, and, in many
cases, upon the whole of these faculties.  Their derange-
ment has received different  names, according to the num-
ber or nature of the faculties that are affected.   The  loss
of memory  has been  called " amnesia;" false judgment
upon one  subject has been called " melancholia;" 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 properly,
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 necessary first to show their
effects upon the memory, the imagination, and the judg-
ment ; and at the same time to point out the aaalogy
between their operation upon the intellectual faculties of
the mind and the moral faculty.
   1. Do we observe a connection between  the  intellec-
tual faculties and the degrees of  consistency  and  firmness
of the brain in infancy and childhood ? The  same con-
nection  has been  observed  between  the strength, as  well
as the progress, of the moral faculty in children.
   VOL.  I.                   N 
98        INFLUENCE 01 PHYSICAL CAUSES
  2. Do we  observe  a  certain size  of the brain, and a
peculiar cast of features, such as the prominent eye, and
the aquiline nose, to be connected with extraordinary por-
tions of genius ? We observe a similar connection between
the figure and temperament of the body and certain moral
qualities.  Hence we often ascribe good  temper and be-
nevolence to corpulency, and irascibility to sanguineous
habits.  Caesar thought himself safe in the friendship of
the " sleek-headed" Anthony and Dolabella, butwas afraid
to trust to the professions of the slender Cassius.
  3. Do we observe certain  degrees of the intellectual
faculties  to be hereditary m certain families ?  The  same
observation has been frequently extended to moral quali-
ties.  Hence we  often find certain virtues and vices as
peculiar to families, through  all their degrees of  consan-
guinity and duration, as a peculiarity of  voice, complex-
ion, or shape.
  4. Do we observe instances of a total want of memory,
imagination,  and judgment, either  from an original de-
fect in the stamina of the brain, or from the influence of
physical causes ? The same unnatural defect is sometimes
observed, and probably  from the same causes, of a moral
faculty.  The celebrated Servin, whose character is drawn
by  the duke of  Sully, in  his  memoirs, appears to be an
instance of the total absence of the  moral faculty,  while
the chasm, produced  by this defect, seems to have been
filled up by a more than common extension 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 ig-
norant 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 mathematics,
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
disputant for and against the  reformed religion,  indiffer-
ently.   He not only understood Greek,  Hebrew, and all 
             UPON THE MORAL FACULTY.           99

the languages which we call learned, but also all the dif-
ferent 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 quality he  applied  to counterfeit all
sorts of persons,  wherein  he  succeeded  wonderfully.
He was, moreover, the best comedian, and  the greatest
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 agreeably 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 leaping, he was admired.  There are not any recreative
games that he did not know,  and he was skilled in almost
all mechanic arts.  But now for the reverse of the medal.
Here it appeared, that he was treacherous, cruel, cowardly,
deceitful, a liar, a cheat, a drunkard, and a glutton, a shar-
per in play, immersed in every species of vice, a blasphe-
mer, an atheist.  In a word, in him might  be found all
the vices that are contrary 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, in a
common brothel, perfectly corrupted by his debaucheries,
and expired  with the glass in his hand, cursing and de-
nying 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  essence  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
choosing,t as well as the capacity of enjoying, moral good.
   * Vol. iii. p. 216, 217.
   f Milton seems to have been of this opinion. Hence, after ascribing re-
pentance to Satan, he makes him declare,
   " Farewell remorse : all good to me is lost,
   ^ Evil, be thou my good.------
                                 Paradisk Lost, Book IV. 
100       INFLUENCE OF PHYSICAL CAUSES
 It is true, we read of their trembling in a belief of the ex-
 istence of a God, and  of  their anticipating future punish-
 ment> by asking whether they were to be tormented before
 their time : but this is 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 pur-
 pose 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 em-
 pire, on purpose to show his property in all  intelligent
 creatures, and their original resemblance to himself.  Per-
 haps the  essence of moral  depravity in man consists in
 a  total, but temporary, suspension of the power of con-
 science.  Persons in this situation are emphatically said
 in the  scriptures  to " be past feeling,"  and to have their
 consciences seared with a  "hot  iron;" they  are likewise
 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 discovered no
 one  mark of reason, who possessed  the moral  sense  or
 faculty in so high a degree, that he spent his whole life in
 acts 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 worship, 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  imagination, 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 
UPON THE MORAL FACULTY.         10l
do we see the temper wholly changed by a fit of sick-
ness ! And how  often do we  hear persons of the most
delicate virtue utter speeches,  in the delirium of a fever,
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 recovery,  a loss  of her former habit of veracity.  Her
memory (a defect of which might  be suspected of 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 diseases ? 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,
sometimes, appears in the operations of the moral faculty.
I have more than once heard the most sublime discourses
of  morality in the  cell of an hospital, and  who has not
seen instances of patients in  acute diseases discovering
degrees of benevolence and  integrity, that were not natu-
ral to them in the ordinary course  of  their lives ?f
   8. Do we ever observe a partial insanity, or  false per-
ception on one subject, while the judgment is sound and
correct,  upon all others ? We perceive, in some instances,
a similar defect in the moral faculty.   There are persons
who are moral, in the highest degree, as to certain duties,
who nevertheless live under the  influence of  some  one
vice.   I knew an instance of  a woman, who was exem-
  * 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.
  | Xenophon makes Cyrus declare, in his last  moments, " That the soul
of man, at the hour of death, appears most divine, and then foresees some-
thing of future events." 
102      INFLUENCE OF PHYSICAL CAUSES
                             1
plary in her obedience  to every command of the moral
law, except one.   She  could  not  refrain from  stealing.
What made this vice the more remarkable was, that she
was in easy circumstances,  and not  addicted to extrava-
gance 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
pockets 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 de-
tected in  it.
   9. Do  we observe the imagination  in many instances to
be  affected with  apprehensions of dangers  that have no
existence? In  like manner we observe  the moral faculty
to discover a sensibility  to vice, that  is by no means  pro-
portioned to its degrees of depravity.  How often do we
see persons labouring under this morbid sensibility of the
moral 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 imagination,
and the judgment ?  Dreams are nothing but incoherent
ideas, occasioned by partial or imperfect sleep.   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 affected, and  in  others the judgment.  But
there are cases, in which the change that is produced in
the state of the  brain,  I)}' 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 impaired.   It cannot therefore be ascribed to
an  absence of the exercises of those two powers of the
mind.
   1 irDo 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 species,  in respect to moral 
UPON THE MORAL FACULTY.
103
capacity and feeling. Here it will be necessary to remark,
that the low degrees of moral perception,  that have been
discovered 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 proportion to  their intellectual faculties.
But I will go further, and admit, with Mr. Locke,* that
some savage nations are totally devoid of the moral facul-
ty,  yet it  will by no  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
disordered 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 savages destroy their beauty
by painting and cutting their faces, that the principles of
taste do not exist 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
subject to mistakes?
  The only apology I shall make,  for presuming to differ
from  that justly celebrated oracle, f who first unfolded to
    * Essay concerning the Human Understanding, book I. chap. 3.
    t Mr Locke. 
 104       INFLUENCE OF PHYSICAL CAUSES

 lis 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 accommodated  to the slender organs oi
 perception of men, who possess no other talent than that
 of observation.
   It  is not  surprising,  that Mr.  Locke has confounded
 this moral principle with  reason, or that lord Shaftsbury
 has confounded it with taste, since all three of these facul-
 ties agree in the objects of their approbation, notwithstand-
' ing they exist in the mind independently of each other.
 The  favourable 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 subsists in
 nature between the dictates of reason, of taste, and of the
 moral faculty. Why has the spirit of humanity made such
 rapid progress for some years past in the courts of Eu-
 rope ?  It is because kings and their ministers have been
 taught to reason upon philosophical subjects. Why have
 indecency 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 Eng-
 lish nations.
   It  must afford great  pleasure to the lovers  of virtue, to
 behold the depth and extent of this  moral 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
 reason and  taste exist in a weak, or in an  uncultivated
 state.  It is  worthy of notice, likewise, that  while  second
 thoughts are best in matters of judgment, first thoughts
 are always to be preferred in matters that relate to morality.
 Second thoughts, in these cases,  arc generally parlies be-
 tween 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  happiness  are not
 committed  to the determination of  a  single legislative
 power. The conscience, like a wise  and faithful legislate 
UPON THE MORAL FACULTY.          105
  council, performs  the  office of a  check upon the moral
  faculty-, and thus prevents the fatal consequences of im-
  moral actions.
    An objection, I  foresee, will arise to the doctrine 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 phy-
  sical causes upon  the  memory, the imagination,  or the
  judgment.  I shall,  however, remark upon this subject,
  that the writers in favour of the immortality of the soul
  have done that truth great injury,  by connecting i< neces-
  sarily with its immateriality* The immortality oi the soul
  depends upon the will of the Deity, and  not upon the
  supposed 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, br.t
  such  as are derived from the Christian revelation.*  It
  would be as reasonable  to assert  that  the  bason of .he
  ocean is immortal, from the  greatness of its capacity to
  hold water; or that we are to live for ever  in this world,
  because we are afraid  of dying;  as  to maintain the im-
  mortality of the  soul, from  the  greatness of its capacity
  for knowledge and happiness,  or from its dread of annihi-
  lation.
    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 medi-
  cine ;  and that there are many cases  upon  record which
  prove, that the  diseases from the derangement of these
  faculties have yielded to the healing art.
    It is perhaps only because the diseases of the moral fa-
  culty  have  not been traced  to a connection  with physical
  causes, that medical writers have neglected to give them
  a place in their systems of nosology,  and  that so few at-
—.  * " Life and immortality are brought to light only through the gospel."
  2 Tim.  i. 10.
    VOL. I.                 0 
 106      INFLUENCE OF PHYSICAL CAUSES

 tempts 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 physical 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 quarter.
   I am aware, that in venturing upon this  subject I step
 upon untrodden groundi   I feel as JEneas did,  when he
 was about  to enter the gates of Avernus, but without a
 sybil to instruct me in the mysteries  that are before me.
 I forsee, that men who have been educated in the mechani-
 cal 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 commend that bold-
 ness of inquiry, that prompted me to broach them.
   I shall begin  with an attempt to supply  the defects of
 nosological writers, by naming the partial or weakened
 action of the moral faculty, micRonomia. The total ab-
 sence  of this faculty I shall call  anomia.  By the law,
 referred to in these new genera of vesaniae, I mean the law
 of nature written in the  human heart, and which I for-
 merly quoted from the writings of St. Paul.
   In  treating of the effects of physical causes upon the
 moral 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 particular 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 audi-
 tors 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, predisposing, or occasional causes.
  1.  The effects of climate  upon  the moral  faculty
claim our first attention.    Not  only individuals,  but na-
tions, derive a  considerable part of their moral,  as well 
             UPON THE MORAL FACULTY.         107

as intellectual character, from the different portions they
enjoy of the  rays  of the sun.  Irascibility, levity, timi-
dity, and indolence, tempered with  occasional emotions
of benevolence, are the moral qualities of the  inhabitants
of warm climates, while selfishness, tempered with sin-
cerity and integrity, from the moral character of the in-
habitants of cold countries.  The state of the  weather,
and the seasons of the year also, have a visible  effect upon
moral  sensibility.   The  month of November,  in  Great
Britain, rendered gloomy by constant fogs and rains, has
been thought to favour the perpetration of the worst spe-
cies of murder, while the veneral sun, in middle latitudes,
has been as generally remarked for producing gentleness
and benevolence.
   2. The effects of diet upon the moral faculty are more
certain, though less attended to, than the effects of climate.
" Fulness of bread," we are told, was one of the predis-
posing causes of the vices of the cities of the  plain. The
fasts so often inculcated among the Jews were intended
to lessen the incentives to vice;  for pride, cruelty, and
sensuality, are as much the natural consequences of luxu-
ry, 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 mention-
ed are most  frequently the offspring of animal food. The
prophet Isaiah seems to have been sensible of this, when
he ascribes such salutary effects to a temperate and vege-
table diet.   " Butter  and honey shall  he eat," says he,
 " that he may know to refuse the evil, and to choose 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 quali-
 ty, and taken in a moderate quantity, are favourable to the
 virtues of candour, benevolence, and generosity; but when
 they are taken in excess, or when they are of  a bad quali-
 ty, and taken even in a moderate quantity, they seldom 
 108       influence of physical causes

 fail of rousing every latent spark of vice into action. The
 last of these facts is so notorious, that when a man is ob-
 served to be ill-natured or quarrelsome in Portugal, after
 drinking, it is common in that country to say, that " he
 has drunken bad wine."  While occasional fits of intoxi-
 cation produce ill-temper in many people, habitual drunk-
 enness (which is generally produced by distilled spirits)
 never fails to eradicate veracity and integrity from the hu-
 man mind.  Perhaps  this may be  the reason why the
 Spaniards, in  ancient times, never admitted a man's evi-
 dence in a court of justice,  who had been convicted of
 drunkenness.   Water is  the universal sedative of turbu-
 lent 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  violent passion,  after the usual
 remedies of reason  had been  applied to no purpose.
  4.  Extreme  hunger produces the most unfriendly
 effects upon moral  sensibility.   It is immaterial, whether
 it act by inducing  a  relaxation of the solids, or  an acri-
 mony 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 pe-
 culiar to them,  by  the stimulous of hunger;  hence, we
 are  told,  they always return meagre and  emaciated from
 their military excursions.   In civilized life we often be-
 hold this sensation to overbalance 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
 walls."   So much  does this sensation predominate over
 reason and  moral feeling, that  cardinal de Retz suggests to
 politicians, never to risk a motion in a popular assembly,
 Jiowever  wise or just it may  be, immediately before din-
 ner.  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 disagreeable to his
 friends and family, from the time he left his bed till he sat
down to his morning repast, after  which,  cheerfulness 
UPON the moral faculty.
109
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 intellects and upon the
moral faculty,  that the latter was frequently impaired by
madness. I beg leave to add further upon this head, that
not only madness,  but the hysteria and  hypochondriasis,
as well as all those  states of the body, whether idiopathic
or  symptomatic, which are accompanied with preternatu-
ral 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,
particularly  by exercise, the cold bath, 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.*
   6.  Idleness  is the  parent of every vice.  It is men-
tioned in the Old Testament as another of the predispos-
ing causes of the  vices of the  cities of the plain.  La-
bour, of all kinds, favours and facilitates the practice of
virtue.   The country life is happy, chiefly because its la-
borious employments  are favourable  to virtue,  and un-
friendly 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

  *  There is a morbid state of excitability in the body during the conva-
lescence from fever,  which is intimately connected with  an undue pro-
pensity to venereal pleasures.  I have met with several instances of it.
The marriage of the celebrated Mr. Howard to a woman who was twice
as old  as himself, and very sickly, has been ascribed, by his biographer,
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 clerymen who married the wo-
men 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 excita-
bility which followed attacks of the plague at Messina, in 1743, in all
ranks of people.  Marriages, he says, were  more frequent after it than
usual, and virgins were,  in some instances, violated, who died of that dis-
ease, by persons who had just recovered from it. 
110      influence of physical causes

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 severe, but the  most bene-
volent  of all punishments, inasmuch as it is one of the
most suitable means of  reformation.  Mr.  Howard tells
us, in his History of Prisons, that in Holland  it is a com-
mon saying, " Make men work, and you will  make them
honest." And  over the rasp and spinhouse at Grceningen,
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 virtu-
ous 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 pre-
ferred masters 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 apprentice-
ship to labour,  are purely mechanical, their effects  are, ne-
vertheless, the same upon the happiness of society, as if they
flowed from principle.   The mind,  moreover, when pre-
served by these means from weeds, becomes a more mel-
low soil, afterwards, for moral and rational improvement.
   7. The  effects  of excessive sleep  are intimately
connected with the effects of idleness upon the moral fa-
culty : hence we find that moderate, and even scanty por-
tions 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
often 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.
   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, upon the
most ordinary subjects, that discover an uncommon eleva- 
             UPON the moral faculty.         Ill

tion 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 reformation, in one
of die prisons which he visited. If pain has a physical ten-
dency to cure vice, I submit it to the consideration of pa-
rents 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,
as a physical means of  promoting virtue.  The writings of
Moses have been  called, by military men,  the best " or-
derly book" in the 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 precept and rite
of the ceremonial parts of  the Jewish religion was, to pre-
vent vice, and to promote virtue.  All writers upon the le-
prosy take notice of its connection with a certain vice. To
this disease gross animal food, particularly swine's flesh,
and  a  dirty skin,  have been thought to be predisposing
causes : hence the reason, probably, why pork was forbid-
den, and why ablutions of the body  and  limbs were so fre-
quendy inculcated by the Jewish law.   Sir John Pringle's
remarks, in his Oration upon captain Cook's voyage, de-
livered before the Royal Society, in  London, are very per-
tinent to this part of our subject.  " Cleanliness (says he)
is conducive to health, but is it not 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 from attending
to these facts is too obvious to be mentioned.
   10.  I hope  I shall  be  excused  in placing  solitude
among the  physical causes which influence the moral facul-
ty, 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 Liege, in Ger-
man},  assured him, "  that the most refractory  and turbu- 
112      influence of  physical CAUSES.
 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 ac-
 tive 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 sufficient chasm in
 their habits of  vice.  Where the benefit of reflection  and
 instruction from books  can be added to  solitude and con-
 finement, their good effects are still more certain.   To this
philosophers and poets in every age have assented, by des-
cribing the life of a hermit as a life of passive virtue.
   II. Connected with  solitude,  as a mechanical means of
promoting  virtue,  silence deserves to  be  mentioned in
this place.   The late Dr. Fothergill, in his plan of educa-
tion for that benevolent institution at Ackworth, which was
the last care of his useful life,  says every thing that can be
said in favour of this necessary discipline, in the following
words:  " To habituate children, from their early infancy,
to silence and attention, is of the greatest advantage to them,
not only  as a preparative to their advancement in religious
life, but as the groundwork of a well cultivated understand-
ing.  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 ab-
stracted quiet;  is a matter of great consequence, and last-
 ing benefit 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 accustomed  thus to quietness
 is no small point gained towards fixing a habit of patience,
 and recollection, which seldom  forsakes those,  who have
 been properlv instructed in this entrance of  the school of
 wisdom, during the residue of their days."
   For the  purpose of acquiring this branch  of education,
 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.  Hence  we are
 able to discover the virtues and vices of different nations,
 by their tunes,  as  certainly as by their laws.   The effects 
UPON THE MORAL FACULTY.
113
of music,  when simply mechanical, upon the passions, are
powerful and extensive.   But it remains yet to determine
the degrees of moral ecstacy that may be produced by an
attack upon the ear, the reason, and the moral principle, at
the same time, by the  combined powers of music and elo-
quence.
   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 propa-
gated, 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 re-
sources for oratory which are contained in the Old and New
Testaments, does not produce in every man who hears him
at least a temporary love of virtue.   I grant  that the elo-
quence of the pulpit alone cannot change men into Chris-
tians, 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 me-
chanical effects upon morals.  The language and imagery
of a Shakespeare, upon moral and religious subjects, pour-
ed upon the passions and the senses,  in all the beauty and
variety of dramatic representation;  who  could  resist,  or
describe their effects?
   14. Odours of various kinds have been observed to act
in the most sensible manner upon the moral faculty.  Bry-
done tells  us,  upon the  authority of  a celebrated philoso-
pher in Italy, that the peculiar wickedness of the people who
live in the neighbourhood of iEtna and Vesuvius is  occa-
sioned chiefly by the smell of the sulphur, and of the hot
exhalations which are constantly discharged from those vol-
canoes.   Agreeable odours seldom fail to inspire  serenity,
and to compose the angry spirits. Hence the  pleasure, and
one of the advantages, of the flower garden.   The smoke
of tobacco is likewise of a composing nature, and  tends
   vol. i.                   p 
114        INFLUENCE of physical causes

not only to produce what is called a train in perception,
but to hush the passions into silence and order.   Hence
the practice of connecting the pipe or segar and the bottle
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 night, 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 gentle pas-
sions?*
   16.  It is to be lamented, that no experiments have as yet
been made, to determine the effects of all the different species
of airs, which chemistry has lately discovered, upon the
moral faculty.  I have authority, from actual experiments,
only to declare,  that dephlogisticated air, when taken into
the lungs,  produces cheerfulness, gentleness,  and serenity
of mind.
   17. What  shall we say of the effects of medicines upon
the moral faculty ? That many substances in the materia
medica act upon the intellects 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 earth
contain, in its bowels, or upon its surface, antidotes ?  But
I will not blend facts with conjectures.   Clouds and dark-
ness still hang upon this part of my subject.
   Let it not  be suspected,  from any thing that I have de-
livered, Jjiat  I suppose the influence of physical causes upon
the mom faculty renders the agency of divine  influence un-
necessary to  our moral happiness.  I only maintain, that
the operations of the divine government  are carried on in
the moral, as in the natural world, by the instrumentality
of second causes. I have only trodden in the footsteps of the
inspired writers; for most  of the physical causes I have
enumerated  are connected  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
  * The temperature of the air has a considerable influence upon moral
feeling. Henry the Third of France was always ill humoured, and some-
times cruel, in  cold weather.  There is a damp air which comes from
the sea in Northumberland county in England which is known by the
name of the Seafrct; from its inducing fretfulness in the temper. 
upon the moral faculty.          115
mentioned,  I shall only add,  that  Nebuchadnezzar was
cured of his pride, by means of solitude  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 extraordi-
nary cases, where bad men are suddenly reformed, without
the instrumentality 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 phy-
sical change ;* and hence the expression of a  "a new crea-
ture,"  which is made use of in the scriptures to denote this
change, is proper in a literal, as well as a figurative sense.
It is probably the beginning of that perfect renovation  of
the human body,  whioh is predicted by  St. Paul in  the
following words:   u For our conversation is in heaven, from
whence we look for the Saviour, 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 devoutly wished for by Dr. Cheyne,  in
which men  will  not be deterred in their researches after
truth,  by the terror of odious or unpopular names.
   I cannot help remarking under this head, that if the con-
ditions of those parts of the human body which  are connect-
ed with the human soul influence  morals,  the same reason
may be given for a virtuous education, that has been  ad-
mitted for teaching music, and the pronunciation of foreign
languages,  in the early and yielding state of those organs
which form 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 principles which were con-
nected with it have been renounced; 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-

  * St.  Paul was suddenly transformed from a persecutor into a man of
a gentle and amiable spirit.  The manner in which this  change  was ef-
fected upon his mind, ne tells us in the following words:  " Neither cir-
cumcision  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. 
lib       influence  of physical causes

ed to operate upon his mind.   The boasted  morality of
the deists is, I believe, in most cases, the offspring of hab-
its, produced originally by the principles and precepts of
Christianity.  Hence  appears 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 opposed to each other,  the
moral faculty should become stationary,  or if the virtue or
vice produced by them  should form a neutral quality, com-
posed of both of them, I hope it will not call in question
the truth of our general propositions. I have only mention-
ed 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  different stages of soci-
ety,  of agriculture and  commerce, of soil and situation, of
the different degrees of cultivation of taste, and of the in.
tellectual powers, of the  different forms of government,
and, lastly, of the different professions and occupations of
mankind, upon the moral faculty;  but  as these act indi-
rectly only, and by the  intervention of causes that are un-
connected with matter, I conceive  they  are foreign to  the
business of the present inquiry.   If they should vary the
action of the simple physical causes in any degree, I hope
it  will not call in question the truth of our general  propo*
sitions,   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 nature, but
they are so nearly related to those which are purely me-
chanical, that I shall beg leave to trespass upon  your pa-
tience, by giving them a place in my oration.
   The  effects  of imitation,  habit, and  association, upon
morals would furnish ample matter for investigation. Con-
sidering  how much the  shape, texture, and conditions of
the human body influence morals, I submit it to  the con-
sideration of the ingenious, whether, in  our  endeavours to

  • The doctrine of the influence of physical causes on morals is happily
calculated to beget charity towards the  failings of our fellow-creatures.
Our duty to practise this virtue is enforced by motives drawn from science,
as well as  from the precepts  of Christianity." 
UPON THE MORAL FACULTY.
117
imitate moral examples,  some advantage  may not  be de-
rived, from our copying the features and external manners,
of the originals.   What makes the success of this experi-
ment probable is, that we generally find men, whose faces
resemble each other, have the same manners and disposi-
tions.   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  resem-
blance to their masters and mistresses, not only in manners,
but in countenance,  in those cases where  they are tied to
them by respect and affection.  Husbands and wives also,
where they possess the same species of face, under circum-
stances of mutual attachment often acquire a resemblance
to each other.
   From the general detestation in which hypocrisy is held,
both by good and bad men, the mechanical effects of habit
upon virtue have not been sufficiently explored.  There
are,  I am  persuaded, many instances, where virtues have
been assumed  by accident, or  necessity,  which  have  be-
come 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
         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 easy:
         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 ser-
vants, which we sometimes 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 spirits, 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 pow- 
 118       INFLUENCE OF PHYSICAL CAUSES

 der, 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.
 Thie mixture is bitter and nauseating in the highest degree.
 An inclination to idolatry,  therefore, could not  be felt,
 without being associated with  the remembrance of this
 disagreeable 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 fol-
 low 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.
   As sensibility  is the  avenue to the moral  faculty,
 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 crimi-
 nals, with wild beasts. For these reasons executions should
 never be public.  Indeed, I believe there are no public
 punishments of any kind, that do not harden the 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 savages has been ascri-
bed in  part  to their peculiar mode of subsistence.   Mr.
Hogarth points out, in his ingenious prints, the connection
between cmelty to brute animals in youth, and murder in
manhood.   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.
   In order to preserve the vigour of the moral faculty, it is
of the utmost consequence to keep young people as igno- 
UPON THE MORAL FACULTY.
119
rant as possible of those crimes that are generally thought
most disgraceful to human nature.  Suicide,  I believe, is
often propagated by means of newspapers.  For this reason,
1 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 morality that I
shall mention, is to keep sensibility alive, by a familiarity
with scenes of distress  from poverty and disease.   Com-
passion 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 counte-
nance, the heart is made better."
   A late French writer, in his prediction of events that are
to happen in the year 4000,  says, " That mankind in that
sera shall be so far improved  by religion and government,
that the sick and the dying shall  no longer be thrown, to-
gether 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 humanity, an institution,*
destined for that distant period, has lately been founded in
this city, that shall perpetuate the year 1786 in the history
of Pennsylvania.  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 solitary blaze by a single contribu-
tion,  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  purpose of drowning herself, by nothing but
the distress 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 distin-
 guished for  virtue than men;  for how seldom do we hear
 of a woman  devoid of humanity ?
   Lastly, attraction, composition, and decompo-
 sition, belong to the passions as well as to matter. 'Vices
                    * A public dispensary, 
120       INFLUENCE of physical causes
of the same species attract each other with the most force:
hence  the bad consequences of crowding  young men,
whose propensities are generally the same,  under one roof,
in our modern plans of education.   The effects of compo-
sition and decomposition upon vices appear,  in the mean-
ness of the school-boy being often cured by the prodigality
of a military life, and by the precipitation of avarice, which
is often produced by ambition and love.
   If physical  causes  influence  morals in the manner we
have described, may they not also influence religious prin-
ciples and opinions ?   I answer in the affirmative ;  and I
have authority, from the records of physic, as well as from
my own observations, 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 diis subject is  foreign to the
business of the present inquiry.
   From a review of our subject, we are led to contemplate,
with admiration, the curious structure  of the  human mind.
How distinct are the number, and yet how united !  How
subordinate, and yet  how  co-equal, are all its faculties!
How wonderful  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 exis-
tence, 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 con-
tains principles of virtue, which have never yet been excit-
ed into action.  We behold with surprise the versatility of
the human body in the exploits of tumblers and rope dan-
cers.  Even the agility of a wild beast has been demonstrat-
ed in a girl of France, and an amphibious nature has been
discovered in the human species in a young man  in Spain.
We listen with astonishment to the accounts  of the memo-
ries of Mithridates, Cyrus, and Servin.  We feel a venera-
tion, bordering upon divine homage, in contemplating the
stupendous understandings of lord Verulam  and  sir Isaac 
UPON THE MORAL FACULTY.           121
 Newton; and our eyes grow dim, in attempting to pursue
 Shakespeare and Milton in in their immeasurable flights of
 imagination.   And if the history of mankind does not fur-
 nish similar instances of the versatility and perfection of our
 species in virtue, it  is because the moral faculty has been
 the subject of less culture and fewer  experiments than the
 body, and the intellectual powers of the mind.  From what
 has  been said, the reason of this is obvious.   Hitherto the
 cultivation  of the  moral faculty has  been the business of
 parents, schoolmasters, and divines.*   But if the princi-
 ples, we have laid down, be just, the improvement and ex-
 tension of this principle should  be equally the business  of
 the  legislator, the natural philosopher, and the physician ;
 and a  physical regimen  should as necessarily accompany a
 moral precept, as  directions with respect to the air, exer-
 cise, and diet, generally accompany prescriptions for the
 consumption, and the gout.   To encourage  us to under-
 take experiments for the improvement of morals, let us re-
 collect the success of philosophy in lessening  the number,
 and mitigating the violence of incurable diseases.  The in-
 termitting 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 medicine has done more.
 It has penetrated into the deep and gloomy abyss of death,
 and acquired fresh honours in his cold embraces. Witness
 the many hundred people who have lately been brought back
 to life by the successful efforts of the humane societies, which
 are now established in many parts of Europe,  and in some
 parts of America.  Should the same industry  and ingenui-
 ty, which have produced these triumphs of medicine over
 diseases and death, be  applied to the moral science, it  is
 highly probable that most of those  baneful vices, which
 deform the  human breast,  and convulse the nations of the
  * The people commonly called Quakers, and the Methodists, make use
 of the greatest number of physical  remedies in their religious and moral
 discipline, of any sects of Christians;  and hence we find them every
 where distinguished for their  good  morals. There are several excellent
physical institutions in other churches;  and if they do not produce the
 same moral effects that we observe from physical institutions among those
 two modern sects, it must be ascribed to  their being more reglected by the
 members of those churches.
     VOL. r.                  O^ 
122       INFLUENCE OF PHYSICAL CAUSES

earth,  might be  banished from the world.   I am not so
sanguine as to suppose, that it is possible for a man to ac-
quire so much perfection from science,  religion, liberty,
and good government, as to cease to be mortal; but I am
fully persuaded,  that from the combined action of 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 phy-
sical causes that have been enumerated, concurred to pro-
duce such attainments in moral excellency, as have  seldom
appeared in a human  being.   This amiable citizen  con-
sidered 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 worshipped 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
commit 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 aits  of civi-
lized life,  being established  among the nations of  Africa,
then remember and record,  that this  revolution  in favour
of human  happiness was the effect of the labours, the pub-
lications, the private letters, and the prayers, of Anthony
Benezet.*

  * 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 himself 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 spirituous  liquors, and one  in favour 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
Aincan trade.  He also wrote an affectionate letter to the king of Prussia,
to dissuade him from making war.  The history of hi* life affords a rt- 
UPON THE MORAL FACULTY.          123
   I return from this digression, to address myself in a par-
ticular manner to you, venerable sages and fellow
citizens in the republic  of  letters.   The influ-
ence 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 Europe,  may be accomplished without
a system of jurisprudence,  by a confederation of learned
men and learned societies.   It is in their power, by multi-
plying the objects of human reason, to bring the monarchs
and rulers of the world under  their subjection,  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 declaration,  from the honour of the Chris-
tian religion.  It is true, Christianity was propagated with-
out the aid of human learning; but this was one of those
miracles, which was  necessary to establish it, and which,
by repetition, would cease to  be a miracle.  They misre-
present the Christian  religion, who suppose it to be wholly
an internal  revelation, and  addressed only to the moral
faculties  of the  mind.  The  truths of Christianity afford
the greatest scope for the  human understanding, and  they
will become 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 involved in obscurity, may be occasion-
ed 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 reli-
gion are  equally the offspring of his goodness.  They must,
markable instance, how  much  it is possible for an individual  to accom-
plish  in the world;  and that the  most humble stations do not preclude
good men from the most extensive usefulness.  He bequeathed his estate
(after the death of his widow) to the support of a school  for the educa-
tion of negro children, which he had  founded and taught for several years
before he died.  He departed this life in May, 1784, in the seventy-first
year of his age, In the meridian of his usefulness, universally lamented by
persons of all ranks and denominations. 
124    INFLUENCE OF PHYSICAL CAUSES, &.C.

therefore,  stand and fall together.   By reason,  in  the pre-
sent instance,  I mean the power of judging of truth,  as
well as the power  of comprehending it.   Happy aera!
when the divine and the philosopher  shall embrace each
other, and unite their labours for the reformation and hap-
piness of mankind!
  Illustrious counsellors andsENATORS of Penn-
sylvania!*  I anticipate your candid reception of  this fee-
ble effort to increase the quantity of virtue in our republic.
It is not my business to  remind  you of the immense re-
sources for greatness, 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 happi-
ness, not the greatness, of  the state.   For this purpose, it
is absolutely 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 con-
science  of an individual.   Nothing 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 suppression of
vice and immorality will be  as ineffectual, 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 education, 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, that were this evening to be  the last
of my life, I would not only say to the asylum of my an-
cestors, 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, u To establish and support pub-
lic schools in every part of the state."
  • The  president and supreme executive council, and the members of
the general assembly of  Pennsylvania, attended the delivery of the ora-
tion, in the hall of the university, by iuvitation from  the Philosophical
Society. 
            AN ACCOUNT





                 OF THE




INFLUENCE OF THE MILITARY AND POLITICAL EVENTS




                 OF THE






      AMERICAN REVOLUTION





                 UPON




          THE HUMAN BODY. 
 
AN  ACCOUNT,  &c.
    THERE were several circumstances peculiar to the
American revolution, which should be mentioned previ-
ously to an account of the influence of the events which
accompanied it upon the human body.
  1. The revolution  interested  every inhabitant of the
country of both sexes, and of every rank and age that was
capable of reflection.  An indifferent, or neutral, spectator
of the controversy was  scarcely to be found in any of the
states.
  2. The scenes of war  and government which it intro-
duced were new to  the greatest part of the inhabitants of
the United States, and operated with all the force of novelty
upon the human mind.
  Q. The controversy was conceived to be the most im-
portant of any that had ever engaged the attention of man-
kind.   It was generally believed,  by the friends of the
revolution, that  the very existence of freedom,  upon our
globe, was involved in the issue of the contest in favour of
the  United States.
  4. The American revolution included in it the cares of
government, as well as the toils and dangers of war.  The
American mind was, therefore, frequently occupied, at the
same time, by the difficult and complicated duties of poli-
tical and military life.
  5. The revolution was conducted by men who had been
bom free, and whose sense of the blessings of liberty was
of course more  exquisite than if they had just  emerged
from a state of slavery.
  6. The greatest part of the soldiers in the armies of the
United States had  family connections and property in the
country. 
128       INFLUENCE OF THE REVOLUTION
   7.  The war was carried on by the Americans against a
nation, to whom they had long been tied by the numerous
obligations  of consanguinity,  laws,  religion, commerce,
language, interest, and a mutual  sense of national  glory.
The resentments of the Americans of course rose, as is
usual in all disputes, in proportion to the number and force
of these ancient bonds of affection and union.
   8.  A predilection to a limited monarchy, as an essential
part of a free  and  safe  government,  and an attachment to
the reigning king of Great Britain (with a very few excep-
tions) were universal in every part of the United States.
   9.  There was at one time a  sudden dissolution of civil
government in all, and of ecclesiastical  establishments in
several, of the states.
   10. The expences of the war were supported by means
of a paper currency, which was continually depreciating.
   From the action of each of these causes, and frequently
from their combination in the same persons, effects  might
reasonably be expected, both  upon  the mind and  body,
which have seldom occurred;  or if they have,  I believe
were never fully recorded in any age or country.
   It might afford some useful instruction, to point out the
influence of the military and political  events of the revolu-
tion upon the  understandings, passions, and morals  of the
citizens of the United States; but my business in the pre-
sent inquiry is only to take notice of the influence of those
events upon the human body, through the  medium of the
mind.
   I shall  first mention the effects of the military, and, se-
condly, of the political events of the revolution.  The last
must be considered in a two-fold view, accordingly as they
affected the friends, or the enemies, of the revolution.
   I. In treating of the  effects of the military events,  I shall
take notice, first, of the influence of actual war, and, se-
condly, of the influence of the  military life.
   In the beginning of a battle, I have observed thirst  to
be a very  common sensation among both officers and sol-
diers.  It occurred where  no  exercise, or action of the
body, could have excited it.
   Many officers have informed  me, that after the first onset
in a battle they felt a glow of heat, so universal as  to  be
perceptible in  both their ears.  This was the case, in  a par- 
              UPON THE HUMAN BODY.            129

ticular manner, in the battle of Princeton, on the  third of
January, in the  year 1777, on which day the weather was
remarkably cold.
   A veteran colonel of a New England regiment, whom I
visited at Princeton, and who was wounded in the hand at
the battle of Monmouth, on the 28th of June, 1778 (a day
in which the mercury stood at 90° of Fahrenheit's ther-
mometer) after  describing his situation at the time he re-
ceived his wound, concluded his story by remarking, " that
fighting was hot work on a cold day, but much more so on
a warm day."  The many instances which appeared after
that memorable battle, of soldiers who were found among
the slain without any marks of wounds or violence upon
their bodies, were probably occasioned by the heat excited
in the body, by the emotions of the mind,  being added to
that of the atmosphere.
   Soldiers bore operations of every kind, immediately
after a  battle, with much more fortitude than they did at
any time afterwards.
   The effects of the military life upon the human body
come next to be considered under this head.
   In another place I have mentioned three cases  of pulmo-
nary consumption  being perfectly cured  by the diet and
hardships of a camp life.
   Doctor Blane, in his valuable observations on  the dis-
eases incident to seamen, ascribes the extraordinary healthi-
ness of the British fleet in the month of April, 1782, to
the effects produced  on the  spirit of the soldiers and sea-
men, by the victory obtained over the French fleet on the
12th of that month; and relates, upon the authority of Mr.
Ives, an instance, in the war between Great Britain and the
combined powers of France and Spain, in  1744, in which
the scurvy, as well as other diseases, were  checked by the
prospect of a naval engagement.
   The American army furnished an instance of  the effects
of victory upon the human mind, which may serve to esta-
blish the inferences from the facts related by Doctor Blane.
The Philadelphia militia who joined the remains of Gene-
ral Washington's army, in December, 1776, and shared
with them a few days afterwards in the capture  of a large
body of Hessians at Trenton, consisted of 1500 men, most
of whom had been accustomed to the habits of  a city life.
   VOL. I.                  R 
 130       INFLUENCE OF THE REVOLUTION

 These men slept in tents and barns, and sometimes in the
 open air, during the usual colds of December and January; f
 and yet there were but two instances of sickness, and only
 one of death,  in that  body of men in the course of nearly
 six weeks,  in those winter months.   This extraordinary
 healthiness of so great a number of men, under such trying
 circumstances, can only be ascribed to  the vigour infused
 into the human body by the victory of Trenton having
 produced insensibility to all  the usual remote  causes of
 diseases.
   Militia officers and soldiers,  who enjoyed  good health
 during a campaign, were often affected by fevers and other
 diseases, as soon as they returned to their respective homes.
 I knew one instance of a militia captain, who was seized
 with convulsions the  first night he lay on a feather bed,
 after sleeping several  months on a mattrass,  or upon the
 ground.   These affections of the body appeared to be pro-
 duced only by the  sudden abstraction of that tone in the
 system, which was excited by a sense of danger, and the
 other invigorating objects of a military life.
   The nostalgia of Doctor Cullen, or the home-sickness,
 was a frequent disease in the American army, more espe-
 cially among the soldiers of the New England states.  But
 this disease was suspended by the superior action of the
 mind, under the influence of the principles which governed
 common soldiers in the American  army.   Of this Gene-
 ral Gates furnished me with a remarkable instance in 1776,
 soon after his return from the command of a large body of
 regular troops and militia at Ticonderoga. From the effects
 of the nostalgia, and the feebleness of the discipline which
 was exercised over the militia,  dissertions were  very fre-
 quent and numerous  in his army,  in the latter part of the
 campaign; and  yet during the  three weeks in which the
 general expected every hour an attack to be made upon him
by General Burgoyne, there was not a single desertion from
 his army, which consisted at that time of 10,000 men.
   The patience, firmness and magnanimity, with which the
 officers  and soldiers of the American  army endured the
 complicated evils of hunger, cold and nakedness,  can only
be ascribed to an insensibility of body produced by an un-
 common tone of mind, excited by the love of liberty and
their country. 
               UPON THE HUMAN BODY.           131

  Before  I proceed to the second general division of this
subject, I shall take notice, that more instances of apoplex-
ies  occurred  in the city of Philadelphia,  in the winter of
1774-5, than had been known  in former years.  I should
have hesitated in recording this fact, had I not found the
observation supported by a fact of the same kind, and pro-
duced  by a nearly similar cause,  in the appendix to the
practical works of Doctor Baglivi, professor of physic and
anatomy at Rome.  After a very wet season in the winter
of 1694-5, he informs us, that " apoplexies displayed their
rage; and perhaps (adds our author) some part of this epi-
demic illness was owing to the universal grief and domestic
care, occasioned by all Europe being engaged in a war.
All commerce was disturbed, and all the avenues of peace
blocked up, so that the strongest heart could scarcely bear
the thoughts of it."  The winter of 1774-5 was a period of
uncommon anxiety among the citizens of America. Every
countenance wore the marks of painful  solicitude for the
event of a petition to the throne of Britain, which was to
determine whether reconciliation, or a civil war,  with all
its terrible and distressing consequences, were to take place.
The apoplectic fit, which deprived the world of the talents
and virtues of  Peyton Randolph,  while he filled the chair
of congress, in  1775, appeared to be occasioned in  part by
the pressure of the uncertainty  of those great events  upon
his mind.  To the name of this illustrious patriot, several
others might be  added, who were affected by the apoplexy
in the same memorable year.   At this time a difference of
opinion upon the subject of the contest with Great Britain
had scarcely taken place among the citizens of America.
  II. The political events of the revolution produced dif-
ferent effects upon the  human body, through the medium
of the  mind, according  as they acted  upon the friends or
enemies of the revolution.
  I shall first describe  its effects upon  the former class of
citizens of the United States.
  Man)r persons, of infirm and delicate habits, were restor-
ed to perfect health, by the change of place, or occupation,
to which the  war exposed  them.  This  was the case in a
more especial manner  with hysterical  women, who were
much interested in the successful issue  of the contest. The
same effects of a civil war upon the hysteria, were  observ- 
132        INFLUENCE OF  THE  KEVOLUTiUW

ed by Doctor Cullen in Scotland,  in the years 1745 and
1746.   It may perhaps help to extend our ideas of the in,
fluence of the passions  upon  diseases,  to add, that when
either love, jealousy,  grief,  or even devotion, wholly en-
gross the female mind, they seldom fail, in like manner, to
cure or to suspend hysterical complaints.
  An  uncommon  cheerfulness  prevailed every  where,
among the friends of the revolution.  Defeats, and even the
loss of relations and property, were soon forgotten in the
great objects of the war.
  The  population  in  the  United States was more rapid
from births during the war, than it had ever been in the
same number of years since the settlement of the country.
  I am disposed to ascribe this  increase of births  chiefly
to the quantity and extensive circulation of  money,  and
to the facility of procuring  the means of subsistence dur-
ing the war, which favoured marriages among the labour-
ing part of the people.*  But I have sufficient documents
to prove, that marriages were  more  fruitful than in former
years, and  that a considerable number of unfruitful mar-
riages became fruitful during  the war.   In  1783, the year
of the peace,  there were several  children born of parents
who had lived many years together  without issue.
  Mr Hume informs us, in his  History of England,  that
some old people, upOn hearing the news of the restoration
of Charles II. died  suddenly of joy.   There was a time
when I doubted the truth of this assertion ; but I am now
disposed  to  believe it, from having  heard of a  similar
effect from an agreeable political event, in the course of
the American revolution.   The  door-keeper of congress,
an aged man, died suddenly,  immediately after hearing of
the capture of lord Cornwallis's army.   His death  was
universally ascribed to  a violent  emotion of political joy.
This species of joy appears  to  be one of the  strongest
emotions that can agitate the human mind.
  Perhaps the  influence of that ardour in trade and spe-
culation, which seized many of the  friends of the  revolu-

  • Wheat, which was sold before the war for seven shilling and six pence,
was sold for several years during the  war for  four, and in some places for
two and sixpence Pennsylvania currency per bushel.  Beggars of every de-
scription disappeared in the year 1776, and were seldom seen till near the
close of the war. 
UPON THE HUMAN BODY.            135
tion, and  which was  excited by the fallacious nominal
amount of the paper money, should rather be considered
as a disease, than as a passion. It unhinged the judgment,
deposed the moral faculty, and  filled the imagination, in
many people,  with airy and impracticable schemes of
wealth and grandeur.  Desultory manners, and a peculiar
species of extempore  conduct, were among its character-
istic symptoms. It produced insensibility to cold, hunger,
and danger.   The trading towns, and in some instances
the extremities of the United States, were frequently visit-
ed in a few hours  or days by persons affected by  this
disease; and hence " to travel with the speed of a specu-
lator," became a common saying in many  parts  of the
country.  This species of insanity (if I may be allowed
to call it by that name) did not require the confinement of
a bedlam  to cure it, like the South-Sea madness described
by Doctor Mead.   Its remedies were the depreciation of
the paper money, and the events of the peace.
   The political events of the revolution produced upon
its enemies  very different effects from those which haye
been mentioned.
   The  hypochondriasis  of Doctor Cullen occurred, in
many instances, in persons of this description.  In some
of them, the terror and distress  of the revolution brought
on a true melancholia.*   The  causes  which produced
these diseases may be reduced to four heads.  1.  T*he
loss of former power or influence in government.  2.  The
destruction  of the  hierarchy of  the English  church in
America. 3. The change in the habits of diet, and com-
pany, and manners, produced by the annihilation of just
debts by means of depreciated paper money.  And 4.  The
neglect, insults, and oppression, to which the loyalists were
exposed, from individuals, and, in several instances, from
the laws of some of the states.
   It was observed in  South Carolina, that several gentle*
men, who had protected their estates by swearing allegi-
ance to the British  government, died soon after the  eva-
cuation of Charleston, by the British army. Their  deaths
were ascribed to the neglect with which they were treated
by their ancient friends, who had adhered to the govern-
        * Insania partialis sine dyspepsia, of Doctor Cullen. 
134     INFLUENCE OF THE REVOLUTION, &C.

ment of the United States.   The disease was called, by
the common people, the protection fever.
   From the causes which produced this hypochondriasis,
I have taken the liberty of distinguishing it by the name
of revolutiana.
   In some cases, this disease was rendered fatal by exile
and confinement; and, in  others, by those persons who
were afflicted with it seeking relief from spirituous liquors,
   The  termination of the war by the peace in 1783 did
not terminate the  American  revolution.   The minds of
the citizens of the United States were wholly unprepared
for their new situation.  The excess of the passion  for
liberty,  inflamed by the successful issue of the war, pro-
duced, in many people, opinions and conduct, which could
not be removed by reason nor restrained  by government.
For a while, they threatened to render abortive the good-
ness of Heaven to the United States, in delivering them
from the evils of slavery and war.   The extensive influ-
ence which these opinions had upon the  understandings,
passions, and morals of many of the citizens of the Uni-
ted States, constituted a form of insanity, which  I shall
take the liberty of distinguishing by the name of anarchia.
   I hope no offence will be given by the freedom of  any
of these remarks.   An  inquirer after  philosophical truth
should consider  the passions of men in the  same light
that he  does the laws of matter or motion.  The  friends
and enemies of the American revolution  must  have been
more, or less, than men, if they could have sustained the
magnitude and rapidity of the events that characterised
it, without discovering some  marks of human weakness,
both in body and mind.  Perhaps these  weaknesses were
permitted, that human nature might receive fresh honours
in America, by the contending parties (whether produced
by the controversies about independence or the national
government) mutually  forgiving each  other, and uniting
in plans of general order, and happiness. 
           AN INQUIRY





                INTO





THE RELATION OF TASTES AND ALIMENTS






           TO EACH OTHER,





               AND INTO






  THE INFLUENCE OF THIS RELATION





               UPON





       HEALTH AND PLEASURE. 
* 
AN  INQUIRY, &c
     IN entering upon this subject,  I feel like the clown,
who, after  several unsuccessful  attempts to play  upon a *
violin, threw it hastily from him, exclaiming at the same
time, that  " there was  music in it," but  he could not
bring it out.
  I shall endeavour,  by a few  brief remarks, to lay a
foundation for more successful inquiries upon this diffi-
cult subject.
  Attraction and repulsion seem to be the active princi-
ples of the universe.  They pervade not only the greatest,
but the minutest, works of nature.  Salts, earths, inflam-
mable bodies, metals, and vegetables, have all their re-
spective relations to each other.  The order of these
relations is so uniform,  that it has been ascribed by some
philosophers to a latent principle of intelligence pervading
each of them.
   Colours,  odours,  and sounds, have likewise  their re-
spective relations to each other.  They become agreeable
and disagreeable, only in proportion to the  natural or un-
natural  combination which takes  place between each of
their different species.
   It is remarkable, that the number of original colours and
notes in music  is exacUy the same.   All the variety in
both proceeds  from the difference of combination.   An
arbitrary combination of them is by no means productive
of  pleasure.  The relation which every colour and sound
bear to each other, was as immutably established at the
creation, as the order of the heavenly bodies, or as the re-
lation of the objects of chemistry to each other.
   But this  relation is not confined  to colours and sounds
alone.   It probably extends  to the objects of human ali«
    VOL. I.                 S 
138       THE RELATION OF TASTES AND

ment.   For example, bread and meat, meat and salt, the
alkalescent meats and acescent vegetables, all harmonize
with each other upon the tongue; while fish and flesh, butter
and raw onions, fish and milk, when combined, are all
offensive to a pure and healthy taste.
   It would be agreeable to trace the  analogy of  sounds
and tasks.  They have both their flats and  their sharps.
They  are  both improved by the contrast of discords.
Thus pepper, and other condiments (which are disagreea-
ble when taken by themselves) enhance the relish of many
of our aliments, and they are both delightful in proportion
as they are simple in their composition.  To illustrate this
analogy by more  examples from  music  would lead us
from the subject of the present inquiry.
   It is observable that the tongue and the stomach,  like
instinct and reason,  are,  by nature,  in unison with each
other.   One of those organs  must always be disordered,
when they disagree in a single article of aliment.  When
they both unite in articles of diet that were originally dis-
agreeable,  it is owing to a perversion in each of them,
similar to  that which  takes place in the human mind,
when both the  moral faculty and the conscience lose their
natural sensibility to virtue and vice.
   Unfortunately for this part of science, the taste  and the
stomach are so much perverted in infancy and childhood
by heterogenous aliment,  that it is difficult to tell what
kinds and  mixtures of food are natural, and what are  arti-
ficial.   It is true, the system possesses a power of accom-
modating itself both to artificial food, and to the most dis-
cordant mixtures of that which is natural; but may not wc
reasonably suppose,  that the  system  would preserve its
natural strength and order much longer,  if no such  vio-
lence had been offered to it ?
   If the relation of aliments to each other follows the
analogy of the objects of chemistry, then their union will
be influenced by many external  circumstances,  such as
heat and cold,  dilution, concentration, rest, motion,  and
the addition of substances which promote unnatural, or
destroy natural mixtures.  This idea enlarges the field of
inquiry before us,  and leads us still further from facts and
•certainty upon this subject, but at the same time it does 
ALIMENTS TO EACH OTHER.
139
not preclude us from  the hope of obtaining both;  for
every difficulty that arises out of this  view of the subject
may be removed by observation and experiment.
   I come now to apply these remarks to health and plea-
sure.  I shall select only a few cases for this purpose;
for if my principles be true, my readers cannot avoid dis-
covering many other illustrations of them.
   1.  When an article of diet is grateful to the taste, and
afterwards disagrees with  the stomach, may it not be oc-
casioned by some other kind of food, or by some drink
being taken into the stomach, which refuses to unite with
the offending article of diet ?
   1.  May not the uneasiness which  many  persons feel,
after a moderate meal, arise  from its  having consisted of
articles of aliment which were not related to each other ?
   3.  May not the delicacy of stomach which sometimes
occurs  after the fortieth or forty-fifth year of human life
be occasioned  by nature recovering  her empire in  the
stomach, so as to require simplicity in diet, or such arti-
cles only of aliment as are related ?   May not this be the
reason why most  people,  who have passed those periods
of life, are unable  to retain or to digest fish and flesh at
the same time, and why they generally dine only upon one
kind of food ?
   4.  Is not the language of nature in  favour of simplicity
in diet discovered,  by the avidity with which the luxuri-
ous and  intemperate often seek relief  from variety and
satiety,  by retreating to spring water for drink,  and to
bread and milk for aliment ?
   5.  May not  the reason why plentiful meals  of  fish,
venison, oysters, beef, or mutton, when eaten alone, lie so
easily in the stomach, and digest so speedily, be occasion-
ed by no other food being taken  with them ?  A pound,
and even more,  of the above articles, frequently oppress
the system much less than half the quantity of heteroge-
neous aliments.
   6.  Does not the facility with which  a due mixture of
vegetable and animal food digests in the stomach indicate
the certainty of their relation to each other?
   7.  May not the peculiar good effects of a diet  wholly
vegetable, or animal, be occasioned by the more frequent 
140        THE RELATION OF TASTES AND
and intimate relation of the articles of the same kingdom*
to each other ? And may not this be the reason why so
few inconveniences are felt from the mixture of a variety
of vegetables in the stomach ?
   8. May not the numerous acute and chronic diseases of
the rich and luxurious arise from heterogeneous aliments
being  distributed  in a diffused, instead of a mixed state,
through every part of the body.
   9. May not the many cures which are ascribed to cer-
tain articles of diet be occasioned more by their being
taken alone, than to any medicinal quality inherent in them?
A diet of oysers  in one  instance, of strawberries in ano-
ther, and of sugar of roses, in many instances, has cured
violent and dangerous diseases of the breast.*  Grapes,
according to Doctor Moore, when eaten in large quanti-
ties, have produced the same salutary effect. A milk diet,
persisted  in for .several years, has cured the gout and
epilepsy.  I have seen many cases of dyspepsia cured by
a simple diet of beef and mutton, and have  heard of a
well-attested case of a diet of veal alone having removed
the same disease.  Squashes, and  turnips likewise, when
taken by themselves, have cured that distressing complaint
in the stomach. It has been removed even by milk, when
taken by itself in a moderate quantity.f  The further the
body, and more especially the stomach, recede from health,
the more this simplicity  of diet becomes necessary.  The
appetite in these cases does not speak the language of tin-
corrupted nature.  It frequently calls for various and im.
proper aliment;  but this is the effect of intemperance
having produced an early breach between^the taste and the
stomach.
   Perhaps the extraordinary cures  of obstinate diseases,
which  are sometimes performed by persons not regularly
educated in physic, may be occasioned by a long and steady-
perseverance in the use. of a single article, of the materia
medica.   Those  chemical medicines which  decompose
each other, are  not the only  substances which  defeat the
intention  of the  prescriber.  Galenical medicines,  by-
combination, I believe, frequently produce effects that are
  * Vansweiten, 1209. S.
  t Medical Observations and Inquiries, vol. vi. p. 310, 319. 
            ALIMENTS TO EACH OTHER.          141

of a compound and contrary nature to their original and
simple qualities.   This remark is capable of extensive           >;
application, but I quit it as a digression from the subject           !|
of this inquiry.
   10.  I wish it to be observed, that  I  have condemned
the mixture of different  aliments in the stomach only in a
few cases, and under certain circumstances.  It remains
yet to determine by experiments,  what changes are pro-           £
duced  upon aliments by heat, dilution, addition, concen-
tration, motion, rest, and the addition of uniting substan-
ces, before we can decide upon the relation of aliments to
each other^ and the influence of that relation upon health.
The olla podrida of Spain is said to be a pleasant and
wholesome dish.   It  is probably rendered so,  by a pre-
vious tendency of all its ingredients to putrefaction,  or by
means of heat producing a new arrangement, or additional
new relations of all its parts.   I suspect heat to be a pow-
erful agent in disposing heterogeneous  aliments to unite
with each other;  and hence  the  mixture  of aliments is
probably less unhealthy in France and Spain, than in Eng-
land, where so much less fire is used in  preparing them,
than in the former countries.
   As too great a mixture  of glaring colours,  which are
related to each other, becomes painful to the eye, so too
great a mixture of related aliments oppresses the stomach,
and debilitates the powers of the system. The original co-
lours of the sky, and of the surface of the globe, have ever
been  found the  most permanently agreeable  to the eye.
In like manner,  1 am disposed to believe  that there are
certain simple aliments which correspond, in their sensible
qualities, with the intermediate colours of blue and green,
that are  most permanently agreeable to the tongue and
stomach,  and that every deviation from them is a depar-
ture from the simplicity of health  and nature.
   11.  While nature seems to have limited us to simpli-
city in aliment, is not this restriction abundantly compen-
sated by the variety of  tastes which she allows us to im-
part to it, in order to diversify and increase the  pleasure
of eating ? It is remarkable that salt, sugar, mustard,  horse-
radish, capers, and spices of all kinds, according to Mr. 
142        THE RELATION OF TASTES AND
 Gosse's experiments,  related by Abbe Spallanzani,* all
 contribute not only to render aliments savoury, but to pro-
 mote their digestion.
   12. When we consider, that part of the art of cookery
 consists in rendering the taste of aliments agreeable, is it
 not probable that the pleasure of eating might be increased
 beyond our present knowledge upon that subject; bycer-
 tain new arrangements or mixtures of the subsances which
 are used, to impart a pleasant taste to our aliment ?
   13. Should philosophers ever stoop to this subject, may
 they not discover and ascertain  a table of the relations of
 sapid bodies to each otht r, with the accuracy that  they
 have ascertained  the relation of  the  numerous objects of
 chemistry to each other?
   14. When the tongue and stomach agree in the same
 kinds of aliment, may not the increase of  the pleasure of
 eating be accompanied with an increase of health and pro-
 longation of life ?
   15. Upon the pleasure of eating,  I shall add the follow-
 ing remarks.   In order to render it  truly exquisite,  it is
 necessary that all the senses, except that of taste, should
 be as quiescent as possible.  Those  persons mistake  the
 nature of the appetite for food, who attempt to whet it by
 accompanying a  dinner by  a band of music,  or by con-
 necting the dining table with an  extensive and  delightful
 prospect.  The undue excitement of one sense always pro-
 duces weakness in another.  Even conversation sometimes
 detracts from  the pleasure of eating  ; hence great feeders
 love to eat in silence,  or alone ;  and hence the  speech of
 a passionate Frenchman, while dining in a talkative com-
 pany, was not so improper as might be at first imagined.
 " Hold your tongues (said  he) I cannot taste m\ dinner."
 I know a physician, who, upon the same principle, always
 shuts his eyes, and requests silence in a sick  chamber,
 when he wishes to determine by the pulse  the propriety
of blood-letting, in cases where its indication is doubtful.
His perceptions become more distinct, by  confining  his
whole attention to the sense of feeling.
  It is  impossible to mention  the  circumstance of the
senses acting only in succession  to each other in the en-
                 * Dissertations, vol. i. p. 326. 
ALIMENTS TO EACH OTHER.
143
joyment of pleasure, without being struck with the im-
partial goodness of Heaven, in placing  the rich and the
poor so much upon a level in the pleasures of the table.
Could the numerous objects of pleasure, which are ad-
dressed to the ears and the eyes, have been possessed at
the same time with the pleasure of eating, the  rich would
have  commanded three times as much pleasure  in that
enjoyment as the poor;  but this is so far from being the
case,  that a king has no advantage over a beggar,  in eat-
ing the same kind of aliment. 
 
     4  THE RESULT OF OBSERVATIONS

                    MADE

          UPON THE  DISEASES

                WHICH OCCURRED

        IN THE MILITARY HOSPITALS

            OF THE UNITED STATES,
DURING THE REVOLUTIONARY WAR BETWEEN GREAT BRITAIN
             AND THE UNITED STATES.
VOL. I. 
 
RESULT OF OBSERVATIONS, &c.
    1. THE army, when in tents, was always more sick-
ky than in the open air.  It was likewise more healthy when
it was kept in motion, than when it lay in an encampment.
  2. Young men under twenty years  of  age were subject
to the greatest number of camp diseases.
  3. The southern troops were more  sickly than the nor-
thern or eastern troops.
  4. The native Americans were more sickly than the na-
tives of Europe who served in the American army.
  5. Men  above thirty and  five and thirty years  of age
were the hardiest soldiers  in  the army.   Perhaps the rea-
son why the natives of Europe were more healthy than the
native Americans was, they were more advanced in life.
  6. The southern troops sickened from the want of salt
provisions.  Their strength and spirits were restored only
by means of salted meat.  I once saw a  private in a Vir-
ginia regiment throw away his ration  of choice fresh beef,
and give a dollar for a pound of salted bacon.
  7. Those officers who wore flannel shirts or waistcoats
next to their skins, in general, escaped fevers and diseases
of all kinds.
  8. The principal diseases in the hospitals were the typhus
gravior and mitior of Doctor Cullen.  Men who came into
the hospitals with pleurisies  or rheumatisms soon lost the
types of  their original diseases,  and suffered, or died, by
the abovementioned states of fever.
  9. The typhus mitior  always prevailed most, and with,
the worst symptoms, in winter.   A free  air, which could
only be obtained in summer,  always  prevented, or miti-
gated it. 
 148          OBSERVATIONS UPON THE

   10.  In all those cases, where the contagion was recciv-
 ed, cold seldom failed to render it active.  Whenever an
 hospital  was removed  in winter,  one half of the patients
 generally sickened on the way, or soon after their arrival
 at the place to which they were sent.
   11.  Drunken soldiers and convalescents were most sub-
ject to this fever.
   12.  Those patients in this fever, who had large ulcers
 on their backs or limbs, generally recovered.
   13.  1  met with several instances of buboes, also of ul-
 cers in the throat, as described by Doctor Donald Monro.
 They were mistaken by some of the junior surgeons for
 venereal sores,  but they yielded to the common remedies
 of the hospital fever.
   14.  There were many instances of patients in this fever,
 who suddenly fell down dead,  upon being moved, without
 any previous symptoms of approaching dissolution.  This
was more especially the case, when they arose to go to
stool.
   15. The contagion of this fever was frequently convey-
ed  from the hospital to the camp, by means of blankets
 and clothes.
   16. Those  black  soldiers  who  had been  previously
slaves died in  a greater proportion by this fever, or had a
 much  slower recovery from it, than the same number of
white soldiers.
   17. The remedies which appeared to do most service
in this disease were vomits of tartar emetic, gende dozes
of laxative salts, bark,  wine, volatile salts, opium, and
blisters.
   18 An emetic seldom failed of checking this fever, if
exhibited while it was in a forming state, and before the
patient was confined to his bed.
   19. Many causes  concurred to produce, and increase
this fever; such as the want of cleanliness, excessive fa-
tigue, the ignorance  or negligence of officers in providing
suitable diet and accommodations for their men, the  ge-
neral use of linen instead of woollen clothes in the sum-
mer months, and the crowding too many patients together
in one  hospital,  with  such  other  inconveniences and
abuses,  as usually follow the union of the purveying and 
DISEASES OF MILITARY  HOSPITALS*.
149
directing departments of hospitals in the same persons.
But there is one more cause of this fever which remains
to be mentioned, and that is, the sudden assembling of a
great number of persons together of different habits and
manners, such as the soldiers of the American army were
in the years 1776 and 1777.  Doctor Blane informs us,
in his observations upon the diseases of seamen, " that it
sometimes happens that a ship with a long established crew
shall  be very healthy, yet if strangers  are introduced
among them, who are also healthy, sickness will be mu-
tually produced." The history of diseases furnishes many
proofs of the truth of this assertion.*   It is very remarka-
ble,  that while the American army at Cambridge, in the
year  1775,  consisted only of New Englandmen  (whose
habits and manners were the-same) there was scarcely any
sickness among them.  It was  not till the troops of the
eastern, middle, and southern states met at New York
and Ticonderoga, in the year 1776, that the typhus became
universal, and spread with such peculiar mortality in the
armies of the United States.
   20. The dysentery prevailed, in the summer of 1777, in
the military hospitals of New Jersey, but with very few
instances of mortality.  This dysentery was  frequently
followed by an obstinate diarrhoea,  in  which the warm
bath was found in many cases to be an effectual remedy.
   21. I saw several instances of fevers occasioned by the
use of the common ointment made of the flour of sulphur
and hog's lard, for the cure of  the itch.   The fevers were
probably brought on by the exposure of the body to the
cold air, in the usual method in which that ointment is ap-
plied.  I have since learned,  that the itch may be cured
as speedily  by rubbing the parts affected,  two or three
times, with the dry flour of sulphur, and that no inconve-
nience, and scarcely any smell, follow this mode of using it.
   22. In gun-shot  wounds of  the joints, Mr. Ranby's
advice of amputating the limb  was followed with success.
I saw two cases of death where this advice was neglected.
   • " Cleanliness is founded on a natural aversion to what is unseemly and
offensive in the persons of others: and there seems also to be an instinc-
tive honor at strangers implanted in human nature for the same purpose,
as is visible in  young children, and uncultivated people.  In  the early
ages of Home,  the same  word signified both a stranger and an enemy."
Dr. Blane, p. 225.                                      ' 
150
OBSERVATIONS UPON THE, &C.
   23. There was  one instance of a soldier who lost his
hearing, and another of a soldier who had been deaf who
recovered his hearing, by the noise of artillery in battle.
   24. Those soldiers who were billetted in private houses
generally escaped the hospital fever, and recovered soonest
from all their diseases.
   25.  Hospitals built of coarse logs, with  ground floors,
with fire-places in  the middle of them, and a hole in the
roof,  for the discharge of smoke, were found to be very
conducive to the recovery of the soldiers from the hos-
pital  fever.  This form of a military hospital was  intro-
duced into the army by Dr. Tilton, of the state of Dela-
ware *
   26. In fevers and dysenteries, those  soldiers recovered
most certainly, and most speedily, who lay at the greatest
distance from the walls of the hospitals.  This important
fact was communicated to me by the late Dr. Beardsley,
of Connecticut.
   27.  Soldiers are but little more than adult children.
That officer, therefore, will  best perform his duty to  his
men, who obliges them to take the most care  of their
HEALTH.
   28. Hospitals are the sinks of human life  in an army.
They robbed the United States of more citizens than the
sword.  Humanity, economy, and phylosophy, all concur
in giving a preference to the conveniences and wholesome
air of private houses; and should war continue to be the
absurd and unchristian mode of deciding national disputes,
it is to be hoped that the progress of science will  so far
mitigate one of its greatest  calamities,  as to  produce an
abolition of  hospitals for acute diseases.   Perhaps  there
are no cases of sickness, in which  reason and  religion do
not forbid the  seclusion of our fellow creatures  from the
offices of humanity in private families, except  where they
labour under the  calamities of madness and  the  venereal
disease, or where they are the subjects of some of the ope-
rations of surgery.
  • " It is proved, in innumerable instances, that sick men recover health
sooner and better in sheds, huts, and barns, exposed occasionally to wind,
and sometimes to rain, than in the most superb hospitals in Europe."
Jackson's Remarks on the Constitution of the Medical Department of tbe
British Army, p. 340. 
AN INQUIRY
INTO THE
EFFECTS OF ARDENT SPIRITS
UPON THE
HUMAN BODY AND MIND.
WITH
AN ACCOUNT OF THE MEANS OF PREVENTING,
AND OF
THE REMEDIES FOR CURING- THEM. 
 
AN INQUIRY,  &c.
    BY ardent spirits, I mean those liquors only which
are obtained by distillation from fermented substances of
any kind.  To their effects upon the  bodies and minds of
men,  the following inquiry shall be exclusively confined.
Fermented liquors contain so little spirit,  and that so inti-
mately combined with other matters,  that they can seldom
be drunken in sufficient quantities to produce intoxication,
and its subsequent effects, without exciting a disrelish to
their taste, or pain,  from their  distending the stomach.
They are moreover, when taken in  a moderate quantity,
generally innocent, and often have a friendly influence upon
health and life.
  The effects of ardent spirits divide themselves into such
as are of a prompt, and  such as are of a chronic nature.
The former discover themselves in drunkenness, and the
latter, in a numerous train of diseases  and vices of the body
and mind.
  I. I  shall begin by briefly describing their prompt, or
immediate effects, in a fit of drunkenness.
  This odious disease (for by that name it should be call-
ed) appears with more or less of the following symptoms,
and most commonly in the order in which I shall enume-
rate them.
   1. Unusual garrulity.
  2. Unusual silence.
  3. Captiousness, and a disposition to quarrel.
  4. Uncommon good humour, and an insipid simpering,
or laugh.
  5. Profane swearing, and cursing.
  6. A disclosure of their own, or other people's secrets.
   VOL. I.                 u 
154             ON THE EFFECTS  Oif

   7. A rude disposition to tell those persons in company,
whom they know, their faults.
   8. Certain immodest actions.   I am sorry to say, this
sign of the first stage of drunkenness sometimes appears
in women, who, when sober, are uniformly remarkable
for chaste and decent manners.
   9. A clipping of words.
   10. Fighting; a black eye, or a swelled nose, often mark
this grade of drunkenness.
   11. Certain extravagant acts, which  indicate a tempo-
rary fit of madness. These are singing, hallooing, roaring,
imitating the noises of brute animals, jumping, tearing off
clothes, dancing naked, breaking glasses and  china, and
dashing  other articles of household furniture upon the
ground, or floor.  After a while the paroxysm of drunken-
ness is  completely formed.   The  face now becomes
flushed;  the  eyes project, and  are somewhat watery;
winking  is less frequent than  is natural; the under lip is
protruded ;  the head inclines a little to one shoulder; the
jaw falls;  belchings  and hiccup take  place;  the  limbs
totter; the whole body staggers.  .The unfortunate sub-
ject of this history next falls on his seat; he looks around
him with a vacant countenance, and mutters inarticulate
sounds to himself.  He attempts to rise and walk;  in this
attempt,  he fails upon his side, from which he gradually
turns upon  his back.  He now closes  his eyes, and falls
into a profound sleep, frequently attended with snoring,
and profuse sweats, and sometimes with such a relaxation
of the  muscles which  confine the bladder and  the  lower
bowels, as to produce a symptom which delicacy forbids
me to mention.  In this condition, he often  lies from ten,
twelve, and twenty-four hours, to two, three, four, and five
days, an  object of pity  and  disgust  to  his family and
friends.  His recovery from  this fit  of intoxication  is
marked with several peculiar appearances.   He opens his
eyes, and closes them again;  he  gapes, and stretches his
limbs ;  he then  coughs and pukes;  his voice  is hoarse;
he rises with difficulty, and staggers to a chair; his eyes
resemble balls of fire ;  his hands tremble ; he loathes the
sight of  food ; he calls for a  glass of  spirits to compose
his stomach; now and then he emits a deep-fetched sigh, 
ARDENT SPIRITS.               155
or groan, from a transient twinge  of conscience, but he
more frequently scolds, and curses every thing around him.
  In this state of langour and stupidity he remains for two
or three days, before he is able to resume his former habits
of business and conversation.
  Pythagoras we are told maintained that the souls of men,
after death, expiated the crimes committed by them in this
world,  by animating certain brute  animals;  and that the
souls of those animals, in their turns, entered into men, and
carried With them all their peculiar qualities and vices. This
doctrine of one of the wisest and best of the Greek philoso-
phers, was probably intended only to convey a lively idea of
the changes which are induced in the body and mind of man
by a fit of drunkenness. In folly, it causes him to resenible
a calf;  in stupidity, an ass; in roaring, a mad bull; in quar-
relling,  and fighting, a dog; in cruelty, a tiger; in fetor, a
skunk;  in filthiness, a hog; and in obscenity, a he-goat.
  It belongs to the history of drunkenness to remark, that
its paroxysms occur, like the paroxysms of many diseases,
at certain periods,  and after longer  or shorter intervals.
They often begin with annual,  and gradually increase in
their frequency, until they appear  in  quarterly, monthly,
weekly, and quotidian or daily periods. Finally, they afford
scarcely any marks of remission, either during  the day or
the night. There was a citizen of Philadelphia, many years
ago, in  whom drunkenness  appeared in this  protracted
form. In speaking of him to one of his neighbours, I said,
" does he not sometimes get drunk ?"  " You mean," said
his  neighbour, " is he not sometimes sober?"
  It is further remarkable, that drunkenness resembles cer-
tain hereditary,  family, and contagious diseases.   I have
once known it to descend from a father to four out of five
of his children.  I have seen three, and once four brothers,
who were born of  sober ancestors, affected  by it, and I
have heard of its spreading dirough a whole family com-
posed of members  not  originally  related to each other.
These  facts are important, and  should not be overlooked
by parents, in  deciding upon the matrimonial connections
of their children.
  Let us next attend to the chronic effects of ardent spirits
upon the body and  mind.   In the  body, they dispose to
every form of  acute disease; they moreover  excite fevers 
156             ON THE EFFECTS OF
in persons predisposed to them, from other causes. This
has been  remarked in all  the  yellow fevers which have
visited the cities of the  United States.  Hard drinkers
seldom escape, and rarely recover from them.  The fol-
lowing diseases are the usual consequences of the habitual
use of ardent spirits, viz.
   1.  A decay of appetite, sickness at stomach, and a puk-
ing of bile, or a discharge of a frothy and viscid phlegm by
Hawking, in the morning.
   2.  Obstructions of the liver.   The fable of Prometheus,
on whose liver a vulture was said to prey constantly,  as a
punishment for his stealing fire from heaven, was intended
to illustrate the painful effects of ardent spirits upon that
organ of the body.
   3.  Jaundice and dropsy of  the  belly and  limbs,  and
finally of every cavity in the body. A swelling in the  feet
and legs is so characteristic a mark of habits of intempe-
ranee, that the merchants in Charleston, I have been told,
cease to trust the planters of South Carolina, as soon as
they perceive it.  They very naturally conclude industry
and virtue to be extinct in that  man, in whom that symp.
torn  of  disease has been produced by the intemperate use
of distilled spirits.
   4.  Hoarseness, and a husky cough, which often termi-
nate  in consumption,  and sometimes in an acute and fatal
disease of the lungs.
   5. Diabetes, that is, a frequent and weakening discharge
of pale, or sweetish urine.
   6.  Redness and eruptions on different parts of the body.
They generally begin on the nose, and after gradually  ex-
tending all over the face, sometimes descend to the limbs
in the form  of leprosy.   They have  been called  "rum-
buds,"  when  they appear in the  face.  In persons who
have  occasionally survived  these effects of ardent spirits
on the skin, the  face after  a while becomes bloated,  and
its redness is succeeded by a death-like paleness.   Thus
the same fire which produces a red colour in iron, when
urged to a more intense degree, produces what has been
called a white heat.
   7.  A fetid breath, composed of every thing that is of»
fensive in putrid animal matter. 
ARDENT SPIRITS.               157
  8. Frequent and disgusting belchings.  Dr. Haller re«
lates the case of a notorious drunkard having been sudden-
ly destroyed, in consequence of a vapour discharged from
his stomach by belching accidentally taking fire, by coming
in contact with the flame of a candle.
  9. Epilepsy.
  10. Gout, in all its various forms of  swelled  limbs,
colic, palsy, and apoplexy.
  Lastly, 11. Madness.  The late Dr. Waters, while he
acted as house pupil and apothecary of the Pennsylvania
hospital, assured me, that in one third of the patients con-
fined by this terrible disease it had been induced by ardent
spirits.
  Most of the diseases which have been enumerated  are
of a mortal nature.  They are more certainly induced, and
terminate more speedily in death, when spirits are taken
in such quantities, and at such times,  as to produce fre-
quent intoxication:  but it  may serve to remove an error
with which  some intemperate people console themselves,
to remark, that ardent spirits  often bring on fatal diseases
without producing drunkenness.  I have known many
persons destroyed by them, who were never completely in-
toxicated  during the whole course of their lives.  The
solitary instances of longevity which are  now and then
met with  in hard drinkers,  no more disprove the  deadly
effects of ardent spirits, than the solitary instances of reco-
veries from  apparent death  by drowning, prove that there
is no danger to life from a human body lying an hour or
two under water.
  The  body after  its death, from the use of distilled
spirits,  exhibits by dissection certain appearances  which
are  of a  peculiar nature.   The fibres of  the  stomach
and  bowels  are contracted; abscesses,  gangrene, and
schiri,  are  found in the viscera;  the  bronchial vessels
are contracted;  the blood-vessels  and tendons, in many
parts of the body, are more  or less ossified; and even  the
hair of  the  head possesses  a crispness,  which renders it
less valuable to wig-makers than the hair of sober people.
  Not less destructive are the effects of ardent spirits upon
the  human  mind.   They impair  the memory, debilitate
the  understanding, and pervert the moral faculties.   It
was probably from observing these effects of intemperance 
158              ON THE EFFECTS  OF
 in drinking upon the mind, that a law was formerly pass-
 ed in Spain, which excluded drunkards from being wit-
 nesses in a court of justice.  But the demoralizing effects
 of distilled spirits do not stop here.  They produce not
 only falsehood, but fraud, theft, uncleanliness, and murder.
 Like the demoniac mentioned in the New Testament, their
 name is " legion," for they convey into  the soul a host of
 vices and crimes.
   A more affecting spectacle cannot be exhibited,  than a
 person into whom this  infernal spirit,  generated  by habits
 of intemperance, has entered.   It is more or less  affecting,
 according to the station the person fills in a family, or in
 society,  who is possessed by it.   Is he a husband ? How
 deep  the anguish  which rends the bosom of his wife!  Is
 she a wife ? Who can measure  the shame and aversion
 which she excites in her husband ! Is he the father, or is she
 the mother of a family of children ? See their averted faces
 from their parent, and their blushing looks  at each other!
 Is he a magistrate ? or has he been chosen to fill a high and
 respectable station in the councils of his country ? What
 humiliating fears  of corruption in the administration of the
 laws, and of the subversion of public order and happiness,
 appear in the  countenances of all who  see him! Is he a
 minister of the  gospel ?  Here language fails me.-----If an-
 gels weep,—it is  at such a sight.
   In  pointing out the evils produced by ardent spirits, let
 us not pass by their effects upon the estates of the persons
 who are addicted to them.   Are they inhabitants of cities?
 Behold  their houses stripped gradually of their  furniture,
 and pawned, or sold by a constable,  to pay tavern debts!
 See their names upon record in the dockets of every court,
 and whole pages of newspapers filled with advertisements
 of their  estates for public sale!   Are they inhabitants of
country places ? Behold their houses with shattered win-
dows ! their barns with leaky roofs ! their gardens over-run
with weeds 1  their  fields  with  broken fences!  their hogs
without yokes! their sheep without wool! their cattle and
horses without fat!  and their children filthy, and half clad,.
without manners, principles, and morals !   This picture of
agricultural wretchedness  is seldom of long duration. The
farms and property thus  neglected,  and  depreciated,  are
seized and sold for the benefit of a group of creditors.  The 
ARDENT SPIRITS.              159
children that were born with the prospect of inheriting them
are bound out to service in the neighbourhood; while their
parents, the unworthy authors of their misfortunes, ramble
into new and distant settlements, alternately fed on their way
by the hand of charity, or a little casual labour.
  Thus we see poverty and misery, crimes and infamy,
diseases and death, are all the natural and usual consequen-
ces of the intemperate use of ardent spirits.
  I have  classed death among  the consequences of hard
drinking.   But it is not death from the immediate hand of
the Deity, nor from any of the instruments of it which were
created by him.  It is death from suicide.  Yes ! thou
poor degraded creature,  who  art daily lifting the poisoned
bowl  to thy lips,  cease to avoid the unhallowed ground in
which the self-murderer is interred, and wonder no longer
that the sun should shine, and the rain fall, and the grass
look green, upon his grave.   Thou art perpetrating gradu-
ally, by the use of ardent spirits, what he has effected sud-
denly, by opium or a halter.   Considering how many cir-
cumstances,  from  a  sudden gust  of passion,  or  from
derangement, may palliate his guilt, or that (unlike yours)
it was not preceded and accompanied by any other crime,
it is probable  his condemnation will be less than yours at
the day of judgment.
  I shall novv take notice of the occasions and circumstan-
ces which are supposed to render the use of ardent spirits
necessary, and endeavour to show  that the arguments  in
favour of their use in such cases are founded in error,  and
that  in each of them,  ardent  spirits, instead of affording
strength to the body, increase the evils they are intended to
relieve.
  1.  They are said to be necessary in very cold weather.
This is far from being true ; for the temporary warmth they
produce is always succeeded by a greater disposition in the
body  to be affected  by cold.  Warm  dresses, a plentiful
meal just before exposure to the cold, and eating occasion-
ally a little gingerbread, or any other cordial food, is a much
more  durable method of preserving the heat of the body in
cold weather.
  2.  They are said  to be necessary in very warm weather.
Experience  proves  that they increase instead of lessening
the effects of heat upon the body,  and thereby dispose to 
 160              ON THE EFFECTS OF

 diseases of all kinds.   Even in the warm climate of the
 West Indies, Dr. Bell asserts this to be true.  " Rum (says
 this author) whether used habitually, moderately, or in ex-
 cessive quantities, in the West Indies, always diminishes
 the strength of the body, and renders men more susceptible
 of disease, and unfit for any service in which vigour or ac-
 tivity is required."*   As  well might we throw oil into a
 house, the roof of which was on fire, in order to prevent the
 flames from extending to its inside, as pour ardent spirits
 into the stomach, to lessen the effects of a hot sun upon the
 skin.
  3.  Nor do ardent spirits lessen the effects of hard labour
 upon the body.  Look at the horse: with every  muscle of
 his body swelled from morning till night in the plough, or a
 team, does he make signs for a draught of toddy or a glass
 of spirits, to enable him to cleave the ground, or to climb
 a hill ?  No; he requires nothing but cool water, and sub-
 stantial food.  There  is no  nourishment in ardent spirits.
 The strength they produce in  labour is of a transient na-
 ture,  and is  always followed by a sense of weakness and
 fatigue.
  But are there no conditions of the human body in which
 ardent spirits may be  given ?   I answer there are.   1st.
 When  the body  has been  suddenly exhausted  of  its
 strength,  and a disposition to faintness has been induced.
 Here a few spoonsful, or a wine-glassfull of spirits,  with or
 without water, may be administered with safety and advan-
tage.   In this case we  comply strictly with the advice of
Solomon, who restricts  the  use of  "  strong drink" only
 " to him who is ready to perish."   2dly.  When the body
has been exposed for a long time to wet weather, more es-
pecially if it  be combined with  cold.  Here  a  moderate
quantity of spirits is not only safe, but highly proper to ob-
viate  debility, and to prevent  a  fever.  They will more
certainly have those salutary effects, if the feet are at the
same time bathed with them, or a half pint of them  poured
 into the shoes or boots.   These I believe are the only two
cases,  in which distilled spirits are useful or necessary to
persons in health.
  But it may be said, if we reject spirits from being a part
  *  Inquiry into the causes which produce, and the means of preventing
diseases among British officers, soldiers, and others, in the West Indies. 
ARDENT SPIRITS.               161
of our drinks, what  liquors shall we substitute in their
room ?  I answer,  in the first place,
   1. Simple water.   I have known many instances of
persons,  who have followed the most laborious employ-
ments  for many years in the open air, and in warm and
cold weather, who never drank any thing but  water, and
enjoyed uninterrupted good health.  Dr.  Moseley, who
resided many years in the West Indies,  confirms this  re-
mark.   " I aver (says the Doctor) from my own know-
ledge and custom, as well as the custom and observations
of many other people, that those who drink nothing but
water, or make it their principal drink, are but little affect-
ed by the climate, and  can undergo the greatest fatigue
without inconvenience,  and are never subject  to trouble-
some or dangerous diseases."
   Persons who are unable to relish this simple beverage of
nature, may drink some one, or of all the following liquors,
in preference to ardent spirits.
   2. Cyder. This excellent liquor contains a small quan-
tity of spirit, but so diluted, and blunted,  by being com-
bined with a large quantity of saccharine matter, and water,
as to be pefectly wholesome.  It sometimes disagrees with
persons subject to the rheumatism, but  it may be made
inoffensive to such people, by extinguishing a red hot iron
in it,  or  by mixing it with water.  It is to be lamented,
that the late frosts in the spring so often deprive us  of the
fruit which affords this liquor.   The effects of these frosts
have been in some measure obviated by giving an orchard
a north-west exposure, so as to check too early vegetation,
and by kindling two or three large fires of brush or straw,
to the windward of the orchard, the evening before we ex-
pect a night of frost.  This last expedient has in many in-
stances preserved the fruit of an orchard, to the great joy
and emolument of the ingenious husbandmen.
   3. Malt liquors. The grain from which these liquors
are obtained is not liable, like the apple,  to be affected by
frost, and therefore they  can be  procured at all times, and
at a moderate price.   They contain a good  deal of nour-
ishment ;  hence we find many of the poor people in Great
Britain endure hard labour with no other food than a quart
or three pints of beer,  with a few pounds of bread in a day.
As it will be difficult to prevent small beer from becoming
     vol. i.                x 
162             ON THE EFFECTS OF

sour in warm weather, an excellent substitute may be made
for it by mixing bottled porter, ale,  or strong beer, with an
equal quantity of water;  or a pleasant beer may  be made
by adding to a bottle of porter, ten quarts of water, and a
pound of brown sugar, or a pint of molasses.   After they
have been well mixed, pour the liquor into bottles,  and
place them, loosely corked, in a cool cellar.   In two or
three days, it  will be fit for use.   A spoonful of  ginger
added to the mixture renders it more lively, and agreeable
to the taste.
   3.  Wines.  These fermented liquors are composed of
the same ingredients as cyder, and are  both  cordial and
nourishing.  The peasants of  France,  who drink them in
large quantities,  are a sober and  healthy body of people.
Unlike ardent  spirits, which render the  temper  irritable,
wines generally inspire cheerfulness  and good humour. It
is to be lamented that the grape has not as  yet been suffi-
ciently cultivated in  our country,  to afford wine to our
citizens ; but  many excellent substitutes  may  be  made for
it, from the native fruits of all the states.  If two barrels of
cyder, fresh from the press, are boiled into one, and after-
wards fermented, and kept for two  or three years in a dry
cellar,  it affords  a liquor, which,  according to the quality
of the apple from which the cyder is made, has the taste of
Malaga,  or Rhenish wine.   It affords, when  mixed with
water, a most agreeable drink  in  summer.   I have taken
the liberty of calling it Pomonawine.   There is another
method of making a pleasant wine from the  apple, by add-
ing four and twenty  gallons of new  cyder to three gallons
of  syrup made from the expressed juice of sweet apples.
When thoroughly fermented, and kept for  a few  years, it
becomes fit for use.   The blackberry of our fields, and the
raspberry and  currant of our gardens,  afford  likewise an
agreeable and wholesome wine, when pressed  and mixed
with certain proportions of sugar and  water,  and a little
spirit,  to counteract their disposition  to  an excessive fer-
mentation.   It is no objection to  these cheap  and home-
made wines, that they are unfit for  use until they are two
or three years old.  The foreign wines in common use in
our country require not only a much longer time  to bring
them to perfection, but to prevent their being disagreeable.
even to the taste- 
ARDENT SPIRITS.              163
  4. Molasses  and water,  also vinegar and wa-
ter, sweetened with sugar or molasses, form an agreeable
drink in warm weather.  It is pleasant and cooling, and
tends to keep up those gentle and uniform sweats, on which
health and life often  depend.   Vinegar and water consti-
tuted the only drink of the soldiers of the Roman republic,
and it is well known they marched and fought in a  warm
climate, and beneath a load of arms which weighed sixty
pounds.  Boaz, a wealthy farmer in Palestine, we find
treated his reapers with nothing but bread dipped in vine-
gar.   To such  persons as object  to the taste of vinegar,
sour milk, or butter-milk, or sweet milk diluted with wa-
ter, may be given in its stead.   I have known the labour
of the longest and hottest days in  summer supported, by
means  of these pleasant and wholesome drinks, with great
firmness, and ended, with scarcely a complaint of fatigue.
  5. The sugar  maple affords a thin juice, which has
long been used by the farmers in Connecticut as a cool and
refreshing drink, in the time  of  harvest.   The settlers  in
the western counties of the middle states will do well to let
a few of the trees which yield this pleasant juice remain in
all their fields.  They  may prove the means, not  only of
saving their  children  and  grand-children many hundred
pounds, but of saving their bodies from disease and death,
and their souls from misery beyond the grave.
  6. Coffee possesses agreeable  and exhilarating quali-
ties, and might be used with great advantage to obviate
the painful effects of heat, cold, and fatigue upon the  body.
I once knew a country physician, who made it a practice
to drink a pint of strong coffee previously to his taking a
long or cold ride.  It was more cordial to him than spirits,
in any  of the forms in which they are commonly used.
  The use of the  cold bath in the morning,  and  of the
warm bath in the evening, are happily calculated to strength-
en the body  in the  former part of the day, and to restore it
in the latter, from the languor and fatigue which are  indu-
ced by heat and labour.
  Let it not be said, ardent spirits have become necessary
from habit in harvest,  and in  other seasons of uncommon
and arduous labour.  The habit is a bad one, and may be
easily broken.  Let but half a dozen farmers  in a neigh-
bourhood combine to allow higher wages to their labourers 
164             ON IHU JE.FFJECI5 Vt
than are common,  and a sufficient quantity of any of the
pleasant and wholesome liquors I have recommended, and
they may soon, by their example, abolish the practice of
giving them spirits.  In a little while they will be delighted
with the good effects of their association.  Their  grain and
hay will be gathered into their barns in less time, and in a
better condition, than formerly, and of course at  a less ex-
pence, and a hundred  disagreeable, scenes from sickness,
contention, and  accidents,  will be avoided,  all of which
follow in a greater or less degree the use of ardent spirits.
  Nearly all diseases have their predisposing causes. The
same thing may  be said of the intemperate use of distilled
spirits.  It will,  therefore,  be useful to point out the dif-
ferent employments,  situations, and conditions of the body
and mind,  which predispose to the love of those liquors,
and to accompany them with directions to prevent persons
being ignorantly  and undesignedly seduced into the habitual
and destructive use of  them.
   1. Labourers  bear with great difficulty long intervals be-
tween their meals.   To  enable them to support the waste
of their strength, their stomachs should be constantly, but
moderately, stimulated by aliment, and this is best done by
their eating four or five times in a day during the seasons
of great bodily exertion.  The food at this time should be
solid, consisting chiefly of salted  meat.   The   vegetables
used with it should possess  some activity, or they should
be made savoury by a mixture of spices.  Onions and gar-
lic are of  a most cordial nature.   They composed a part
of the diet which enabled the Israelites to endure,  in a warm
climate, the heavy tasks imposed upon them by their Egyp-
tian masters ;  and diey were eaten, Horace and  Virgil tell
us, by the Roman farmers,  to repair  the waste  of their
strength by the toils of harvest. There are likewise certain
sweet substances, which support the body under the pressure
of labour. The negroes in the West Indies become strong,
and even fat, by drinking the juice of the sugar cane, in the
season of grinding it. The Jewish soldiers were invigorated
by occasionally eating raisins and figs. A bread composed
of wheat  flour,  molasses,  and ginger (commonly called
gingerbread) taken in  small quantities during the day, is
happily calculated to obviate the debility induced upon the
body by constant labour.  All these substances,  whether 
ARDENT spirits.               165
of an animal or vegetable nature, lessen the desire, as well
as the necessity, for cordial drinks, and impart equable and
durable strength to every part of the system.
   2. Valetudinarians,  especially those who  are afflicted
with diseases of the stomach and bowels, are very apt to
seek relief from ardent spirits.   Let such people be cau-
tious how they make use of this dangerous remedy. I have
known many men and womam of excellent characters and
principles, who have been betrayed, by occasional doses of
gin and brandy, into a love of those liquors, and have after-
wards fallen sacrifices to their fatal effects.   The different
preparations of opium are much more  safe and efficacious
than distilled cordials of any kind, in flatulent or spasmodic
affections of the stomach and, bowels. So great is the dan-
ger of contracting a love  for distilled liquors, by accustom-
ing the stomach to their stimulus, that as few medicines as
possible  should be given in spirituous vehicles, in chronic
diseases.  A physician, of  great eminence and uncommon
worth, who died towards the close of the last century, in
London, in taking leave  of a young physician of this city,
who had finished his studies under his  patronage, impress-
ed this caution with peculiar force upon him, and lamented
at the same time, in pathetic terms, that  he had innocently
made many sots, by prescribing  brandy  and  water in sto-
mach complaints.  It is difficult to tell how many persons
have been destroyed by those physicians  who have adopted
Dr. Brown's indiscriminate practice in the use of stimulat-
ing remedies, the most popular of which is ardent spirits,
but, it is well known, several of them have died of intem-
perance in this city since the year 1790.   They were pro-
bably led to  it,  by drinking brandy and water, to relieve
themselves from the frequent attacks of debility and  indis-
position, to which the labours of a physician expose him,
and for which rest, fasting, a gentle purge, or weak diluting
drinks, would have been safe and more certain cures.
   None of these remarks are intended to preclude the use
of spirits in the low state of short, or what are called acute
diseases, for, in such cases, they produce their effects too
soon to create a habitual desire for them.
   3. Some people, from living in countries subject  to in-
termitting fevers, endeavour to fortify themselves against
them, by taking two or three wine-glasses of bitters, made 
166              ON THE EFFECTS O*
 with spirits,  every day.  There is great danger  of con-
 tracting habits of intemperance from this practice. Besides,
 this mode of preventing intermittents is far from  being a
 certain one.  A much  better security against them, is a
 tea-spoonful of the Jesuits bark,  taken every morning dur-f
 ing a  sickly season.   If this safe and  excellent medicine
 cannot be had, a gill or  half a pint of a strong watery infu-
 sion of centaury,  camomile, wormwood, or  rue, mixed
 with a little of the calamus of our meadows, may be taken
 every morning,  with nearly the same  advantage as the
 Jesuits bark.  Those persons who live in a sickly country,
 and cannot procure  any of the preventives  of autumnal
 fevers which have been mentioned, should avoid the morn-
 ing and  evening air; should kindle fires in their  houses,
 on damp days, and in cool evenings, throughout the whole
 summer; and put on winter clothes about the first week
 in September.   The  last part of these  directions applies
 only to the inhabitants of the middle states.
   4. Men who follow professions, which require constant
 exercise of the faculties of their minds, are very apt to seek
 relief,  by the use of ardent spirits, from the fatigue which
 succeeds great mental exertions.  To such persons, it may
 be a discovery to know,  that tea is a much better remedy
 for that purpose.   By its grateful and  gentle  stimulus,  it
 removes fatigue, restores the excitement of the mind, and
 invigorates the whole system.  I am no advocate for the
 excessive use of tea.  When taken too strong, it is hurtful,
 especially to the female constitution ; but when taken of a
 moderate degree of strength, and  in moderate quantities
 with sugar and cream, or milk, I believe it is, in general,
 innoxious, and at all times to be preferred to ardent spirits,
 as a cordial for studious  men. The late Anthony Benezet,
 one of the most laborious schoolmasters I ever knew, in-
 formed me, he had been  prevented from the love of spiri-
 tuous  liquors by acquiring a love for tea  in early  life.
 Three or  four cups, taken in an  afternoon, carried off the
fatigue of a whole day's labour in his school.  This worthv
man lived to be seventy-one years of age, and died of an
acute disease, with the full exercise of all the  faculties of
his mind.   But the  use of tea counteracts a desire for dis-
tilled spirits, during great  bodily, as well as mental exertions.
Of this, captain Forest has furnished us with a recent and 
ARDENT SPIRITS.
167
remarkable proof, in his History of a Voyage from Calcutta
to the Marqui Archipelago.   " I have  always observed
(says this ingenious  mariner)  when sailors drink  tea, it
weans them from the thoughts of drinking strong liquors,
and pernicious grog; and with this they are soon content-
ed. Not so with whatever will intoxicate, be it what it will.
This  has always been my remark.   I  therefore  always
encourage it, without their knowing why."
   5.  Women have sometimes been led to seek relief from
what  is  called  breeding sickness,  by the use of ardent
spirits. A little gingerbread, or biscuit, taken occasionally,
so as  to prevent the stomach being empty, is a much bet-
ter remedy for that disease.
   6.  Persons under the pressure of debt, disappointments
in worldly pursuits, and guilt,  have sometimes sought to
drown their  sorrows in strong drink.   The only  radical
cure for those evils is to be found in religion; but where
its support is not restored to, wine and opium should always
be preferred to ardent spirits.   They are far less injurious
to the body and mind than spirits, and the habits of attach-
ment to them afe easily broken, after time and repentance
have removed the evils they were  taken to relieve.
   7.  The sociable and imitative nature of man often dis-
poses him to adopt the most odious and destructive practi-
ces from his companions.   The French soldiers who con-
quered Holland,  in the  year 1794, brought back with them
the love and use of brandy, and thereby corrupted the in-
habitants of  several  of the departments  of France,  who
had been previously  distinguished for  their temperate and
sober manners.   Many other facts might  be mentioned, to
show how important it is to avoid the company of persons
addicted to the use of ardent spirits.
   8.  Smoking and chewing tobacco,  by rendering water
and simple liquors insipid to the state,  dispose very much
to the stronger stimulus of ardent spirits.   The practice
of smoking  segars has, in every part of our country, been
more followed by a  general use of brandy and water as a
common drink,  more  especial 1}' by that  class of citizens
who  have not been in  the habit of drinking wine, or malt
liquors.  The less, therefore, tobacco is used in the above
ways, the better.
   9.  No man ever became suddenly a  drunkard.  It is bv 
168
OF THE EFFECTS OF
gradually accustoming  the  taste and  stomach  to  ardent
spirits, in the forms of grog and toddy, that  men have
been led to love them in their  more destructive  mixtures,
and in their simple state.   Under the impression of this
truth, were it possible for me to speak with a voice so loud
as to  be heard from the river  St. Croix to the remotest
shores of the Mississippi, which bound the territory of the
United  States, I would say, Friends and  fellow-citizens,
avoid the  habitual use of  those two seducing liquors,
whether  they  be made with brandy,  rum, gin, Jamaica
spirits, whiskey, or what  is called cherry bounce.  It is
true, some men, by limiting the strength of those  drinks
by measuring the spirit  and water, have drunken them for
many years, and even during a long life, without acquiring
habits of intemperance or intoxication, but  many more
have been insensibly led, by drinking weak toddy and grog
first  at their  meals, to take them for their  constant drink,
in the intervals of  their meals; afterwards to take them, of
an increased strength, before breakfast in the morning; and
finally to destroy themselves by  drinking undiluted spirits,
during every hour of the day and night. *I am not singu-
lar in this remark.   " The consequences of drinking rum
and water, or grog,  as it is  called (says Dr.  Moseley) is,
that habit increases the desire of more spirits, and decreas-
es its effects;  and  there are very few grog-drinkers who
long  survive  the  practice of debauching with it, without
acquiring the odious nuisance  of dram-drinkers breath,
and down  right stupidity and impotence."*  To enforce
the caution against the use of those two  apparently inno-
cent and popular liquors still further, I shall select one in-
stance,  from among many, to show  the ordinary manner
in which they beguile and destroy their votaries.  A citi-
zen  of Philadelphia, once of a fair and sober  character,
drank toddy for many years, as his constant drink.  From this
he proceeded to drink grog.  After a  while nothing would
satisfy him but slings made of equal parts of rum and wa-
ter, with a little sugar.  From slings he advanced  to raw
rum, and from common rum to Jamaica spirits.  Here he
rested for a few months, but at length, finding even Jamai-
ca spirits were  not strong enough to  warm his stomach,
he made it a constant practice to throw  a table-sponful of
               * Treat':se on Tropical diseases. 
ARDENT SPIRITS.               169
ground pepper in each glass of his spirits, in order, to use
his own words, " to take off their coldness." He soon after
died a martyr to his intemperance.
   Ministers of  the  gospel, of every denomination, in the
United States!  aid  me with all the weight you possess in
society, from the dignity and usefulness of your sacred of-
fice,  to save our fellow men from being destroyed by the
great destroyer of their lives  and souls.   In  order more
successfully to effect this purpose, permit me to suggest to
you to employ the same wise modes of instruction, which
you  use in  your attempts to prevent their destruction by
other vices.  You  expose the evils  of covetousness, in
order to prevent theft; you point out the sinfulness of im-
pure desires, in order to prevent adultery; and you dissuade
from anger,  and malice,  in order to prevent murder.   In
like manner, denounce, by your preaching, conversation,
and  examples,  the seducing influence of toddy and grog,
when you aim to prevent ali the crimes and miseries which
are the offspring of  strong drink.
   We have hitherto considered the effects of ardent spirits
upon individuals,  and the means of preventing them.  I
shall close this head of our inquiry, by a few remarks upon
their effects upon the population and welfare of our country,
and the means of obviating them.
   It is highly probable not less than 4000 people die annu-
ally,  from the use of  ardent spirits, in the United States.
Should they continue  to  exert this deadly influence upon
our population,  where will their evils  terminate ?  This
question may be answered, by asking,  where are all the
Indian tribes, whose  numbers and arms formerly spread
terror among their civilized neighbours? I answer, in the
words of the famous Mingo chief, " the blood of many of
them flows not in the veins of any human creature." They
have  perished,  not by  pestilence,  nor war,  but by  a
greater foe to human life than either of them—ardent spii its.
 The loss of 4000 American citzens, by the yellow fever,
in a single year, awakened  general sympathy and terror,
and called forth all the strength and ingenuity of laws, to
prevent its recurrence.  Why is not  the same zeal mani-
fested in protecting our citizens from the more general and
consuming ravages  of distilled spirits ? Should the customs
of civilized life  preserve our  nation from extinction,  and
   VOL. I. 
170               THE EFFECTS OF
even from an increase of mortality, by those liquors; they
cannot prevent our country being governed by men, cho-
sen by intemperate and corrupted voters.  From such legis-
lators, the republic would soon be in danger.  To avert
this evil, let good men of even  class unite, and besiege the
general and  state  governments  with  petitions to limit the
number of taverns;  to impose  heavy duties upon ardent
spirits ; to inflict a mark of disgrace, or a temporary abridg-
ment  of  some  civil  right, upon  every man convicted of
drunkenness ; and finally to secure the property of habitual
drunkards, for the benefit of their families, by placing it in
the hands of trustees, appointed  for that purpose by a court
of justice.
  To aid the operation of these laws, would it not be ex-
tremely useful for the rulers of the different denominations of
christian  churches to unite, and render the sale and con-
sumption of ardent spirits a subject of ecclesiastical juris-
diction ?  The methodists,  and society of friends, have, for
some  time past, viewed them as contraband articles to the
pure laws of the gospel, and have borne many public and
private testimonies against making them the objects of com-
merce. Their success, in this benevolent enterprise, affords
ample encouragement for all  other religious societies to fol-
low their example.
  We come now to the  third part of this inquiry, that is,
to mention the remedies for the evils which are brought on
by the excessive use of distilled spirits.
  These remedies divide themselves into two kinds.
  I. Such as are proper to cure a fit of drunkenness, and
  II.- Such  as are proper to prevent  its  recurrence and to
destroy a desire for ardent  spirits.
  I. I am aware that the efforts of science and humanity,
in applying their resources to the cure of a disease induced
by an  act of vice, will meet with  a cold reception from many
people.  But let such people remember, the subjects of our
remedies are their fellow  creatures,  and  that the miseries
brought upon human nature, by its crimes, are as much the
objects of divine compassion (which  we are bound to imi-
tate) as the  distresses which are brought upon men by the
crimes  of  other  people,   or  which  they  bring upon
themselves  by  ignorance  or  accidents.   Let  us  not
then pass by the prostrate sufferer from strong drink,  but 
ARDENT SPIRITS.               171
administer to him the same relief we would afford to a fel-
low creature, in a similar state, from an accidental, and in-
nocent cause.
   1. The first thing to be done to cure a fit of drunken-
ness, is to open the collar, if in a man, and remove all tight
ligatures from every other part  of the body.   The head
and shoulders should at the same  time be elevated,  so as
to favour a more feeble determination of the blood to the
brain.
   2. The contents of the stomach should be discharged,
by thrusting  a feather down the throat.   It often restores
the patient immediately to his senses and feet.   Should it
fail of exciting a puking,
   3. A napkin  should be wrapped round the head, and
wetted for an hour or two with cold water, or cold  water
should be poured in a stream upon the head.   In the latter
way I have sometimes seen it used, when a boy, in the city
of Philadelphia.   It was applied, by dragging the patient,
when found drunk in the street,  to a pump, and pumping
water upon his head for ten or fifteen  minutes.  The  pa-
tient generally rose, and walked off, sober and sullen, after
the use of this remedy.
   Other remedies, less common, but not less effectual for
a fit of drunkenness, are,
   4. Plunging the whole body into cold water.  A  num-
ber of gentlemen who had drunken to intoxication, on
board a ship in the stream, near Fell's point, at Baltimore,
in consequence of their reeling in a  small boat, on their way
to the  shore, in  the evening,  overset it, and fell into the
water.   Several  boats from the shore hurried to their re-
lief.   They were all picked up, and  went home, perfectly
sober to their families.
   5. Terror.  A number of young merchants, who had
drunken  together, in a compting-house,  on  James  river,
above thirty years ago, until  they  were intoxicated, were
carried away by a sudden rise of  the  river, from  an im-
mense  fall of rain.   They floated  several miles with  the
current, in their little cabin,  half filled with water.  An
island in the river arrested it.  When  they reached  the
shore that saved their  lives, theyr were all sober.   It is pro-
bable terror assisted in the cure of the persons who fell into
the water at Baltimore. 
172
THE EFFECTS OF
  6. The excitement of a fit of  anger.   The  late  Dr.
Witherspoon used to tell a story of a man in Scotland, who
was always cured of a fit of drunkenness by being made
angry.  The means chosen for that purpose was a singular
one.  It was talking against religion.
  7. A severe whipping.   This remedy acts by exciting
a revulsion of the blood from the brain to the external parts
of the body.
  8.  Profuse sweats. By means of this evacuation, nature
sometimes cures a fit of drunkenness.  Their good effects
are  obvious in labourers, whom quarts of spirits taken in a
day will seldom  intoxicate while they sweat freely.  If the
patient be unable to swallow warm drinks, in order to pro-
duce sweats, they may be excited by putting him in a warm
bath, or wrapping his body in blankets, under which should
be placed half a  dozen hot bricks,  or bottles filled with hot
water.
  9. Bleeding.  This remedy should always be used, when
the former ones have  been prescribed  to no purpose, or
where there is reason to fear, from  the long duration of the
disease, a material injury may be done to the brain.
  It is  hardly necessary to add, that each of the above re-
medies  should be regulated by the grade of drunkenness,
and the greater or less degree in which the intellects are af-
fected in it.
  II. The remedies which are proper to prevent the recur-
rence of fits of drunkenness, and to destroy the  desire for
ardent spirits, are religious, metaphysical,  and medical.  I
shall briefly mention them.
  1.  Many hundred drunkards  have been cured  of their
desire for ardent spirits, by a practical belief in the doctrines
of the christian religion.   Examples of the divine efficacy
of Christianity for this purpose have lately occurred in many
parts of the United States.
  2.  A sudden  sense of the guilt contracted  by drunken-
ness,  and of its punishment in  a future world.  It once
cured a gentleman in Philadelphia,  who,  in a fit of drunken-
ness,  attempted  to murder  a wife whom he loved.  Upon
being told of it when he was sober, he was so struck with
the enormity of the crime he had nearly committed, that he
never tasted spirituous liquors afterwards.
  3.  A  sudden sense of shame.  Of the efficacv of this 
ARDENT SPIRITS*              173
deep  seated principle  in  the  human bosom,  in curing
drunkenness, I shall relate three remarkable instances.
  A farmer in England, who had been many years in the
practice of coming home intoxicated, from a market town,
one day observed  appearances of rain, while he was  in
market.  His hay was cut, and ready to be housed.  To
save it,  he returned in haste to his farm, before he had
taken his customary dose of grog.  Upon coming into his
house, one of his children, a boy of six years old, ran to
his  mother, and cried out, " O,  mother!  father is come
home, and he is not drunk."   The father,  who heard this
exclamation, was so severely rebuked by it, that he sud-
denly became a sober man.
  A noted drunkard was once followed  by a favourite
goat to a tavern, into which he was invited by his master,
and drenched with some of his liquor.  The poor animal
staggered home with his master, a good deal intoxicated.
The next day he followed him to his accustomed tavern.
When the goat came to the  door, he paused : his master
made signs to him to follow  him into the house.  The
goat stood still.  An attempt was made to thrust him into
the tavern.  He resisted, as if struck with the recollection
of what he suffered from being intoxicated the night be-
fore.   His master was so much affected  by a sense  of
shame, in observing the conduct of his goat to be so much
more rational than his own, that he ceased from that time
to drink spirituous liquors.
  A gentleman, in one of the southern states, who had
nearly destroyed himself by strong drink, was remarkable
for  exhibiting the grossest marks of folly in his fits of in-
toxication.  One evening, sitting in his parlour, he heard
an uncommon noise in his kitchen.  He went to the door,
and peeped through the key hole, from whence he saw one
of his negroes diverting his fellow servants, by mimicking
his  master's gestures and conversation when he was drunk.
The sight overwhelmed him with shame and distress, and
instantly became the means of his reformation.
  4.  The  association of the idea of ardent spirits with a
painful or disagreeable impression upon some part of the
body, has sometimes cured the love of strong drink.  I
once  tempted  a negro  man,  who was habitually fond of 
174               THE EFFECTS OF
ardent spirits, to drink some rum (which I placed in his
way) and in which I had put a few grains of tartar emetic.
The tartar sickened and puked him to such a degree, that
he supposed himself to be poisoned.  I was much gratifi-
ed by observing he could not bear the  sight, nor smell, of
spirits for two years afterwards.
  I have heard of a man who was cured of the love of
spirits, by working off a puke by large draughts of brandy
and water, and I know a gentleman, who in consequence
of being affected with a rheumatism,  immediately after
drinking some  toddy, when overcome with fatigue and
exposure to the rain,  has ever  since loathed that liquor,
only because it  was accidentally  associated in his memory
with the recollection of the  pain he suffered from his dis-
ease.
  This  appeal to that operation of the human mind, which
obliges  it to associate ideas,  accidentally or otherwise
combined,  for the cure of vice, is very ancient.  It was
resorted to by Moses,  when he compelled the children of
Israel to drink the solution of the golden calf ^ which they
had  idolized)  in  water.  This solution, if made, as it
most probably was, by means of what is called hepar sul-
phuris,  was extremely bitter,  and nauseous, and could
never be recollected  afterwards,  without bringing into
equal detestation the sin which subjected  them to the ne-
cessity of drinking it.  Our knowledge of this principle
of association upon the minds and conduct of men should
lead us  to destroy, by  means of other impressions, the in-
fluence  of all those circumstances, with which the recol-
lection  and desire of spirits  are combined.   Some men
drink only in the  morning,  some at noon, and some only
at night.  Some men  drink only on a market day, some
at one tavern only, and some only in one kind oi company.
Now by finding  a new and interesting  employment or
subject  of conversation for drunkards, at the usual times
in which they  have been accustomed to drink,  and  by
restraining them by the same means from  those places and
companions, which suggested to them the idea of ardent
spirits,  their habits of intemperance  may be completely
destroyed.   In  the same way the periodical returns of ap-
petite,  and  a desire of sleep,  have been destroyed in a 
ARDENT SPIRITS.
175
hundred instances.  The desire for strong drink differs
from each of them,  in being of an artificial nature, and
therefore not disposed to return, after being chased for a
few weeks from the system.
   5. The love of ardent spirits has sometimes been sub-
dued, by exciting a counter passion in the mind.  A citi-
zen of Philadelphia had made many unsuccessful attempts
to cure his wife of drunkenness.   At length, despairing of
her reformation,  he purchased a hogshead of rum, and,
after tapping it, left the key in the door of the room  in
which it was placed, as if he had forgotten it. His design
was to give his wife an opportunity  of drinking herself
to death.  She suspected this to be his motive,  in what
he had done, and suddenly left off drinking. Resentment
here became the antidote to intemperance.
   6. A diet consisting wholly of vegetables  cured a phy-
sician in Maryland of drunkenness, probably by lessen-
ing that thirst, which is always more  or  less excited by
animal food.
   7. Bjisters to the ankles, which were  followed by an
unusual degree of inflammation, once suspended the love
of ardent spiritSj for one month,  in a lady in this city.
The degrees of her  intemperance may be conceived of,
when I add, that her grocer's account for  brandy alone
amounted, annually, to  one  hundred pounds, Pennsylva-
nia currency, for several years.
   8. A violent attack  of an acute disease has sometimes
destroyed a  habit of drinking distilled  liquors. I attended
a notorious drunkard, in the yellow fever in the year 1798,
who recovered,  with the  loss of  his  relish for  spirits,
which  has, 1 believe, continued ever since.
   9. A salivation has lately performed a cure of drunken-
ness, in a person of  Virginia.  The new disease  excited
in the  mouth  and throat, while it  rendered  the action of
the smallest  quantity of spirits  upon  them painful, was
happily calculated to destroy the disease  in  the stomach
which  prompts to drinking, as well as to render, the re-
collection of them disagreeable, by the laws of association
formerly mentioned.
   10.  1 have  known an oath, taken before a magistrate,
to drink no more spirits, produce a perfect cure of drun- 
176             THE EFFECTS OF, &C

kenness.  It is sometimes cured in this way in  Ireland.
Persons who take oaths for this purpose are called affi-
davit men.
   11. An advantage would probably arise from frequent
representations being made to drunkards, not only of the
certainty, but of the suddenness of death, from  habits of
intemperance.   I have heard of two persons being cured
of the  love  of ardent spirits,  by seeing  death  suddenly
induced  by fits  of  intoxication;  in the  one case, in a
stranger, and in the other, in an intimate friend.
   12. It has been said, that the disuse of spirits should
be gradual,  but my observations authorise me to say, that
persons who have been addicted to them should abstain
from them suddenly, and entirely.   " Taste  not> handle
not, touch not,"  should be inscribed upon every  vessel
that contains spirits,  in the house of a man who wishes to
be  cured of habits  of intemperance.  To obviate, for
awhile, the debility which arises from the sudden abstrac-
tion of the stimulus of  spirits, laudanum, or bitters infu-
sed in water, should be  taken, and perhaps a larger quan-
tity of beer  or wine, than is consistent with the strict rules
of temperate living.  By the temporary  use  of these sub-
stitutes for spirits, I have  never known the transition to
sober habits to be attended with any bad effects,  but often
with permanent health of  body, and peace of mind. 
OBSERVATIONS UPON THE TETANUS.
vol. I. 
 
OBSERVATIONS,  &c.
     FOR a history of the different names and symptoms
of this disease, I beg leave to refer the reader to practical
books, particularly to Doctor Cullen's First Lines.  My
only design in this inquiry is, to deliver  such a theory of
the disease,  as may lead to  a new and successful use of
old and common remedies for it.
   All the remote and predisposing causes of the tetanus
act by inducing preternatural debility, and irritability in
the muscular parts of the body.  In many cases, the re-
mote causes act alone, but they more frequently require
the co-operation of  an exciting cause.   I shall briefly
enumerate, without discriminating them,  or pointing out
when they act singly, or when  in conjunction with each
other.
   1. Wounds on different parts of the body are the most
frequent causes of this  disease.  It was formerly supposed „
it was the effect only of a wound, which  partially divided
a tendon,  or  a nerve;  but  we now know it is often the
consequence of laesions which affect the body in a super-
ficial manner.   The  following is a list of such wounds
and lassions as have been known to induce the disease:
   1. Wounds in the soles of the feet, in the palms of
the hands, and under the nails, by means of nails or splin-
ters of wood.
  2. Amputations, and fractures of limbs.
  3. Gun-shot wounds.
  4. Venesection.
  5. The extraction  of a tooth,  and the insertion of new
teeth. 
180      OBSERVATIONS ON THE TETANUS-
  6. The extirpation of a schirrus.
  7. Castration.
  8. A wound on the tongue.
  9. The injury which is done to the feet by frost.
  10. The injury which is sometimes done to one of the
toes, by stumping it (as it is called) in walking.
  11. Cutting a nail too closely.   Also,
  12. Cutting a corn too closely.
  13. Wearing a shoe so tight as to abrade the skin of
one of the toes.
  14. A wound, not more than an eighth part of an inch,
upon the forehead.
  15. The stroke  of a whip  upon the arm, which  only
broke the skin.
  16. Walking too soon upon a broken limb.
  17. The sting of a wasp upon  the glands penis.
  18. A fish bone sticking in the throat.
  19  Cutting the naval string in new born infants.
  Between the time in which the body is thus  wounded
or injured, and the time in  which the disease makes its
appearance, there is an interval, which extends  from one
day to six weeks.  In the person who injured his toe by
stumping it in walking, the disease appeared the next day.
The trifling wound on the forehead which I have mention-
ed,  produced  both  tetanus and death,  the day  after
it was received.   I have  known two instances of  teta-
nus, from running nails in the feet, which  did not  appear
until six weeks afterwards.    In most of the cases of this
disease from wounds, which  I have seen, there was a total
absence of pain and inflammation, or but  very moderate
degrees of them, and in some of them the wounds  had
entirely healed, before any of the symptoms of the  disease
had made their appearance.  Wounds and lassions are
most apt to produce tetanus,  after the long continued ap-
plication of heat to the body ; hence its greater frequency,
from these causes, in warm than  in cold climates, and in
warm than in cold weather, in northern countries.
  II.  Cold applied suddenly to the body, after it has been
exposed to intense heat.  Of this Dr. Girdlestone men-
tions many instances, in his Treatise upon  Spasmodic Af-
fections in India.   It  was  most  commonlyr induced  by 
OBSERVATIONS ON THE TETANUS.      181
sleeping upon the ground, after a warm day.   Such is the
dampness and  unwholesome nature of the ground,  in
some parts of that country, that " fowls (the Doctor says)
put into coops  at night, in the sickly season of the year,
and on the same soil that the men slept, were always found
dead the next  morning,  if the coop was not placed at a
certain height above the surface of the earth."*  It was
brought on by sleeping on  a damp pavement in a servant
girl of Mr. Alexander Todd, of Philadelphia, in the even-
ing of a day in which  the  mercury in Fahrenheit's ther-
mometer stood at 90°.   Dr. Chalmers relates an instance
of its having been induced by a person's sleeping without
a nightcap, after shaving  his head.  The late Dr. Bartram
informed me, that he had known  a draught of cold water
produce  it in a man who was in  a preternaturally heated
state.  The cold air more certainly brings on this disease,
if it  be applied to the body in the form of a current.  The
stiff neck, which is sometimes felt after exposure to a
stream of cool air from an open window, is a tendency to
a locked jaw, or a feeble and partial tetanus.
   II I. YVorms and  certain  acrid matters in the alimentary
canal.   Morgagni relates an instance of the former, and 1
shall hereafter  mention instances of the latter in  new-born
infants,
   IV. Certain poisonous vegetables.   There are several
cases upon record of its being induced by the  hemlock
drop wort, and the datura stramonium, or Jamestown weed,
of our country.
   V.  It is sometimes a symptom of the bilious remitting
and  intermitting fever.  It is said to occur more frequently
in those states of fever in the island of Malta, than in any
other part of the  world.
   VI. It is likewise a symptom of that malignant state of
fever which is brought on by the bite of  a rabid animal,
also of hysteria and gout.
   VII. The grating noise produced  by  cutting with a
knife upon a pewter plate excited it in a servant, while he
was waiting upon his master's table in London.   It proved
fatal in three days.
   VIII. The  sight of food, after long fasting.
                       * Page. 55. 
182      OBSERVATIONS ON THE TETANUS.
   IX. Drunkenness.
   X. Certain emotions and passions of the mind.  Terror
brought it on a brewer in this city.  He had been previ-
ously debilitated by  great labour, in warm  weather.   I
have heard of its having  been induced in a man by agita-
tion of mind, occasioned  by seeing a girl tread upon a nail.
Fear excited it in a soldier who kneeled down to be shot.
Upon being pardoned he was unable to rise,  from a sud-
den attack of tetanus.   Grief produced it in a case men-
tioned by Dr. Willan.
   XI. Parturition.
   All these remote and exciting causes act with more or
less  certainty and force,  in  proportion to the greater or
less degrees of fatigue which have preceded them.
   It has been customary  with authors to call all those cases
of tetanus,  which are not brought on by wounds, sympto-
matic.  They are no more  so than those which are said
to be idiopathic.  They all depend alike upon irritating
impressions made upon  one  part of the body, producing
morbid excitement,  or disease in  another.  It is immate-
rial,  whether the impression be made upon the intestines
by a worm, upon the ear by an ungrateful noise, upon the
mind by a strong emotion, or upon the sole of the foot by
a nail; it is alike communicated to the  muscles, which,
from  their previous  debility and  irritability, are thrown
into commotions by  it.   In  yielding to  the impression of
irritants, they follow  in their contractions the order of their
predisposing debility.   The  muscles  which move the
lower jaw are affected more  early, and more obstinately,
than  any of the other external muscles of the body,  only
because they are more  constantly in a relaxed, or  idle,
state.
   The negroes in the West Indies are more subject to
this disease  than  white people.   This has been  ascribed
to the greater irritability of their muscular systems, which
constitutes a part of its predisposing cause.   It is remark-
able that their sensibility  lessens with the increase of their
irritability ; and hence, Dr. Moseley says, they bear surgi-
cal operations much better than white people.
   The new-born  infants of the negroes in the West Indies
are often affected  with this  disease, among  whom  it is 
       OBSERVATIONS ON THE TETANUS.          183

known by the  name of the jaw-fall.   Dr. Dazille  says,
that during a residence of thirty years in the islands, and
chiefly at St. Domingo, he saw but one instance of it in
a white child.  It is said one-tenth of all the negro chil-
dren that are born  in the West Indies, die of it.  Local
circumstances influence its mortality.  Nineteen out of
twenty black children, Dr. Gordon informed me, in his
visit to Philadelphia in the summer of 1806, died upon a
plantation in Berbice,  while upon a neighbouring planta-
tion not a single instance of death had ever occurred  from
it.  Dr. Cleghorn  informs us that it is a common disease
among the white children in  Minorca.*   I have  seen  a
few cases of it  in the children of white persons in Phila-
delphia.   Its causes are,
   1. The cutting of the navel-string.  This is often done
with a pair of dull scissars, by which means the cord is
bruised.
   2. The  acrimony of the meconium retained  in the
bowels.
   3. Cold air acting  upon the body, after it  has  been
heated by the air of a hot room.
   4. Smoke is supposed to excite it in  the negro quar-
ters in the West Indies.   Perhaps this, and  the preced-
ing cause induced the great mortality of the disease upon
the plantation in Berbice, mentioned by Dr. Gordon.
   It is unknown, Dr. Winterbottom  informs us, among
the native Africans in the neighbourhood of Sierra Leone.
   I  am aware  that it is ascribed by many physicians to
only one of the above causes;  but I see no reason why it
should not be induced by more than one cause in infants,
when we see it  brought on by so many different causes
in grown people.
   The tetanus is not confined to the human species.  It
often affects horses in the West Indies.   1 have seen se-
veral cases of it in Philadelphia.  I have likewise seen it
appear in the form of opisthotinos in a pidgeon, brought
on by a wound in one of its wings.
   The want of uniform success in the treatment of this
disease has long been a subject of regret among physi-
cians.   It may be ascribed to the use of the same reme-
        * Diseases of Minorca, p. 46.  Philadelphia Edition. 
 184     OBSERVATIONS ON THE TETANUS.

 dies, without any respect to the nature of the causes which
 produce it, and  to an undue reliance upon some one re-
 medy, under a belief of its specific efficacy.   Opium has
 been considered as its antidote, without recollecting that
 it was one only, of a numerous class of medicines,  that
 are all alike useful in it.
   Tetanus, from  all its  causes, has nearly the same pre-
 monitory symptoms.  These are, a stiffness in the neck,
 a disposition to bend forward, in order to relieve a pain
 in the back, costiveness, a pain about the external region
 of the stomach, and a disposition to start in sleep. In this
 feeble state of  the  disease,  an emetic, a strong  dose of
 laudanum, the warm bath, or a few doses of bark, have
 often prevented its being completely formed.  When it
 has arisen from a wound, dilating it,  if small or healed,
 and afterwards  inflaming  it,  by applying to it turpentine,
 common salt, corrosive sublimate, or Spanish flies, have,
 in many hundred instances, been attended with the same
 salutary effects.
  The disease  I have said is seated in the muscles, and,
 while they are  preternaturally excited, the blood-vessels
 are in a state of reduced excitement.  This is evident from
 the feebleness and  slowness of the pulse,  and the feeble
 coherence, or total dissolution, of the blood.   The pulse
 sometimes beats, according to Dr. Lining, but forty strokes
 in a minute.   By  stimulating the wound, we not only re-
 store the natural excitement of the blood-vessels,  but we
 produce an inflammatory diathesis  in them,  which  ab-
 stracts morbid exeitement from the muscular system, and,
 by equalizing it, cures the disease.   This remedy, I ac-
 knowledge, has not been as successfully employed in the
 West-Indies  as in the United States, and that for an ob-
 vious reason. The blood-vessels in a warm climate refuse
 to assume an inflammatory action.   Stimuli  hurry them
 on suddenly to  torpor or gangrene.   This is so uniformly
 the case, that Dr. Dazille not only forbids their application
to recent wounds, but advises the most lenient applications
to them.*  But widely different is the nature of wounds,
and of the tension of the  blood-vessels, in the inhabitants
of northern countries. While Dr. Dallas deplores the loss
             " Observations sur le Tetanos, p. 326. 
        OBSERVATIONS  ON  THE  TETANUS.       185

of 49 out of 50 affected with tetanus from wounds, in the
West India islands, I am sure I could mention many hun-
dred instances of the disease being prevented, and a very
different proportion of cures being performed, by inflam-
ing the  wounds, and exciting a counter  morbid action in
the blood-vessels.
  This  disease like many others has its anomalies. I have
seen it attended with a complete intermission of spasms,
and a total relaxation of all the muscles which are usu illy
affected by it, and in one instance  I  have  observed  the
spasms  to be confined exclusively to one side of the body.
I have likewise met with a case in a black girl, in whom
all the symptoms of  the disease occurred, except a tris-
mus or  a contraction of the jaw. 'The force  of the disease
in that part of her body spent itself upon her tongue. She
lost the  power of speech.  The disease  was  brought on
by a wound in her hand.   She was cured by tonic  reme-
dies.
  When the disease is the effect of fever,  the  same re-
medies  should be given, as are employed in  the cure of
that fever.  I have once  unlocked  the jaw  of a woman,
who was seized at the same time with a remitting fever,
by an emetic, and I have heard of  its being cured in a
company of surveyors, in whom it was the effect of an
intermittent, by large doses of bark.   When it accompa-
nies malignant fever, hysteria, or gout,  the remedies for
those forms of disease should be employed.   Bleeding
was highly useful in it, in a case of yellow fever which
occurred in Philadelphia in the year 1794.
  When it is produced by the suppression of perspiration
by means of cold, the warm bath and sweating medicines
have been found most useful in it.   Nature  has in one in-
stance pointed out  the use of this remedy, by curing the
disease  by a miliary eruption on the skin.*
  If it be the effect  of poisonous substances taken into
the stomach,  or of worms in the bowels, the cure should
be begun by emetics, purges, and anthelmintic medicines.
  Where patients are unable to swallow, from the teeth
of the upper and lower jaw pressing  upon  each other,  a
tooth or two  should be extracted, to  open  a  passage for
                      * Burserus.
   VOL.  I.                a  a 
186        OBSERVATIONS ON THE TETANUS

our medicines into the  throat.   If this be impracticable,
or objected to, they should be injected by way of glyster.
   In the locked jaw which arises from the extraction of a
tooth, an instrument should be introduced to depress the
jaw.  This has been done by a noted English dentist in
London, with success.
   As the habit of diseased action often continues after the
removal of its causes, and as some of the remote causes of
this disease are beyond the reach of medicine, such reme-
dies should be given as are calculated, by their stimulating
power, to overcome the  morbid or spasmodic action of
the muscles.  These are:
   1. Opium.  It should be given in large and  frequent
doses.   Dr.  Streltz says he has found from  one to two
drachms of an alkali, taken in the course of a day, greatly
to aid the action of the opium in  this disease.
   Dr. Dazille advises the exhibition of opium in glysters,
and speaks in high terms of the efficacy of a plaister com-
posed of three drachms of opium and a dram of camphor
finely powdered,  and applied to the sole of each foot, in
the tetanus of the West-Indies.*
   2.  Wine: This should be given in quarts,  and even
gallons, daily.  Dr. Currie relates a case of a  man in the
infirmary of Liverpool,  who was cured of  tetanus, by
drinking nearly a quarter cask of Madeira wine.  Dr. Ho-
sack speaks in high terms of it, in a letter to Dr. Duncan,
and advises its being given without any other stimulating
medicine.
   3.  Ardent  Spirits. A quack in New England has
lately  cured tetanus,  by giving  ardent  spirits  in  such
quantities as to produce intoxication. Upon being asked
his reason for this strange practice, he said he had always
observed the jaw to fall in drunken men, and any thing
that would produce that effect, he supposed to be proper
in the locked jaw.
   4. The bark has of late years been used in this disease
 with success.  I had the  pleasure of first seeing its  good
 effects  in the case of colonel  Stone,  in whom a  severe te-
 tanus followed a wound in the foot, received at the battle
 of Germantown, in October, 1777.
          *  Observations sur le Tetanus, p. 286 and 300. 
OBSERVATIONS  ON  THE  TETANUS.      187
  5. The cold bath.  This remedy has been revived
by Dr. Wright of Jamaica, and has in many instances per-
formed cures of this disease.  In one of two cases in which
I have used it with success, the patient's jaw opened in
a few minutes after the affusion of a single bucket of water
upon her body.  The disease was occasioned* by a slight
injury done to one of her toes, by wearing a tight shoe.
The signals for continuing the  use of the cold bath are, its
being followed by a slight degree of fever, and  a  general
warmth of the skin.  Where these do not occur, there is
reason to believe it will do no service, or perhaps do harm.
We have many proofs of the difference in the same dis-
ease, and in the operation of the same medicine, in differ-
ent and opposite climates. Dr. Girdlestone has mentioned
the result of the use of the cold bath in tetanus in the
East Indies, which furnishes  a striking addition to the
numerous facts that have been collected upon that subject.
He tells us the cold bath uniformly destroyed  life, in every
case in which it was used.   The reason is obvious.   In
that extremely debilitating climate, the system in  tetanus
was prostrated too low, to re-act under the sedative opera-
tion of the cold water.
  6. The  warm bath has often been used  with success
in this disease.  Its temperature should be  regulated by
our wishes to promote sweats, or to produce excitement
in the blood-vessels. In the latter case it should rise above
the heat of the human body.
  7. The  oil of amber acts powerfully upon the mus-
cular system.  I have seen the happiest effects from the
exhibition  of six or eight drops of it, every two  hours, in
this disease.
  8. A salivation  has  been often recommended  fot
the cure of tetanus, but unfortunately it can seldom be
excited in  time to do service.  I once saw it  complete the
cure of a sailor in the Pennsylvania hospital,  whose life
was prolonged by the alternate  use of bark and wine.  The,
disease  was brought on him by a mortification of his feet,
in consequence of their being frost-bitten.
  9. Dr. Girdlestone commends blisters  in high terms
in this disease, lie  says he never saw it prove fatal, even
where they only produced a redness on the skin. 
188       observations on the tetanus.

   10.  I have heard of electricity having been used
with advantage in  tetanus, but I can say nothing in  its
favour from my own experience.
   In order to ensure the utmost benefit from the use of
the above remedies, it will be  necessary for a  physician
always to recollect, that the disease is attended with great
morbid action,  and of course each of the stimulating me-
dicines that has been mentioned should be given,  1st, in
large doses; 2dly, in succession ; 3dly,  in rotation; and
4thly, by way  of glyster, as well as by the mouth.
   The jaw-fall in new born infants  is,  I believe, always
fatal.   Purging off the meconium from the bowels im-
mediately after birth has often prevented  it from  one of
its causes; and applying a rag wetted with spirit of tur-
pentine to the navel-string, immediately after  it is cut,
Dr. Chisholm  says, prevents it from another of  its causes
which has been mentioned.  Dr. Dazille says  it is pre-
vented by the  Indians, in the neighbourhood of Cayenne,
by anointing their children daily,  for nine  days  after their
birth, with sweet oil.
   This disease, I have said, sometimes affects horses.  I
have twice seen it  cured by applying a potential caustic
to the neck, under the mane,  by large doses of the oil of
amber, and by plunging one  of them into a river, and
throwing buckets of cold water  upon the other.   It was
cured in  the pidgeon  formerly mentioned, by two grains
of opium administered in the form of a pill.
   I shall conclude my observations upon the tetanus with
the following queries:
   1. What would be the effects of copious blood-letting
in this disease ?   There is a case upon record of its effi-
cacy,  in the Medical Journal of Paris, and I have now in
my possession a letter from the late Dr. Hopkins of Con-
necticut,  containing the history of a cure performed by it.
WThere tetanus is the effect of primary gout, hysteria, or
fever, attended with highly inflammatory symptoms, bleed-
ing is certainly indicated,  in order to prevent the blood-
vessels opposing their force to the action of tonics, and
to place  them in  a  minus or craving state of excite-
ment.  By means of this  remedy employed once in  the
case of Mrs. Coates, at  Kensington, and twice in the case 
observations on  the  tetanus      189
of Miss Germon, in Swanson street, I was enabled to cure
the disease in both of them  It was brought on by a corn
in the former, and by a wound in the latter instance. The
blood of Miss Germon was very sizy.  In general, how-
ever, the disease is so completely insulated in the muscles,
and the arteries  are so far  below their par of excitement
in frequency and force, that little benefit can be expected
from that remedy.  The disease, in these cases, seems to
call for an  elevation, instead of a diminution, of the ex-
citement of the  blood-vessels.  Perhaps bleeding ad deli-
guium animi might so far relax  the muscles,  as to enable
the blood-vessels and other  parts of the body to abstract
from them  their agreeable  and  natural portions of excite-
ment.   It  is certain the muscles of a horse in a tetanus
become relaxed  the instant he dies. By inducing this re-
laxation, in the manner  that has been mentioned, before
the relations of  the different systems of the body to each
other are weakened and dissolved, it is possible the disease
might be cured.
   2. What would be the effect of extreme  cold in this
disease ? Mr. John Hunter used to say,  in his lectures,
" Were he to be attacked  by it,  he would if  possible, fly
to Nova-Zembla, or throw himself into an ice-house."  I
have no doubt of the efficacy of intense cold, in subduing
the inordinate morbid actions which occur in the muscular
system; but it offers so much violence to the fears  and
prejudices of sick people,  or their friends, that it can sel-
dom be applied in such a manner as to derive much bene-
fit from it. Perhaps the  sedative effects of cold might be
obtained with  less difficulty,  by  wrapping  the body in
sheets, and wetting them occasionally for an hour or two
with cold water.
   3. What would be the effect of exciting a strong coun-
ter-action in the stomach and bowels in this disease ? Dr.
Brown of Kentucky cured a tetanus by inflaming the sto-
mach,  by  means of the tincture of cantharides.   It has
likewise been cured by a severe cholera morbus, induced
by a large  dose of corrosive sublimate. The stomach and
bowels, and the external  muscles of the body,  discover
strong associations in many  diseases.  A sick stomach is
always followed by general  weakness, and the dry  gripes 
 190      observations on  the tetanus.

 often paralyse the muscles of the arms and limbs.  But
 further, one of the remote causes of tetanus, viz. cold air,
 often shows the near relationship of the muscles  to the
 bowels, and the vicarious nature of disease in each of them.
 It often produces in the latter, in the West Indies, what
 the French Physicians call a " crampe seche," or, in other
 words, if I may be allowed the expression, a tetanus in
 the bowels.
   4.  A sameness has been pointed out between many of
 the symptoms of hydrophobia and tetanus.   A similar
 difficulty of swallowing, and similar convulsions after it,
 have been remarked in both  diseases.  Death often takes
 place suddenly in tetanus, as it does in hydrophobia, with-
 out producing marks of fatal disorganization in any of
 the internal parts of the body.   Dr.  Physick supposes
 death in these cases to be the effect of suffocation, from
 a sudden spasm and  closure of the glottis,  and proposes
 to prevent it in the same manner that he  has proposed to
 prevent death from hydrophobia, that is, bylaryngotomy.*
 The prospect of success from it appears  alike reasonable
in both cases.
* Medical Repository, 
         an account





                OF






     THE DISEASE OCCASIONED





                BY






DRINKING COLD WATER IN WARM WEATHEB,






              AND THE






        METHOD OF CURING IT. 
i 
AN ACCOUNT, &c.
     FEW summers elapse in  Philadelphia, in which
there are not instances of many persons being diseased by
drinking cold water.  In some seasons, four or five per-
sons have died suddenly from this cause in one day. This
mortality falls chiefly upon the labouring part of the com-
munity,  who seek to allay their thirst by drinking the  wa-
fer from the pumps in the streets, and who are too impa-
tient, or too ignorant, to use the  necessary precautions for
preventing its morbid or deadly effects upon them. These
accidents seldom happen, except when the mercury rises
above 85° in Fahrenheit's thermometer.
   Three circumstances generally concur to produce dis-
ease or death, from drinking cold water.   1.  The patient
is extremely warm.  2. The water is extremely cold. And
3. A large quantity of it is suddenly taken into the body.
The danger from  drinking the cold water is always in
proportion to the degrees of combination  which occur in
the three circumstances that have been mentioned.*
   The following symptoms generally follow, where cold
water has been taken, under the above circumstances, into
the body:
   In a few minutes after the patient has swallowed the  wa-
ter, he is affected by a dimness of sight; he staggers, in
attempting  to walk, and unless supported, falls to  the
  * Dr. Carrie has supposed, in his Medical Reports, that the persons who
are thus affected  by drinking cold water are in a state of debility from the
long continued action of heat upon their bodies; but this is not the  case.
They arc generally in a state ot very high excitement. Tl.i- Doctor's mis-
take is founded upon an erroneous belief,  that the skin and the stomach
possess a similar susceptibility to the action of cold water.
   VOL.  1.             B b 
194     ON THE DISEASE  OCCASIONED BY

ground; he breathes with difficulty; a rattling  is heard
in his throat; his nostrils and cheeks expand and contract
in every act of respiration; his face appears suffused with
blood, and of a livid colour, his extremities become cold,
and his pulse imperceptible; and, unless relief be speedily
obtained, the disease terminates  in death, in four or five
minutes.
   This description includes only the less common cases
of the  effects of drinking  a large quantity of cold water,
when the body  is preternaturally heated.  More frequent-
ly, patients are seized with acute spasms in the breast and
stomach. These spasms are so painful as to produce syn-
cope, and asphyxia.  They are sometimes of the tonic but
more frequently of the clonic kind.  In  the intervals be-
tweeYi each spasm  become longer or shorter, according
as the  disease tends to  life or death.
   It may not be improper to take notice,  that punch, beer,
and even toddy, when drunken  under the same circum-
stances as cold water, have all been known to produce the
same morbid and fatal  effects.
   I know of but one certain remedy for this disease,  and
that is liquid laudanum. The doses of it, as in other
cases of spasms, should be proportioned  to the violence
of the disease. From a teaspoonful to near a table-spoon-
ful have been given  in some  in  stances,  before relief has
been obtained. Where  the powers of life appear to be sud-
denly  suspended,  the same  remedies  should  be used,
which  have been so  successfully employed in  recovering
persons supposed to be dead from drowning.
   Care should be taken in every case of disease, or ap-
parent  death, from  drinking  cold  water, to prevent the
patient's suffering from being surrounded, or even attend-
ed, by too  many people.
   Persons  who have been recovered from the immediate
danger which attends this  disease are sometimes affected.
after it, by  inflammations and obstructions in the breast or
liver.  These generally yield to the usual remedies which
are administered in those complaints, when they arise from
other causes.
   If neither the voice of reason,  nor the fatal examples of
those who have perished from this cause, are  sufficient to 
DRINKING COLD  WATER.
195
produce restraint in drinking a large quantity of cold  li-
quors, when the body is preternaturally heated,  then  let
me advise to
   1. Grasp the vessel out of which you  are  about to
drink for a minute or longer, with both your hands. This
will abstract a portion of heat from the body, and impart
it at the same time to the cold liquor, provided the vessel
be made of metal,  glass, or earth;  for  heat follows the
same laws, in  many instances, in passing through bodies,
with regard to  its relative velocity, which we observe  to
take place in electricity.
  2. If you are not furnished with a cup, and are obliged
to drink by bringing  your mouth  in contact with the
stream which issues from a pump, or a spring, always wash
your hands and face, previously to your drinking, with a
little of the cold water.  By receiving the shock of the wa-
ter first upon those parts of the body, a portion of its heat
is conveyed away, and the vital parts are thereby defended
from the action of the cold.
  By the use of these preventatives, inculcated by adver-
tisements  pasted  upon pumps by the Humane Society,
death from drinking cold water has become a rare occur-
rence for many years past in Philadelphia. 
 
         AN ACCOUNT






             OF THE







CURE OF SEVERAL DISEASES,






            BY THE







  EXTRACTION OF DECAYED TEETH.
/ 
 
AN ACCOUNT, &c.
     SOME time in the month of October,  1801, I at-
tended Miss A. C. with a rheumatism  in her hip joint,
which yielded, for awhile, to the several remedies for that
disease. In the month of November it returned with great
violence, accompanied with a severe tooth-ache. Suspect-
ing the rheumatic affection was excited by the pain in her
tooth,  which was decayed, I directed it to be extracted.
The rheumatism  immediately left her hip, and she reco-
vered in a few days. She has continued ever since to be
free from it.                            .
  Soon after this I was consulted by Mrs. J. R. who had
been affected for several  weeks  with dyspepsia and tooth-
ache.  Her tooth, though no mark of decay appeared in
it, was drawn by my advice.  The next day she wras re-
lieved from her distressing  stomach complaints, and has
continued ever since  to enjoy good  health.   From the
soundness of the external part  of  the tooth, and the ad-
joining gum,  there was  no  reason to  suspect a discharge
of matter from it had produced the disease in her stomach.
  Some time in the year 1801 I was  consulted by the
father of a young gentleman in Baltimore, who had been
affected with epilepsy.   I inquired into the state  of his
teeth, and was informed that several of them in his upper
jaw were much decayed.  I directed  them to be extract-
ed, and advised him afterwards  to  lose a few ounces of
blood, at any time  when he felt the  premonitory symp-
toms of a recurrence of his fits.   He followed my advice,
in consequence of which I had lately the pleasure of hear-
ing from his brother that he was perfectly cured.
  I have been made  happy by discovering that  I have 
200     ON THE CURE OF SEVERAL DISEASES,   «

only added to the observations of other physicians,  in
pointing out a connection between  the extraction of de-
cayed and diseased teeth and the cure of general diseases.
Several cases of the  efficacy of that remedy in  relieving
head-ache and vertigo are mentioned by Dr. Darwin. Dr.
Gater relates that Mr. Pettit, a celebrated French surgeon,
had often cured  intermitting fevers, which had resisted
the bark for months, and even years, by this prescription;
and he quotes from his works two cases, the one of con-
sumption, the other of vertigo, both of long continuance,
which were suddenly cured by the  extraction of two de-
cayed teeth in the former, and of two supernumerary teeth
in the latter case.*
   In  the second number of a  late work,  entitled,  " Bi-
bliotheque Germanique Medico Chirurgicale,"  published
in Paris,  by Dr. Bluver and Dr. Delaroche, there is  an
account, by Dr. Siebold,  of  a young  woman  who had
been  affected for several months with great inflammation,
pain and ulcers, in her right upper and lower jaws, at the
usual time of the appearance of the catamenia,  which  at
that period vv^ere always deficient in quantity.  Upon in-
specting the seats of those morbid affections, the Doctor
discovered several of the molares in both jaws to be de-
cayed.  He directed them  to be drawn,  in consequence
of which the woman was relieved of the monthly disease
in her mouth,  and afterwards had a regular discharge  of
her catamenia.
   These facts, though but little attended to, should not
surprise us, when we  recollect how often the most dis-
tressing general  diseases are brought on by very incon-
siderable inlets of morbid excitement into the  system.
A small tumour, concealed in a fleshy part of the leg, has
been  known to bring on epilepsy.   A trifling wound with
a splinter or a nail, even after  it lias healed, has often in-
duced a fatal tetanus.   Worms in the bowels have pro-
duced internal dropsy of the brain, and a stone in the kid-
ney has excited  the most violent commotions  in  every
part of the system. Many hundred facts of a similar nature
are to be met with in the records  of medicine.
  * Recherches sur diflerens points tie Physiologic dc Pathologie et de
Therapeutique, p. 355, 354. 
           ,BY EXTRACTING DECAYED TEETH.     201

  When we consider how often the teeth, when decayed,
are exposed to irritation  from hot and  cold drinks and
aliments, from pressure by mastication, and from the cold
air, and how intimate the connection of the mouth is with
the whole system, I  am disposed to believe they are often
the unsuspected causes of general, and particularly of ner-
vous diseases.  When we add to the list of those diseases
the  morbid effects of the acrid and putrid matters which
are sometimes discharged from caries teeth, or from ulcers
in the gums created  by them, also the influence which
both have in preventing  perfect mastication, and the con-
nection of that animal function  with  good health, I can-
not help thinking that our success in  the treatment of all
chronic diseases would be very much promoted,  by di-
recting our inquiries  into the state of  the  teeth in sick
people, and by advising their extraction in every case in
which they are  decayed.  It  is  not  necessary that  they
should be attended with  pain,  in order to produce diseases,
for splinters, tumours, and other irritants before mention-
ed, often bring on disease and death,  when they  give no
pain, and are unsuspected as causes of them  This trans-
lation of sensation and motion to parts  remote from the
place where impressions are made  appears in many in-
stances, and seems to depend  upon an original law of the
animal  economv.
VOL. I.
c c 
 
                       4




              OBSERVATIONS


                    UPON


    WORMS IN THE ALIMENTARY CANALS,


                   UPON THE


           ANTHELMINTIC MEDICINES.








I
/










i 
 
OBSERVATIONS, &c.
  WITH great diffidence  I venture to lay before  the
public my opinions upon worms; nor should I have pre-
sumed to do it, had I not entertained a hope of thereby
exciting further inquiries upon this subject.
  When we consider how universally worms are found in
all young animals, and how frequently they exist in the
human body, without producing disease of any kind, it
is natural to conclude, that  they serve some useful and
necessary purposes in the animal economy.  Do they con-
sume the superfluous aliment which all young animals are
disposed to take,  before they have been taught, by ex-
perience or reason, the bad consequences which arise from
it?   It is  no objection to this opinion,  that worms are
unknown in the human body in some countries.   The
laws of nature are  diversified,  and often suspended under
peculiar circumstances in many cases, where the departure
from uniformity is still more unaccountable than in the
present instance.  Do worms produce diseases  from  an
excess in their number, and an error in their  place,  in
the  same manner that blood,  bile, and air produce diseases
from an error in their place, or from excess in their quan-
tities ?  Before these questions are decided,  I shall men-
tion a few facts, which have been the result of my own ob-
servations upon this subject.
  1. In many instances, I have seen worms discharged in
the  small-pox and measles, from children who were in per-
fect health previously to their being attacked by those dis-
eases, and who never before discovered a single symptom
of worms. I shall say nothing here of the swarms of worms
which are discharged in fevers of all kinds, until I attempt
to prove that an  idiopathic fever is never  produced by
worms. 
206        OBSERVATIONS UPON WORMS

   2. Nine out of ten of the cases which I have seen oi
worms, have been in children of the grossest habits and
most vigorous constitutions.  This is more especially the
case, where the worms are dislodged  by the  small-pox
and measles.   Doctor Capelle of Wilmington, in a letter
which I received from him, informed me, that in the livers
of sixteen out of eighteen rats which he dissected, he found
a number of  the taenia worms.   The rats were  fat, and
appeared in other respects to have been in perfect health.
The two rats in which  he found no  worms,  he  says,
" were very lean, and their livers smaller in proportion
than the  others."
  3. In weakly children, I have often known the most
powerful anthelmintics given without  bringing away  a
single worm.  If these medicines have afforded any re-
lief,  it has been by their tonic  quality.  From this fact,
is it not probable—the conjecture, I am afraid,,is too bold,
but I will risk it:—is it not probable, I say, that children
are sometimes disordered from the want of worms ?  Per-
haps the  tonic medicines  which  have  been mentioned ren-
der the bowels a more quiet and comfortable asylum for
them, and thereby provide  the system with the means of
obviating the effects of crapulas, to which all children are
disposed.  It is in this way that nature, in many instances,
cures evil by evil.   I confine the salutary office of worms
only to that species of them which is known by the name
of the round worm,  and which occurs most frequently in
children.
  Is there any such disease as an idiopathic worm-fever?
The Indians in this country say there is not, and ascribe
the discharge of worms to a fever and  not a fever to the
worms.*
  By adopting this opinion, I am aware that I contradict
the observations of many eminent and respectable phy-
sicians.
  Doctor Huxham describes an epidemic pleurisy, in the
month of March, in the year  1740, which  he supposes
was produced by his patients feeding upon some corn that
had been injured by the  rain the August beforef.   He
         * See the Inquiry into the Diseases of the Indians.
         | Vol. ii. of his Epidemics, p. 56. 
AND ANTHELMINTIC MEDICINES.      207
likewise mentions that a number of people, and those too
of the elderly sort,* were afflicted at one time with worms,
in the month of April, in the year  1743.
   Lieuteaud gives an account of an epidemic worm fever
from Velchius, an Italian physician ;f and Sauvages des-
cribes, from Vandermonde, an epidemic dysentery from
worms,  which yielded  finally only to worm medicines.^
Sir John Pringle, and Doctor Monro, likewise, frequently
mention  worms as accompanying  the dysentery and re-
mitting fever, and recommend the use of calomel as an
antidote to them.
  I grant that  worms appear more frequently in some
epidemic diseases than in others, and oftener in some years
than in others.   But may not the  same heat, moisture,
and diet, which produced the diseases, have produced the
worms ?  And may not their discharge from the  bowels
have been occasioned in those epidemics, as in the small-
pox and measles, by the increased heat of the body,  by the
want of nourishment, or by an anthelmintic quality being
accidentally  combined with some of the medicines that
are usually given in fevers ?
  I answer to this, we are told that we often see the crisis
of a fever brought  on  by the discharge of worms from
the bowels by means of a purge, or by anthelmintic me-
dicine.   Whenever this is the case, I believe  it is occa-
sioned by offending bile being dislodged by means of the
purge, at the same time with the worms,  or  by the  an-
thelmintic medicine (if not a purge) having been given
on, or near, one of the usual critical days of the  fever.
What makes the latter supposition probable is, that worms
are seldom suspected in the beginning of fevers, and an-
thelmintic medicines seldom given, till every other re-
medy has failed  of success;  and this generally happens
about the usual time in which fevers terminate in  life or
death.
  It is very remarkable, that  since  the discovery and  de-
scription of the hydrocephalus internus we hear and read
much less than formerly of worm fevers.   I suspect that
disease of the brain has laid the  foundation for the prin-
cipal part of the cases  of worm-fevers, which are upon
      * P. 136.      f Vol. i. p. 76.      % Vol. ii. p. 329. 
208         OBSERVATIONS UPON WORMS
record in books of medicine. I grant that worms sometimes
increase the danger from fevers, and often confound the
diagnosis and prognosis of them, by a number  of  new
and anomalous symptoms. But here we see nothing more
than that complication of symptoms, which often occurs
in diseases of a very different and opposite nature.
   Having rejected  worms as the cause of fevers,  I  pro-
ceed to remark, that the  diseases  most commonly  pro-
duced by them belong to Dr. Cullen's class of neuroses.
And here I might  add,  that there  is scarcely a  disease,
belonging to this class,  which is not produced by worms.
   It would be only publishing  extracts  from books,  to
describe them.
   The chronic and nervous diseases of children,  which
are so numerous, and frequently fatal, are, 1 believe, fre-
quently- occasioned by worms.   There is no great danger,
therefore, of doing misehief, by prescribing anthelmintic
medicines in all our first attempts  to cure  their chronic
and nervous diseases.
   I have been  much gratified by finding myself supported
in the above theory of worm-fevers, by the late Dr. Wil-
liam Hunter, and by Dr. Butter, in his excellent treatise
upon the infantile remitting fever.
   I have taken great pains to find out,  whether the pre-
sence of the different species of worms might not be dis-
covered by certain peculiar symptoms: but all to no
purpose.   I once attended a girl of twelve years of age in
a fever,  who discharged four yards of a taenia, and who
was so far from having discovered any peculiar symptom
of this species of worms, that she had never complained
of any other indisposition,  than now and then a slight pain
in the stomach, which often occurs  in young girls from a
sedentary life,  or from  errors in their diet.   I beg leave
to add further,  ths-t there is not a symptom which has
been said to indicate the presence of worms of any kind,
as the cause of a disease, that has not deceived me; and
none oftener than the one that has been so much depended
upon, viz. the picking of the nose.  A discharge of worms
from the bowels is, perhaps, the  only symptom  that is
pathognomonic of their presence in the intestines.
   I shall now make a  few remarks upon anthelmintic
remedies. 
AND ANTHELMINTIC MEDICINES.      209
  But I shall first give an account of some experiments
which I made in the year 1771,  upon the common earth-
worm, in order to ascertain the  anthelmintic  virtues of a
variety of substances.   I made choice of the earth-worm
for this purpose, as it  is,  according to naturalists,  nearly
the same in its structure, manner of subsistence, and mode
of propagating its species, with  the round worm  of the
human body.
  In the first column I shall set down, under distinct
heads, the substances in which worms  were placed ; and
in the second and third columns the time of their death,
from the action of these substances upon them.
I. Bitter and astringent sub-		Hours.	Minutes.
stances.			
Watery infusion of aloes		2	48
		1	30
		1	30
11. Purges.			
Watery infusion of Jalap		1	—
-----------------bear's-foot		1	17
		1	wmimm
			
III. Salts. ,			
1. Acids.			
Vinegar		—	1} convulsed.
Lime juice		—	1
Diluted nitrous acid		—	4
2. Alkali.			
A watery solution of salt of tartar		—	2 convulsed, throwing up
			a mucus on the surface
3 Neutral Salts.			of the water.
In a watery solution of common			
salt		—	1 convulsed.
----of nitre		— ■	ditto.
----of sal diuretic		—	ditto.
----of sal ammoniac		—	i*
----of common salt and sugar		—	
4. Earthy and metallic salts.			
In a watery solution of Epsom	salt	—	15£
----. of rock alum		—	10
----of corrosive sublimate		__	li convulsed.
----of calomel		__	49
----of turpeth mineral		—	1 convulsed.
----of sugar of lead		—	3
----of green vitriol		—	1
----of blue vitriol		__	10
----of white vitriol		—	30
VOL. I.
nd 
210         OBSERVATIONS UPON  WORMS
IV. Metals.
  Filings of steel
  Filings of tin

V. Calcareous earth.
  Chalk.

VI. Narcotic substances.
  Watery infusion of opium
  —— of Carolina pink-root
  — of tobacco

VII. Essential oils.
  Oil of Wormwood
  — of mint
  — of caraway seed
  — of amber
  — of anniseed
  — of turpentine

VIII. Arsenic
  A watery solution of white arsenic

IX. Fermented liquors.
  In Madeira wine
  Claret

X. Distilled spirits.
  Common rum

XI. The  fresh juices of  ripe
             FRUITS.
  The juice of red cherries
  .        of black do.
  -------. ftf red currants
          of gooseberries
Hours.
Minutes.
— of wortleberries
— of black berries
— of raspberries
— of plums
  of peaches
  The juice of water-melons, no ef-
    fect

XII. Saccharine substances.
  Honey
  Molasses
  Brown sugar
  Manna

XIII. In aromatic substances.
 • Camphor
  Pimento
  Black pepper

XIV. Foetid substances.
  Juice of onions
  Watery infusion of assafcetida
  ——— Santonicum,  or worm seed
	25|
1	
2	—
__	11$ convulsed
—	33
—	14
	3 convulsed.
^_	3
__	3
—	H
—	*i
—•■	6
near	
2	—-
	3 convulsed,
—	10
—	1 convulsed.
	51
	5
_	21
—	
—■	12
—.	7
__	si
—	13*
25
 7
 7
30
 5
 3i
45
5
 3*
27 
AND ANTHELMINTIC MEDICINES.       211
XV. Miscellaneous substances.
  Sulphur mixed with oil
iEthiops mineral
Sulphur
Solution of gunpowder
  -------- of soap
  Oxymel of squills
  Sweet oil
Hours, i Minutes.
   2
   2
   2
tf
  In the application of these experiments to the  human
body, an allowance must always be made for the alteration
which the several anthelmintic substances that have been
mentioned may undergo, from mixture and diffusion, in
the stomach and bowels.
  In order to derive any benefit from these experiments,
as well as  from the observations that have been made upon
anthelmintic  medicines, it  will be necessary to  divide
them into such as act,
  1. Mechanicallv,
  2. Chemically upon worms; and,
  3. Into those  which possess a power composed of che-
mical and mechanical qualities.
   1. The mechanical medicines act indirectly and directly
upon the  worms.
  Those which  act indirectly are, vomits, purges,  bitter
and astringent substances, particularly aloes, rhubarb, bark,
bear's-foot, and  worm seed.  Sweet  oil acts indirectly and
very feebly upon worms. It  was introduced into medicine
from its efficacy in destroying the  botts in horses; but
the worms which infest the human bowels are of a differ-
ent nature, and possess very  different organs  of life from
those which are  found in the stomach of a horse.
   Those  mechanical medicines which act directly upon
the worms, are cowhage* and powder of tin.  The last
of  these medicines has been supposed  to act chemically
upon the  worms, from  the  arsenic which  adheres to it;
but from  the length of time a worm lived in a solution of
white arsenic, it is probable  the  tin acts altogether me-
chanically upon  them.
   2. The medicines  which  act chemically upon  worms
appear, from our experiments, to be very numerous.
   Nature has wisely  guarded children against the morbid
* Dolichos Prurians, of Linnseus. 
212        OBSERVATIONS UPON WORMS
effects of worms, by implanting in them an early appetite
for common salt,  ripe fruits, and saccharine substances;
all of which appear to be among the most speedy and ef-
fectual poisons for worms.
   Let it not be said,  that nature here counteracts her own
purposes.   Her conduct in  this  business is conformable
to many of her operations in the  human  body,  as well as
throughout all htr  works.   The  bile is  a necessary part
of the animal fluids, and yet an appetite for ripe fruits seems
to be  implanted, chiefly to obviate the consequences of its
excess, or acrimony,  in the summer and autumnal months.
   The use of common salt as an  anthelmintic medicine is
both ancient and universal.   Celsus recommends it.  In
Ireland it is a common practice to feed children, who are
afflicted by worms, for a week or two upon a salt sea-weed,
and when the bowels are well charged with it, to give  a
purge of wort in order to carry off the worms,  after they
are debilitated by the salt diet.
   I have administered many pounds of common salt co-
loured with cochineal, in doses of half a drachm, upon an
empty stomach in the morning, with  great success in de-
stroying worms.
   Ever since I  observed the effects of sugar  and other
sweet substances upon  worms,  I  have recommended  the
liberal use of all of them in the diet of children, with the
happiest effects.  The sweet substances  probably act in
preventing the diseases from worms in the stomach only,
into which they often insinuate  themselves, especially in
the morning   When we wish to dislodge  worms from
the bowels by sugar  or molasses, we must give these sub-
stances in  large quantities, so that they may escape in part
the action of the stomach upon them.
   I can say nothing  from my own experience of the effi-
cacy of the mineral salts,  composed of copper,  iron, and
zinc,  combined with vitriolic acid, in destroying worms
in the bowels.  Nor have 1 ever  used the corrosive sub-
limate in small doses as an  anthelmintic.
  ^ I have heard of  well-attested cases of the efficacy of the
oil of turpentine in destroying worms.
   The expressed juices of onions and of garlic are very
common remedies for  worms.   From one of the experi 
             AND ANTHELMINTIC MEDICINES.        213

     ments,  it appears  that the onion juice possesses strong
     anthelmintic virtues.
        I have often prescribed a tea-spoonful of gun-powder
     in  the  morning, upon  an empty stomach,  with obvious
     advantage. The active medicine here is probably the nitre.
        I have found a syrup made of the bark of the Jamaica
     cabbage-tree* to be a powerful, as well as a most agreea-
     ble anthelmintic medicine.  It  sometimes purges and vo-
     mits, but its good effects may be obtained, without giving
     it in such doses as to produce these evacuations.
        There is not a more  certain anthelmintic  than Carolina
     pink-root, f  But as there have been instances of death hav-
     ing followed excessive  doses of it,  imprudently adminis-
     tered, and a§ children are often affected by giddiness, stu-
     por, and a redness and  pain in the  eyes, after taking it,  I
     acknowledge that I have generally preferred  to it less cer-
     tain, but more  safe, medicines for destroying worms.
        3. Of the medicines whose action is compounded  of
      mechanical and chemical qualities,  calomel, jalap, and the
      powder of steel, are the principal.
        Calomel,  in order to  be effectual, must be given in large
      doses.  It is a safe and  powerful anthelmintic. Combined
      with jalap,  it  often Wings away worms when given for
      other purposes.
         Of all the medicines that I have administered, I know
      of none more safe and certain than the simple preparations
      of iron, whether they be given in the form of steel-filings,
      or of the rust of iron.  If ever they fail of success, it is be-
      cause they are  given in too small doses.  I generally pre-
      scribe  from five to thirty grains, every morning, to children
      between one year and ten years old; and I have been taught
      by an  old  sea-captain, who was cured of a taenia by this
f     medicine, to give  from two drachms to half an ounce of
      it, every morning, for three or four days,  not only with
      safety, but with success.
         I shall conclude this essay with the following remarks :
         1. Where the action of medicines upon worms in the
      bowels does not agree  exactly with their action upon the
      earth-worms,  in the experiments that  have been related
                    • Geoffrea, of Linnaeus.
                    | Spigelia Marylandica, of Linn sens. 
214         OBSERVATIONS UPON WORMS.
it must be ascribed to the medicines being more or less
altered by the action of the stomach  upon them.   I con-
ceive that the superior anthelmintic qualities of pink-root,
steel-filings, and calomel  (all of which  acted  but slowly
upon the earth-worms compared with  many  other sub-
stances) are in a great degree occasioned by their escap-
ing the digestive powers unchanged, and acting in a con-
centrated state upon the worms.
   2.  In fevers attended with anomalous symptoms, which
are supposed to arise from worms,  I have  constantly re-
fused to yield to the solicitations of my patients,  to aban-
don the indications of cure in  the fever, and to pursue
worms as the principal cause of the disease.  While I have
adhered steadily to the usual remedies  for the  different
states of fever, in all their  stages, I have at the same time
blended  those remedies  occasionally with anthelmintic
medicines. In this I have imitated the practice of physi-
cians in  many other diseases,  in which troublesome and
dangerous symptoms are pursued, without  seducing the
attention from the  original disease.   The anthelmintic
medicines prescribed in these cases should not  be the rust
of iron, and common salt, which are so very useful in
chronic diseases from worms, but calomel and jalap, and
such other medicines as aid in  the cure of fevers. 
AN ACCOUNT
OF THE
EXTERNAL USE OF ARSENIC,
IN
THE CURE OF CANCERS.
ft
i 
 
AN ACCOUNT, &c.
     A FEW years ago, a certain Doctor Hugh Martin,
a surgeon of one of the Pennsylvania regiments stationed
at Pittsburg; during the latter part of the late war,  came
to this city, and advertised to cure  cancers with a medi-
cine which he  said he had discovered in the woods, in the
neighbourhood of the garrison.  As  Dr. Martin had once
been  my pupil, I took the liberty of waiting upon him,
and asked  him some questions  respecting his discovery.
His answers were calculated to make me believe, that his
medicine was of a vegetable nature, and that it was origi-
nally an  Indian remedy.   He  showed me  some of the
medicine,  which appeared to be the powder of a  well-
dried root of some kind.   Anxious  to see the success of
this medicine in cancerous sores,  I prevailed upon the
Doctor to admit me to see him apply it in  two or  three
cases.  I observed, in some instances, he applied a pow-
der to the parts affected, and in  others only touched them
with a feather  dipped in a liquid which had a white sedi-
ment, and which he made me  believe was the vegetable
root diffused in water.  It gave me great pleasure to wit-
ness the  efficacy of the Doctor's applications.  In several
cancerous ulcers, the cures he performed were complete.
Where the cancers were much  connected with the lym-
phatic system, or accompanied  with a  scrophulous habit
of body, his medicine always failed, and,  in some instan-
ces, did  evident mischief.
VOL. I.
e e 
 218      ACCOUNT OF  THE  USE  OF ARSENIC

   Anxious to discover a medicine that promised relief in
 even a few cases of cancers, and supposing that all the cau-
 stic vegetables were nearly alike, I applied the phytolacca
 or poke-root, the stramonium,  the arum, and  one or two
 others, to foul  ulcers,  in hopes of seeing the same effects
 from them which  I had seen from Doctor Martin's  pow-
 der ; but in these  I  was disappointed.   They  gave  some
 pain, but performed no cures.  At length I was furnished
 by a gentleman from Pittsburg with a powder which I had
 no doubt, from a variety of circumstances,  was of the same
 kind as that used by Dr. Martin. I applied it to a fungous
 ulcer, but without producing the degrees of pain, inflamma-
 tion, or discharge, which I had been accustomed to see
 from the application of Dr.  Martin's powder.  After this,
 I should have suspected that the powder was not a simple
 root had not the Doctor  continued  upon all occasions  to
 assure me, that it  was  wholly a vegetable  preparation.
   In the beginning of the year 1784, the Doctor died, and
 it  was generally believed that his medicine had died with
 him.   A few weeks after his death  I procured, from one
 of his administrators, a few ounces of the Doctor's powder,
 partly with a view  of applying it to a cancerous sore which
 then offered, and partly with a view of examining  it more
 minutely than I had been able to do during the Doctor's
 life.   Upon throwing the powder, which was of a brown
 colour, upon a piece of white paper, I perceived distinctly
 a number of white particles  scattered through  it.   I sus-
 pected at first that  they were corrosive sublimate, but the
 usual tests of that metallic salt soon convinced me that I
 was  mistaken.  Recollecting that arsenic was the basis  of
 most of the celebrated cancer powders that have been used
 in  ttu  world, I had recourse to  the  tests for detecting  it.
 Upon  sprinkling a small quantity  of the powder  upon
 some coals of fire,  it emitted the garlick smell  so percep-
tibly as to be known by several persons whom I called in-
to  the room where  I made the experiment, and who knew
nothing of the object of my inquiries.   After this,  with
some difficulty, I picked out about three or four grains of
the white powder, and bound them between two pieces of
copper, which I threw into the fire.   After the copper
pieces became red hot, I took them out of the fire, and 
IN  THE  CURE  OF CANCERS.         219
when they had cooled, discovered an evident  whiteness
imparted to both of them.   One of the pieces afterwards
looked like dull silver.  Tnese  two tests have generally
been thought sufficient to distinguish the  presence of ar-
senic in any bodies; but I made use of a third,  which has
lately been communicated to the world by Mr.  Bergman,
and which is supposed to be in all cases infallible.
  I infused  a small quantity of the  powder in a solution of
a vegetable alkali in water for a few hours, and then pour-
ed it upon  a solution of blue vitriol in water. The co-
lour of  the  vitriol  was immediately changed to a beautiful
green, and afterwards  precipitated.
  I shall close  this paper with a  few remarks upon this
powder, and upon the cure  of cancers and foul ulcers of
all kinds.
  1. The use of caustics in  cancers and foul ulcers is very
ancient, and universal.  But I believe arsenic to be the
most efficacious of any that  has ever been used. It is the
basis of Plunket's and probably of Guy's well-known can-
cer powders.  The great art of applying it successfully,
is to dilute  and mix it in such a manner as to mitigate the
violence of its action.  Doctor Martin's composition was
happily calculated for this purpose. It gave less pain than
the common or lunar caustic.   It excited a moderate in-
flammation, which separated the morbid from  the sound
parts, and promoted a plentiful afflux of humours to the
sore during its application.  It seldom produced an escar;
hence it insinuated itself into  the deepest recesses of the can-
cers, and  frequently separated those fibres in an unbroken
state, which are generally called the  roots of the cancer,
Upon this account, I think, in some ulcerated cancers it
is to be preferred to the knife.   It has no action upon the
sound skin.   This Doctor Hall  proved, by confining a
small quantity of it upon his arm for many hours.  In those
cases where Doctor Martin  used it to extract cancerous or
schirrous tumours that were not ulcerated, 1 have reason to
believe that he always broke the skin with Spanish  ies.
   2. The arsenic  used by the Doctor was the pure white
arsenic.  I should suppose from the  examination I made
of the powder with the eye, that the proportion of arsenic
to the vegetable powder, could not be more than one-for- 
220     ACCOUNT OF  THE  USE  OF ARSENIC

tieth part of the whole compound.  I have re uson to think
that the Doctor employed different vegetable substances at
different times.   The vegetable matter with which the ar-
senic was combined in the powder which 1 used in my ex-
periments, was probably nothing more than the powder of
the root and berries of the solanum lethale, or deadly night-
shade.   As the principal,  and perhaps the only design of
the vegetable addition was to blunt the activity of the ar-
senic, I should suppose thatthe same proportion of common
wheat flour as the Doctor used  of his caustic vegetables,
would answer nearly the same purpose.  In  those cases
where the Doctor applied a feather dipped in a liquid to the
sore of his patient, I have no doubt but his phial contained
nothing but a weak solution of arsenic in water.  This is
no new method of applying arsenic to foul ulcers. Doctor
Way, of Wilmington, has spoken in the highest terms to
me of a wash for foulnesses on  the skin, as well as old
ulcers,  prepared  by boiling an ounce of white arsenic in
two quarts of water to three pints, and applying it once or
twice a day.
   3.  I mentioned, formerly, that Doctor Martin was often
unsuccessful in the application of his powder.  This  was
occasioned by  his using it  indiscriminately in all cases.
In schirrous  and  cancerous tumours, the knife should al-
ways be preferred to the caustic.  In cancerous ulcers at-
tended with a scrophulous or a bad habit of body,  such
particularly as  have  their seat  in the neck, in the breasts
of females, and in the axiliary glands, it can only protract
the patient's  misery.  Most of the cancerous sores cured
by Doctor Martin were  seated on the nose, or cheeks, or
upon the surface or extremities of the body. It remains yet
to discover a cure for cancers that taint the fluids, or infect
the whole lymphatic system.  This cure I apprehend must
be sought for in diet, or in  the long use of some internal
medicine.
   To pronounce a disease incurable, is often to render it so.
 The intermitting fever if left to itself, would probably prove
 frequently and perhaps  more  speedily  fatal than cancers.
 And as cancerous tumours and sores are often neglected, or
 treated improperly by injudicious people, from an appre-
 hension that they are incurable (to which the  frequent ad- 
IN  THE  CURE OF CANCERS.         221
vice of physicians " to let them alone," has no doubt con-
tributed) perhaps the introduction of arsenic into regular
practice as a remedy for cancers, may invite to a more early
application to physicians, and thereby prevent the deplorable
cases that have been mentioned, which are often  rendered
so by delay or unskilful management.
  4. It is not in cancerous sores only that Doctor Martin's
powder has been found to do service.   In sores of all kinds,
and from a variety of causes, where they have been attended
with fungous flesh or callous edges, I have used the Doctor's
powder with advantage.
   I flatter myself that I shall be excused in giving this detail
of a quack medicine, when we reflect that it was from the in-
ventions and temerity of quacks, that physicians have deriv-
ed some of their most active and useful medicines. 
 
         AN INQUIRY









            INTO THE









CAUSK AND CURE OF SORE LEGS. 
 
AN INQUIRY,  &c.
     HOWEVER trifling these complaints may appear,
 they compose a large class of the diseases of a numerous
 body of people.  Hitherto, the persons afflicted  by them
 have been too generally abandoned to the care of empirics,
 either because the disease was considered as beneath the
 notice of physicians, or because they were unable to cure
 it.   I would rather ascribe it to the latter, than to the for-
 mer cause,  for pride  has no natural fellowship  with the
 profession of medicine.
   The difficulty of curing sore legs has been confessed,
 by physicians in every country.  As far as my observa-
 tions have extended, I am disposed to ascribe this difficul-
 ty to the uniform and  indiscriminate  mode of treating
 them, occasioned by the want of a theory which shall ex-
 plain their proximate cause.   I shall attempt in a few pa-
 ges to deliver one, which, however imperfect, will, I hope,
 lay a foundation for more successful inquiries upon this
 subject hereafter.
   1 shall begin my observations upon this disease, by de-
 livering and supporting the following propositions.
  I.  Sore legs are induced  by general debility.   This
 I infer  from the occupations and habits  of the persons
 who are most subject to them.  They are day-labourers,
 and sailors, who are in  the habit of lifting great weights;
 also washer-women,  and all other persons, who pass the
 greatest part of their time' upon their feet.  The blood-
 vessels and muscular fibres of the legs are thus overstretch-
ed, by which means  either a rupture, or such a languid
action  in the vessels,  is induced, as that an  accidental
wound from any cause, even from the scratch of a pin, or
the biteofamosquetoe,  will not easily heal. But labourers,
  VOL.  i.                 f  f 
226                ON  SORE LEGS.
sailors, and washer-women, are not the only persons who are
afflicted with sore legs.  Hard drinkers of every rank and
description are likewise subject to them.  Where strong
drink, labour, and standing long on the feet are united,
they more certainly dispose to sore  legs, than when they
act separately.  In China, where the labour which is per-
formed  by brutes in other countries is performed by men,
varices on the legs are very common among the labouring
people.   Perhaps, the reason why the debility induced in
the legs produces varices instead of  ulcers in these people,
may be  owing to their not adding the debilitating stimulus
of strong  drink to that of excessive  labour. •
   It is not extraordinary that the debility produced by in-
temperance in drinking ardent spirits should appear first
in the lower extremities.  The debility produced  by in-
temperance in the use of wine makes its first appearance
in the form of gout, in the same part of the body.  The
gout, it is true,  discovers itself most  frequently in pain
only, but there are cases  in which it  has terminated  in
ulcers, and even mortifications on the legs.
   11. Sore legs are connected with a morbid state of the
whole system.   This 1 infer,
   1. From the causes which induce them,  all of which
act more or less upon every part of the  body.
   2 From (heir  following  or preceding diseases,  which
obviously belong to the whole system.  Fevers and dy-
senteries often terminate critically in this disease; and the
pulmonary consumption and  apoplexy have often been
preceded  by  the suppression of a habitual discharge from
a sore leg.  The two latter diseases have been ascribed
to the  translation of  a morbific matter to  the  lungs  or
brain:  but it is more rational to ascribe  them to  a pre-
vious debility in those organs by which means their ves-
sels were more easily excited into  action and effusion  by
the stimulus of the plethora, induced upon the system in
consequence of the confinement of the fluids formerly dis-
charged from the leg,  in the form of pus.  This plethora
can do harm only where there is previous debility ; for I
maintain  that the system (when the  solids are exactly
toned)  will always relieve itself of a sudden  preternatural
 accumulation of fluids by means of some natural emunc- 
ON SORE LEGS.                227
tory.   This has been often observed in the menorrhagia,
which accompanies plentiful living in women,  and in the
copious discharges from the bowels and kidneys, which
follow a suppression of the perspiration.
  3.  I infer it, from their appearing almost universally in
one disease, which is evidently a disease of the whole sys-
tem, viz. the scurvy.
  4.  From their becoming in some  cases the  outlets of
menstrual blood,  which is discharged in  consequence of
a plethora,  which affects  more or less  every part of the
female system.
  5.  I infer it from the symptoms of sore legs, which are
in some cases febrile, and affect the pulse in every part of
the  body with preternatural frequency or force.  These
symptoms were witnessed, in an eminent  degree, in two
of the patients who furnished subjects for clinical remarks
in the Pennsylvania hospital some years ago.
  6.  I infer that sore legs are a disease of the whole sys-
tem,  from the manner in which they are sometimes cured
by nature and art.  They often prove the  oujtlets of many
general diseases,  and all the remedies  which  cure them
act more or less upon the whole system.
  In  all cases of sore legs there is a tonic and atonic state
of the whole system.  The same state  of excessive or
weak morbid action takes place in the parts which are af-
fected by the sores.  The remedies to cure them, there-
fore,  should be general and local.
  In  cases where the  arterial  system  is affected by too
much tone, the general remedies should be,
  I.  Blood-lettinc.   Of the efficacy  of this remedy
in disposing  ulcers suddenly to heal, the two clinical pa-
tients before-mentioned exhibited remarkable  proofs, in
the  presence of all the students of medicine in the univer-
sity.  The  blood drawn was sizy in both cases.  I have
not the merit of having introduced this remedy into prac-
tice in the cure of ulcers.  I learned it  from Sir John
Pringle.   I have known  it to be used with equal success
in a sore breast, attended by pain and inflammation, after
all the usual remedies in that disease had been used to no
purpose.
  II. Genttle  purges. 
228                ON SORE LEGS.
   Ill; Nitre.   From fifteen  to  twenty grains of this
 medicine should be given three times a-day.
   IV. A temperate diet, and a total abstinence from
 fermented and distilled liquors.
   V. Cool and pure air.
   VI. Rest, in a recumbent posture of the body.
   The local remedies in this state of the system should be,
   I. Cold water.   Dr. Rigby has written largely in favour
 of this remedy, when applied to local inflammations.  From
 its good effects in allaying the inflammation, which some-
 times follows the puncture which is made in the arm in
 communicating the small-pox, and from the sudden re-
 lief it affords in the inflammatory state of the ophthalmia
 and in the piles, no one can doubt of its efficacy in sore
 legs, accompanied by inflammation in those vessels which
 are the immediate seat of the disease.
   II. Soft poultices of bread and milk, or of bread  mois-
 tened with  lead  water.   Dr.  Underwood's  method  of
 making a  poultice  of bread and  milk should  be  preferred
 in this case.   He directs us first to  boil the milk, then to
 powder the bread,  and throw it into the milk,  and after
 they have been intimately mixed, by being well stirred and
 boiled together, they should be pouredoutand spread upon
 a rag, and a knife dipped in sweet oil or lard should be run
 over them.  The solidity  and consistence of the poultice
 is hereby  better preserved, than when the oil or lard is
 mixed with the bread and  milk over the fire.
   III. When the inflammation subsides, adhesive plaisters
 so applied as to draw the sound edges of the sores together.
 This remedy has  been used with  great success by Dr.
 Physic,  in the Pennsylvania hospital, and  in  his private
practice.
   IV. Above all,  rest, and a horizontal posture of the leg.
 Too much cannot be said  in favour of this remedy in this
species of sore legs. Nannoni, the famous Italian surgeon,
sums up the cure of sore legs in three words, viz. " Tempo,
riposo, e pazienza;" that is, in  time, rest, and  patience.
A friend of mine,  who was cured by this surgeon of a
sore leg, many years ago,  informed me, that he confined
him to his bed during the greatest part of the time that he
was under his care. 
ON SORE LEGS.                229
  In sore legs, attended  by too  little general  and local
action, the following remedies are proper.
  I. Bark   It should be used  plentifully, but with a
constant reference to the state of the system; for the changes
in the weather, and other accidental circumstances,  often
produce such changes in the system, as to render its disuse
for a short time frequently necessary.
  II. Mercury.  This remedy has been supposed to act
by altering the fluids, or by discharging  a morbid matter
from them, in curing sore legs.   But this is by no means
the case.   It appears to act as a universal stimulant; and
if it prove most useful when  it excites a salivation,  it is
only because in this way it excites the most general action
in the system.
  III. Mineral tonics, such as the different prepara-
tions of iron, copper, and  zinc.
  IV. Gentle exercise. Rest,  and a recumbent pos-
ture of the body, so proper  in the tonic,  are both hurtful
in this species of sore legs. The efficacy# of exercise, even
of the active kind, in the cure of sore legs,  accompanied
by deficient action in the vessels,  may easily be conceived
from its good effects after gun-shot wounds, which are
mentioned by Dr. Jackson.*  He tells us, that those Brit-
ish  soldiers who had been wounded at the battle of Guil-
ford, in North  Carolina, who were turned out of the mili-
tary hospitals and followed the army, soonest recovered of
their wounds.  It was remarkable,  that if they delayed
only a few days on the road,  their  wounds grew worse,
or ceased to heal.
  In the use of the different species of exercise, the same
regard should be had to the state of the system,  which has
been recommended in other diseases.
  V. A nutritious and moderately stimulating  diet,  con-
sisting of milk, saccarhine vegetables, animal food,  malt
liquors, and wine.
  Wort has done great service in sore legs. The manner
in which I have directed it to be  prepared and taken is as
follows: To three or four heaped  table-spoonsful of the
malt, finely powdered  and sifted, add two table-spoonsful
of brown sugar, and three or four of Madeira,  sherry, or
Lisbon wine,  and a quart of boiling water.  After they
                  * Medical Journal, 1790. 
230                ON SORE LEGS.
have stood a few hours, it may be drunken liberally by the
patient, stirring it each time before he takes it, so that the
whole  substance of the malt may be conveyed into the
stomach.   A little lime-juice may be added, if the patient
requires it, to make it more pleasant.  The above quan-
tity may be taken once, twice,  or three times a-day, at
the pleasure of the patient, or according to the indication
of his disease.
   VI.  Opium.   This remedy is not only useful in easing
the pain of a sore leg,  but  co-operates with other cordial
medicines in invigorating the whole system.
   VII. Baglivi says that in Rome, and Dr. Cleghorn tells
us that in Minorca, ulcers of the  legs are  "almost incura-
ble."   It is probable  there are  many parts  of  the world
in which the air has  the same unfriendly influence upon
this disease.   In such cases it will be  proper to advise a
change of climate.
   The local applications should  consist of such substan-
ces as  are gently escarotic, and which excite an action in
the torpid vessels' of the affected part.  Arsenic, precipi-
tate, and blue vitriol, have all been employed with success
for this purpose.   Dr. Griffitts informed me, that he has
frequently accomplished the same thing in the dispensary
by applications of tartar emetic.  They should all be used,
if necessary, in succession to each other;  for there is often
the same idiosyncrasy in a sore leg to  certain topical ap-
plications, that there is in the stomach to certain aliments.
After the use  of  these  remedies, astringents and tonics
should be  applied, such as an infusion  of Peruvian, or
white-oak bark, the water in which the smiths extinguish
their irons,  lime-water, bread dipped in  a weak  solution
of green vitriol (so much commended by Dr. Underwood)
compresses wetted with brandy,  or ardent spirits  of any
kind, and, above all, the adhesive plaisters formerly men-
tioned.
   Tight bandages are  likewise highly proper here.  The
laced stocking has been much used.   It is made of strong
coarse  linen.  Dr. Underwood gives several good reasons
for preferring a flannel roller to the linen  stocking. It sets
easier  on the leg, and yields to  the swelling of the mus-
cles in walking. 
ON  SORE  LEGS.                231
   In scorbutic sores on the legs, navy surgeons have spo-
ken  in high terms of an application of a mixture of lime-
juice and molasses.  Mr. Gillespie commends the use of
lime or lemon-juice alone, and ascribes many cures to it
in the British navy during the late war, after every common
application had been used to no purpose.*
   It is of the utmost consequence, in the treatment of sore
legs, to keep them clean, by frequent dre>sings and wash-
ings.  The success of old women is oftener derived  from
their great attention to cleanliness, in the management of
sore legs, than to any specifics they possess which are un-
known to physicians.
   When sore legs are kept from healing by affections of
the bone, the treatment should be such as is recommend-
ed by  practical writers on  surgery.
   I  shall conclude this inquiry by four observations, which
are naturally suggested by what has been delivered  upon
this disease.
   1. If it has been  proved that  sore  legs are connected
with a morbid state of the whole system, is it  not proper
to inquire, whether many  other diseases, supposed  to be
local,  are not in  like manner connected  with the whole
system; and if sore legs have been cured by general re-
medies, is it not proper to use them  more frequently in
local diseases ?
   2. If there be  two states of action in the arteries in sore
legs, it becomes us to inquire, whether the  same opposite
states  of action  do  not take  place  in many diseases, in
which they are not suspected. It would be  easy to prove,
that they exist in several other local diseases.
   3. If the efficacy of the remedies for sore legs, which
have been mentioned, depend upon their being accommo-
dated  exactly to the state of the arterial system, and if this
 system be liable to frequent changes,  does  it  not become
us to  be more attentive to  the state of the pulse in this dis-
ease, than is commonly supposed to be necessary by phy-
 sicians ?
   4.  It has been a misfortune in  medicine, as well as in
 other  sciences, for men to ascribe  effects  to one cause,
 which should be ascribed  to many.  Hence diseases have
                  • Medical Journal, vol. vi. 
232               ON  SORE  LETS.

been attributed exclusively to morbid affections of the
fluids by some, and of the muscles  and nerves  by others.
Unfortunately,  the morbid states of the arterial system, and
the influence of those states upon the brain, the nerves, the
muscles, the lymphatics,  the glands, the viscera, the ali-
mentary canal, and the skin, as well as the reciprocal influ-
ence of the morbid states of each of those parts of the body
upon the arteries, and  upon  each  other, have been too
much neglected in most of our systems of physic. I con-
sider the pathology of the arterial system as a  mine.  It
was first discovered by Dr. Cullen.  The  man who at-
tempts to explore it will probably impoverish himself by
his researches;  but the men who come after him will cer-
tainly obtain from it a treasure, which cannot fail of adding
greatly to the riches of medicine. 
AN ACCOUNT
OF THE
STATE OF THE BODY AND  MIND




            IN OLD AGE;
WITH
OBSERVATIONS ON ITS DISEASES,
AND THEIR REMEDIES.
VOL. I.           3 g               ^. /.





                              ♦  •*>
  ____________          _____           <•_______yP±____ 

I 
AN ACCOUNT, &c.
     MOST of the facts which I shall deliver upon this
subject are the result of observations, made during the
term of five years, upon persons of both sexes, who had
pas&d the 80th year of their  lives.   I intended to have
given a detail of the names, manner of life,  occupations,
and other circumstances of each of them; but, upon a re-
view of my notes,  I found  so great a sameness in the his-
tory of most of them, that I despaired, by detailing them,
of answering the intention which I have purposed in the
following essay. I shall, therefore, only deliver the facts
and principles, which are the  result of the  inquiries and
observations I  have made upon this subject.
   I. I shall mention the circumstances which favour the
attainment of longevity.
   II.  I  shall mention the phenomena of body and mind
which attend it; and,
   III. I shall enumerate its peculiar diseases, and the re-
medies which are most proper to remove,  or moderate
them.
   I. The circumstances which favour longevity are,
   1. Descent from long-lived ancestors.  I have not found
a single  instance of a person who has lived to be 80 years
old, in whom this  was not the  case.   In some instances I
found the descent was only from one, but,  in general, it
was from both parents.  The knowledge of this fact may
serve,  not only to assist  in calculating what are called the
chances  of lives, but it may be made useful to a physician.
He may learn from it to cherish hopes of his patients  in
chronic, and in some acute diseases, in proportion  to the
capacity of life they have derived from their ancestors.*
  * Dr. Franklin, who died in his 84th year was descended from long-lived
parents.  His father died at 89, and his mother at 87. His father had 17
children by two wives.  The doctor informed me. that he once sat down
as one of 11 adult sons and daughters at his father's table.  In an excur-
sion he once made  to that part of Englaiid fron: whence his family migrat-
ed to America, he discovered, in a grave-y ird, the tomb-stones of several
persons of his name, who had lived to be very old.  These persons he
supposed to have been his ancestors. 
236                ON OLD AGE.
  2. Temperance in eating and drinking.  To this remark
I found several exceptions.   I  met with one man of 84
years of age, who had been  intemperate in eating; and
four or five  persons, who had been intemperate in drink-
ing ardent spirits.   They had all been day-labourers, or
had deferred drinking until they  began to feel the languor
of old age.   I did not meet with a single person,  who had
not, for the  last forty or fifty years of their lives, used tea,
coffee, and bread and butter,  twice a day as part of their
diet.  1 am  disposed to believe that those articles of rliet
do not materially affect the  duration  of  human life,  al-
though they evidently impair the strength of the  system.
The duration of life does  not appear  to depend  so much
upon the strength of the body, or upon the quantity of its
excitability,  as upon an exact accommodation of stimuli
to each of them.  A watch spring will last as long as an
anchor, provided the forces which are capable of destroy-
ing both are always in an exact ratio to their strength.
The use of  tea and coffee in diet seems to be happily suit-
ed to the change which has taken place in the human body
by sedentary occupations,  by which  means less  nourish-
ment and stimulus are required than formerly,  to support
animal life.
  3. The moderate exercise of the understanding. It has
long been an established truth, that literary men (other cir-
cumstances being equal) are longer lived than other peo-
ple.  But it  is not necessary that the understanding should
be employed upon philosophical subjects, to produce this
influence upon human life. Business, politics, and religion,
which  are the objects of attention of men  of all classes,
impart a vigour to  the understanding,  which by being
conveyed to every part of the  body, tends to produce
health and long life.
   4 Equanimity of temper.  The violent and irregular
actions of the passions tends to  wear away  the springs of
life.
   Persons who live upon annuities in Europe  have been
observed to be longer lived, in equal  circumstances, than
other people.  This is probably  occasioned by their being
exempted,  by the certaintycf th ir subs;s enct, from those
fears of want, which so frequently distract the minds, and 
ON OLD AGE.                  237
thereby weaken the bodies, of old people.  Life-rents
have been supposed to have the  same influence in pro-
longing life.   Perhaps the desire of life, in order to enjoy
for as long a time as possible that property, which cannot
be enjoyed a second time by a child or relation, may be
another cause of the longevity of persons who live upon
certain incomes.  It is a fact,  that the desire of life  is a
very power!ul stimulus  in prolonging it,> especially when
that desire is supported by hope.   This is obvious to phy-
sicians every day.   Despair of recovery is  the beginning
of death in .ill  diseases.
   But obvi( us and reasonable as the effects of equanimity
of temper are  upon human life, there are some exceptions
in favour of passionate men and  women having attained
to a great age.  The morbid stimulus of anger, in these
cases, was probably obviated by less degrees, or less active
exercises, oi  the understanding, or by the defect or weak-
ness of some of the other stimuli which keep up the mo-
tions of life.
   5.  Matrimony.   In the course of my inquiries, I met
with 'only one person beyond eighty years of age who had
never been married.  I met with several women who had
borne from ten to twenty children,  and suckled them all.
I met with one woman, a native of Herefordshire, in Eng-
land, who w as in the 100th year of her age,  who had borne
a child at 60, menstruated till 80, and frequently suckled
 two ot her children (though born  in succession to each
 otner) at the  same  time.  She had passed the greatest part
 of her life cvtr a washing-tub.   Of forty persons who
 died in different parts of the world, above 80 years of age,
 in the year 1806, there was but one of them that had not
 been married.  A  majority of them were women.
   6.  Emigration.   I have observed  many  instances of
 Europeans who have arrived in America in the decline of
 life,  who have acquired fresh vigour from the impression
 of our climate, and of new objects, upon their bodies and
 minds ; and whose lives, in consequence thereof, appeared
 to have been prolonged for many years.   This influence
 of climate upon longevity is not confined to the United
 States.  Of  100 European Spaniards,  who emigrate to
 South-America in early life, 18 live to be above 50, where- 
238                ON OLD ACE.
as but 8 or 9 native Spaniards, and but 7 Indians, of the
same number, exceed the 50th year of hum. n life
   7.  I have not found sedentary employments to prevent
long life, where they are not accompanied by intemperance
in eating or drinking.   This observation  is  not  confined
to literary men, nor to women only, in whom longevity,
without much exercise of body, has been frequently ob-
served.   I met with one instance of a weaver;  a second
of  a silver-smith; and a third of a shoe-maker;  among
the number of old people, whose histories have suggested
these observations.
   8.  I have not found that acute, nor that all chronic dis-
eases shorten human life.  Dr. Franklin had two succes-
sive vomicas in his lungs before he was 40 years old   I
met with one man beyond 80, who had survived a  most
violent attack of the yellow fever;  a second,  who had had
several of his bones fractured  by falls,  and in frays: and
many,  who had been frequently  affected by intermittents.
I met with one man of 86,  who had all his life been sub-
ject to syncope ; another, who had for 50 years  been oc-
casionally  affected by a cough;*  and two  instances of
men, who had  been afflicted for  forty years with  obstinate
head-aches.f  I met with only one person beyond 80, who
had ever been affected by a disease in the stomach; and
in him it  arose from  an occa'sional rupture.  Mr.  John
Strange ways  Hutton, of this city,  who died in  1793, in
the 109th  year of his age, informed me, that he had never
puked in his life.  This circumstance is the more r mark-
able, as he passed several years at sea when a young man.J

  * This man's only remedy for his cough was the  fine  powder  of dry
Indian turnip and honey.
  f Dr. Thiery says, that he did not find the itch, or slight degrees of the
leprosy, to prevent longevity. Observations de Physique  et de Medecine
faites en differens lieux de L'Espagne.  Vol. ii. p. 171.
  X The venerable old man, whose history first suggested this remark,
was bfirn in New York in the year 1684.  His grandfather- lived to be 101,
bui was unable to walk for thirty years before he died, from an excessive
quantity of fat.  His mother died at 91. His constant drinks were water,
beer, and cyder.  He had a fixed dislike to spirits of all kinds.  His ap-
petite was good; and he ate plentiful y during the last years of his life. >
He seldom drank any thing between his meals.  He was never intoxicated
but twice in his life, and that was when a boy, and at sea, where he re-
members perfectly well to have celebrated, by a feu de joye, the birth-
day <t queen Anne. Ih- was formerly afflicted with the lit ad-ache and
giddiness, but never had a fever, except from the small-pox, in the course 
ON  OLD AGE.                  239
These facts may serve to extend our ideas of the impor-
tance of a healthy state of the stomach in the animal eco-
nomy ;  and thereby to add to our knowledge in the prog-
nosis of diseases, and in the chances of human life.
  9. I have not found the loss of teeth to affect the duration
of human life, so much as  might be  expected.  Edward
Drinker,  who lived to  be 103 years  old, lost bis teeth
thirty years before he died, from drawing the hot  smoke
of tobacco into his mouth through a  short pipe.
  Dr.  Sayre, of New-Jersey, to whom I am indebted for
several very valuable  histories of old  persons, mentions
one man, aged 81, whose teeth began to decay at 16, and
another of 90,  who lost his teeth thirty years before  he
saw him.   The gums,  by becoming  hard, perform,  in
part, the office of teeth.  But may not the gastric juice
of the stomach, like the tears and urine, become acrid by
age,  and thereby supply, by a more dissolving power, the
defect of  mastication  from the loss of  teeth ?   Analogies
might easily be adduced from several operations of  nature,
which go forward in  the animal economy,  which render
this supposition highly probable.
  10.  I have not observed baldness,  or grey hairs, occur-
ring in early or middle life, to prevent old age.   In one of
the histories furnished me by Dr. Sayre, I find an account
of a man of 81,  whose hair began to assume a silver
colour when he was but one and twenty years of age.
   11.  More women live to be old  than men, but more
men live  to be very old than women.
  I shall conclude this head by the following remark:
  Notwithstanding there appears in the human  body a
certain capacity of long life, which seems to dispose it to
preserve its existence in every situation ; yet this capacity
does not always protect it from premature destruction;
for among the  old people whom I examined, I scarcely
met with one who had not lost brothers or sisters in early
and middle life, and who were born under  circumstances
equally favourable to longevity with themselves.
of his life. His pulse was slow, but regular. He had been twice married.
By his first wife he had eight, and by his second seventeen children. One
of them lived to be 83 years of age.  He was about five feet nine inches in
height, of a slender make, and carried an erect head, to the last year of
hislife. 
240                 ON  OLD  AGE.
   II. I now come to mention some of the phenomena of
the body and mind which occur in old age.
   1.  There is a great sensibility to cold in all old people.
I met with an old woman of 84, who slept constantly un-
der three blankets and a coverlet during the h >ttest sum-
mer months. The servant of prince de Beaufre mont, who
came from Mount Jura to Paris, at the age of  121, to pay
his respects to the first national assembly of France,  shi-
vered with cold in  the middle of the dog-days, when he
was not  near a good fire.  The national assembly direct-   *
ed him to sit with his hat on,  in order to defend his head
from  the cold.
   2.  Impressions made upon the earsoi oldp ople excite
sensation and reflection much  quicker than when they are
made upon their eyes.  Mr. Hutton informed me, that he
had frequently met  his sons in  the street without knowing
them, until they had spoken to him.  Dr. Franklin inform-
ed me, that he recognized his  friends, after a long absence
from  them, first by their voices.  This fact does not con-
tradict the common opinion upon the subject of memory,
for the recollection, in these instances, is the effect of what
is called reminiscence, which differs from memory, in
being excited only by the renewal of the impression which
at first produced  the idea which is  revived.
   3.  The appetite for food is generally increased in old
age.  The famous Parr, who  died at 152,  ate heartily in
the last week of his life.  The kindness of nature, in pro-
viding this last portion of earthly enjoyments for old peo-
pl , deserves to be  noticed.   It is  remarkable, that they
have, like children, a frequent recurrence of appetite, and
sustain with great uneasiness the intervals of regtdar meals.
The  observation, therefore, made by Hippocrates,  that
middle-aged people are more affected by abstinence than
those who are old, is not true.  This might easily be prov-
ed by many appeals  to the records  of medic in ;  but old
people differ from children, in preferring solid to liquid
aliment.  From inattention to this fact,  Dr. Mead has done
great  mischief by advising old people, as their teeth de-
cayed or perished, to lessen the quantity of their solid, and
to increase the quantify of their liquid food.  This advice
is contrary to nature and experience, and I have heard of 
ON  OLD  AGE.                 241
two old persons who destroyed themselves by following
it.  The circulation of the blood is supported in old peo-
ple chiefly by the stimulus of aliment.   The  action  of
liquids of all kinds upon the system is weak and of short
continuance, compared  with the durable stimulus of solid
food.  There  is a gradation in the action of this food upon
the body.   Animal matters are preferred to vegetable, the
fat of meat to  the lean, and salted meat to fresh, by most
old people.  I have met with but few old people who re-
tained an appetite for milk.   It is remarkable, that a less
quantity of strong drink produces intoxication in old peo-
ple than in persons in the middle of life.   This depends
upon the recurrence of the same state of the system, with
respect  to  excitability,  which takes  place in childhood.
Many old  people, from an ignorance  of this fact, have
made shipwreck of characters, which  have commanded
respect  in every previous stage of their lives.  From the
same recurrence of the excitability of childhood in their
systems, they  commonly drink their tea and coffee much
weaker  than in early or  middle life.
  4. The pulse  is generally full, and frequently affected
by pauses in its  pulsations, when felt in the wrists of old
people.   A regular pulse in such persons indicates a dis-
ease, as it  shows the system  to  be under the impression
of a preternatural stimulus of some kind.   This observa-
tion was suggested to me above thirty years ago by Mor-
gagni, and I have often profited by it in attending old peo-
ple.   The pulse in such patients is an uncertain mark  of
the nature, or degree, of an acute disease.  It  seldom
partakes of the quickness or convulsive action of the arterial
system, which attends fever in young or middle-aged peo-
ple.   I once attended a  man of 77 in a fever of the bilious
kind, which confined him for eight  days to his bed,  in
whom I could not perceive the least quickness or morbid
action in his pulse until four and twenty hours  before he
died.
  5. The marks of old age appear earlier, and are more nu-
merous, in persons who  have combined with hard labour
a vegetable or scanty diet, than in persons who have lived
under opposite circumstances.  I think I have observed
these marks of old age  to occur sooner,  and to be more
  vol.  i.               h h 
242                ON  OLD  AGE.
numerous, in the German, than in the English or Irish ci-
tizens of Pennsylvania.  They are likewise more common
among the  inhabitants of country places, than of cities,
and still more so among the Indians of North America,
than among the inhabitants of civilized countries.
  6. Old men tread  upon the whole base of their feet at
once in walking.  This is perhaps one reason why they
wear out fewer shoes, under the same circumstances  of
constant use, than young people, who by treading on the
posterior, and rising on the anterior part of their feet, ex-
pose their shoes to  more unequal  pressure and friction.
The advantage derived to old people from  this mode  of
walking is very obvious.  It lessens that  disposition  to
totter, which is always connected with weakness. hence
we find the same mode of walking is adopted  by habitual
drunkards, and is sometimes from habit practised by them,
when they are not under the influence of strong drink.
  7. The breath and perspiration of old people have a pe-
culiar acrimony, and their urine, in some instances, emits
a fcetor of an  offensive nature.
  8. The eyes of very old people sometimes change from
a dark and blue to a light colour.
  9. The memory is the first faculty of the mind which
fails in the decline of life.   While recent events pass
through the mind without leaving an impression upon it, it
is remarkable that the long  forgotten events of childhood
and  youth are recalled and distinctly remembered.
  I met  with a singular instance of a German woman,
who had learned to speak the language of our country after
she was forty years of age, who  had forgotten  every word
of it after she had passed her 80th year,  but the German
language as fluently as ever  she  had done.   The memory
decays soonest in hard drinkers.  I have observed some
studious men to suffer a decay of their memories, but
never of their understandings.  Among these  was the late
Anthony Benezet,  of this city.  But even this infirmity
did not abate the cheerfulness, nor lessen the happiness of
this pious philosopher, for he once told me, when I was a
young man, that he had a consolation in  the decay of his
memoiy, which gave him a great advantage over me. "You
can read a good book (said he) with pleasure but once, 
ON  OLD  AGE.                 243
but when I read a good book,  I so soon forget the con-
tents of it, that I have the pleasure of reading it over and
over ; and every time I read it,  it isalike new and delight-
ful to me."   The celebrated Dr. Swift was one of those
few studious men, who have exhibited marks of a dccay
of understanding in old age;  but it is judiciously ascribed
by Dr. Johnson to two causes, which  rescue books, and
the  exercise  of the thinking faculties, from having had
any share in inducing that disease upon his mind.  These
causes were,  a rash vow which he made  when a young
man, never to  use spectacles, and a sordid seclusion of
himself from  company, by which means he was cut off
from the use of books, and the benefits of  conversation,
the absence of which left his mind without its usual sti-
mulus :  hence it collapsed into a  state of fatuity.  It is
probably  owing to the constant exercise of the under-
standing, that literary men possess that faculty of the mind
in a vigorous state in extreme old age.  The same cause
accounts for old people preserving  their intellects longer
in cities than in country places.  They  enjoy society upon
such easy terms in the former situation, that their minds
are  kept more  constantly in an excited state, by the ac-
quisition of new, or the renovation of old ideas, by means
of conversation.
  10. I did not meet with a single instance, in which the
moral or religious faculties were impaired in old  people.
I do not believe that  these faculties of the mind are pre-
served by any supernatural power, but wholly by the con-
stant and increasing  exercise of them in  the evening of
life.  In the course of my inquiries, I heard of a man of
101 years of age,  who declared that he had forgotten every
thing he had ever known, except his God. I found the
moral faculty,  or a disposition to do kind  offices,  to be
exquisitely sensible in several old people,  in whom there
was scarcely  a trace left of memory or  understanding.
  11. Dreaming is universal among people.  It appears
to be brought on by their imperfect sleep, of which I shall
say more hereafter.
  12. I mentioned formerly the sign of a second childhood,
in the increase of the appetite in old people.  It appears
further, 1. In a recurrence of the appetite for those arti- 
^44
ON OLD AGE.
 cles of food which were most grateful in childhood, par-
 ticularly sweet substances.  The late Dr.  Redman, who
 died in March, 1808, in the 86th year of his age, became
 so fond of sweet cake, for several years before his death,
 that he seldom passed a day without eating more or less of
 it.  2.  In the marks which slight contusions or impressions
 leave upon their skins.  3. In their being soon fatigued by
 walking or  exercise, and in being as soon refreshed  by
 rest.   4. In their loss of the  command over their limbs,
 so as to be unable to protect themselves  from  the conse-
 quences of a fall by protruding their arms.   5.  In the loss
 of their command over the spincters of the rectum and
 bladder, in consequence  of which  they  discharge  their
 fasces  in an involuntary manner, and with the same fre-
 quency which we observe in infancy and childhood. I took
 notice in the lectures upon animal life, of this return of
 involuntary motions in parts that had become voluntary
 from the influence of habit.  6  In their inability to rest,
 except in a recumbent posture.  7. In the absence of teeth.
.8. In a disposition to nearly constant sleep.  Dr. Haller
 mentions an instance of a very old man, who slept twenty
 out of every twenty-four hours of the last years  of his life.
 9. In their disposition, like children, to detail immediately
 every thing they see and hear.   10. In their aptitude  to
 shed tears;  hence they are  unable to tell a  story, that is in
 any  degree distressing, without weeping.  Dr. Moore
 takes notice of this  peculiarity in Voltaire, after he had
 passed his  80th year.  He wept constantly at the recital
 of his  own tragedies.  This feature in old age did not  es-
 cape Homer.   Old Menelaus  wept ten years after he  re-
 turned from the destruction of Troy,  when he spoke of
 the death  of the heroes  who  perished before  that  city.
 The famous  duke of Marlborough discovered  the same
 disposition to weep in the  close of his life.   11. In the
 absence of memory, and finally,  in the extinction of every
 other faculty of the mind.  The reader will perceive here,
 that not only the marks of a second childhood, but of a
 second infancy, are exhibited  in old age, when it is pro-
 tracted to its extreme point.
   31. The disposition in the system to renew certain parts
 in extreme old age has been mentioned by several authors. 
ON OLD AGE.                   245
 Many instances are to be met with in the records of me-
 dicine of the sight* and hearing having been restored, and
 even of the teeth having been renewed in old people a few
 years before death.  These phenomena have led me  to
 suspect that the antediluvian age was attained by the fre-
 quent renovation of different parts of the body,  and that
 when they occur, they are  an  effort of the  causes which
 support animal life to produce antediluvian longevity, by
 acting upon the revived excitability of the system.
   14. The fear of death appears to  be much less in old
 age, than in early or middle life.   I met with many old
 people  who spoke of  their dissolution with composure,
 and with some who expressed earnest desires to lie down
 in the grave. This indifference to life, and desire for death
 (whether they arise from a  satiety in worldly  pursuits and
 pleasures, or from a desire of being  relieved from  pain)
 appear  to be a wise law in the animal economy, and worthy
 of being classed with those laws which accommodate the
 body and mind  of  man to all the natural evils, to which,
 in the common  order of things, they are necessarily ex-
 posed.
  III.  I come  now briefly to enumerate  the diseases  of
 old age, and the remedies  which are  most  proper to re-
 move,  or to mitigate them.
  The  diseases  are chronic and acute. The chronic are,
   1.  Weakness  of the knees and ancles, a lessened ability
 to walk, and  tremors in the head and limbs.
  2.  Pains in the bones, known among nosological writers
 by  the name of rheumatalgia.

  *  There is a remarkable instance of the sight having been restored,
 after it had been totally destroyed, in an old man near Reading, in Penn-
 sylvania.  My brother, Judge Rush, furnished me with the following ac-
 count of him, in a letter from Reading, dated June 23, 1792.
  "  An old man, of 84 years of age, of the name of Adam Riffle, near
 this town, gradually lost his sight in the 68th year of his age, and con-
 tinued entirely blind for the space of twelve years.  About four years ago
 his 6ight returned, without making use of any means for the purpose, and
 without any visible change in the appearance of the eyes, and he now sees
 as well as ever he did.  I have seen the man,  and have  no doubt of the
fact.  He is at this time so hearty, as to be able to walk from his house
 to Reading (about three miles) which  he frequently does in order to at-
tend church.  I should observe, that, during both the gradual loss and
recovery of his sight, he was no ways affected by sickness, but, on the con-
trary, enjoyed his usual heaith.  I have this account from his daughter
and son-in-law, who live within a few doors of me." 
246                  ON OLD AGE.
   3. Involuntary flow of tears, and of mucus from the nose*
   4. Difficulty of breathing, and a short cough, with co-
pious expectoration.  ^A weak or hoarse  voice generally
attends this cough.
   5.  Costiveness.
   6. An inability to retain the urine as long as in early or
middle life.  Few persons beyond 60 pass a whole night,
without being obliged to discharge their urine.* Perhaps
the stimulus of this  liquor in the  bladder  may be one
cause  of the  universality  of  dreaming  among old  peo-
ple.   It is  certainly  a frequent cause  of dreaming  in
persons in  early and  middle life: this I infer, from its
occurring chiefly in the morning, when the bladder is most
distended with urine.   There is likewise an inability in old
people to discharge their urine as quickly as in early life.
I think I have observed this to be among the first  symp-
toms of the declension of the strength of the  body by age.
   7.  Wakefulness.   This is probably produced in part by
the action of the urine upon the bladder ; but such is the
excitability of the system  in  the first  stages of old  age,
that there is no pain so light, no anxiety so trifling, and no
sound so small, as not to produce wakefulness in old  peo-
ple.   It is owing to their imperfect sleep, that they are
sometimes as unconscious of the moment of their passing
from a sleeping to a waking state, as young  and middle-
aged people are of the moment in which they pass from
the waking to a sleeping state.  Hence we so often  hear
them complain of passing sleepless  nights.   This is no
doubt  frequently the case,  but I  am satisfied,  from the
result of an inquiry made upon this  subject,  that they
often sleep without knowing it,  and that  their complaints
in the morning, of the want of sleep, arise from ignorance,
without the least intention to deceive.
   8.  Giddiness.
   9. Deafness
   10.  Imperfect vision.
   The acute diseases most common among old people are,
   1. Inflammation of the eyes.
   2. The pneumonia notha, or bastard peripneumonv.
  * I met with an old man, who informed me, that if from ai.y accident
he retained his urine after he felt an inclination to  discharge it, lie was
affected by numbness,  accompanied by an uneasv sensation in the palms
of his hands. 
ON OLD AGL.                 247
  3. The colic,
  4. Palsy and apoplexy.
  5. The piles.
  6. A difficulty in making water.
  7. Quartan fever.
  All the diseases  of old people, both  chronic and acute,
originate in predisposing debility.   The remedies for the
former, where a feeble morbid  action takes place in the
system, are stimulants.   The first of these is,
  I. Heat.  The  ancient Romans  prolonged life  byre-
tiring to Naples, as soon as they felt the infirmities of age
coming upon them.   The aged Portuguese imitate them,
by approaching the warm sun of Brazil, in South America.
But heat may be applied to the torpid bodies of old  peo-
ple  artificially.  1. By means  of the  warm bath.   Dr.
Franklin owed much of the  cheerfulness and general
vigour  of body  and mind, which  characterised his old
age, to  his regular use of this remedy.  It disposed him
to sleep, and even  produced a respite from the pain of the
stone, with which  he was afflicted during the last years of
his  life.
  2. Heat may be applied to the bodies of old people by
means of stove rooms. The late Dr. Dewit, of Germantown,
who lived to  be near 100 years of  age, seldom breathed
an air below 72°,  after he had became an old man.   He
lived constantly in a stove room.
  3.  Warm  Clothing,  more  especially warm  bed
clothes, are proper to preserve or increase the heat of old
people.   From the neglect  of  the  latter,  they are  often
found dead in their beds in the morning, after a cold night,
in all cold countries.  The late Dr.  Chovet, of this  city,
who lived to be 85, slept in a baize night gown, under
eight blankets and  a coverlet, in a stove-room, many years
before lie died. The head should be defended in old  peo-
ple, by  means of wollen or fur caps,  in the night, and by
wigs and hats during the day,  in cold weather. These
artificial coverings  will be the more  necessary, where the
head has been deprived  of  its  natural  covering.  Great
pains should be taken likewise  to keep the feet dry and
warm,  by means of thick shoes.* To these modes of ap-
  * I met with one man above 80, who defended his feet from moisture
by covering his shoes in wet weather with  melted wax; and another, 
M8                  ON OLD AGE.
 plying and confining heat to the bodies of old  people,  a
 young bed-fellow has  been added; but  I conceive  the
 three artificial modes which have been recommended will
 be sufficient, without the use of one, which cannot be suc-
 cessfully employed without a breach of delicacy or hu-
 manity.
   II.  To keep up the action of the system,  generous
 diet  and drinks should be given to old people.  Their
 food should partake largely of  the fire, and it should be
 so cooked as to retain all its juices.   By  this means it is
 more easily divided by their gums, and more easily digest-
 ed. Broiled fish,  and what are commonly called stews
 of butchers  meat,  form  excellent  articles of  diet for old
 people.   For a reason mentioned formerly,  they should
 be indulged in eating between  the  ordinary meals of fa-
 milies.   Wine should  be given to them  in moderation.
 It has  been emphatically called the milk of old age.
   III.  Young company should be preferred by old peo-
 ple to  the company of persons of their own age.  I think
 I  have  observed old people to enjoy better health and
 spirits, when they have passed the evening of their lives
 in  the families of  their children,  where  they have been
 surrounded  by grand-children than  when they lived by
 themselves.   Even the solicitude they feel for the welfare
 of their descendants contributes  to invigorate  the circula-
 tion of the blood, and thereby to add fuel to the lamp of life.
   IV. Gentle exercise.  This is of great consequence
 in promoting the health of old people.   It should be mo.
 derate, regular, and always in fair weather.
   V.  Cleanliness.   This should by no means be ne-
glected.  The dress of old people should not only be clean,
 but more elegant than in youth,  or middle life.  It serves
to divert the  eye of spectators from  observing the  decay
and deformity of the body, to view and admire that which
 is always agreeable to it.
who, for the same purpose, covered his shoe* every morning with a mix-
ture composed of the following ingredients melted together : lintseed oil a
pound, mutton suet eight ounces, bees-wax six  ounces, and rosin four
ounces.  This mixture should be moderately warmed, and then applied
not only  to the upper leather,  but to the soles of the shoes.  This com-
position, the old gentieman informed me, was extracted from a book, en-
titied " The Complete Fisherman," published in  England, in the reign of
queen Elizabeth. He had  used it for twenty years in cold and wet wea-
ther, with great benefit, and several of his friends, who had tried it, spoke
of its efficacy in keeping the feet dry in high terms. 
ON OLD AGE.                 249
   VI. To abate the pains of the chronic rheumatism, and
 the  uneasiness of  the old  man's cough (as it is called;)
 also to remove  wakefulness, and to restrain,  during the
 night, a troublesome inclination to make water, opium may
 be given with great advantage.   Chardin informs us, that
 this medicine is frequently used in  the eastern countries,
 to abate  the pains and weaknesses of old age, by those
 people who are debarred the use of wine by the religion of
 Mahomet.
   I  have  nothing  to say upon the acute diseases of old
 people, but what is to be found in most of our books of
 medicine, except to recommend bleeding in those of
 them which are attended with plethora, and an inflamma-
 tory action in the pulse.   The degrees of appetite which
 belong to old age,  the quality of the food taken, and the
 sedentary life which is generally connected with it, all con-
 cur to produce that state of the system,  which requires
 the above evacuation.   I  am sure that I have seen many
 of the chronic  complaints of old people mitigated  by it,
 and  I have more than once seen it used with obvious ad-
 vantage in their inflammatory diseases.  These affections
 I have observed to be more fatal among old people than
 is generally  supposed.   An inflammation of the lungs,
 which terminated   in an abscess, deprived  the world of
 Dr.  Franklin.  Dr. Chovet died of an inflammation in
 his liver.   The blood drawn from him a few days before
 his death was  sizy, and such was  the heat of  his body,
 produced by his fever, that he could not bear more cover-
 ing (notwithstanding his former  habits of warm clothing)
 than a sheet, in the month of January.
  Death from old  age is the effect of a gradual palsy. It
 shows itself first in the eyes and ears, in the decay of sight
 and  hearing; it appears next in the  urinary bladder, in
 the limbs and trunk of the body; then in the sphincters
 of the bladder and rectum;  and finally in the nerves and
 brain, destroying, in the last, the exercise of all the facul-
ties of the mind.
  Few persons appear to die of old age.   Some one of
the diseases which  have  been mentioned generally cuts
the last thread of life.
  vol. i.                 i i 
 
               OBSERVATIONS

                       ON


  THE DUTIES OF  A PHYSICIAN,

                     AND THE

     METHODS OF IMPROVING MEDICINE.

ACCOMMODATED TO THE PRESENT STATE OF SOCIETY

                      AND

        MANNERS IN THE UNITED STATES.
Delivered in the University of Pennsylvania, February 7,1789, at the conclusion
     of a course of lectures upon chemistry and the practice of physic.
PUBLISHED AT THE REQUEST OF THE CLASS. 
 
OBSERVATIONS,  &c.
GENTLEMEN,
     I SHALL conclude our course of lectures, by de-
livering to you a few directions for the regulation of your
future conduct and studies, in the line of your profession.
  I shall, first,  suggest the most probable means of es-
tablishing yourselves in business, and of becoming accep-
table to your patients, and respectable in life.
  Secondly, I shall  mention a few thoughts which have
occurred to me on the mode to be pursued, in the further
prosecution of your studies, and for the improvement of
medicine.
  I. Permit me, in the first place, to recommend to such
of you as intend to settle in the country, to establish your-
selves  as early as possible upon farms.   My reasons for
this advice  are as follow:
  1. It will reconcile the country people to the liberality
and dignity of your profession, by showing them that you
assume no  superiority over them from your education, and
that you intend to share with them in those  toils,  which
were imposed upon man in consequence of the loss of his
innocence.   This will prevent envy,  and render you ac-
ceptable to your patients as men, as well as physicians.
  2. By living on a  farm you may serve your country,
by promoting improvements in agriculture.   Chemistry
(which is now an important branch of medical education)
and agriculture are closely allied to each other.   Hence
some of the most useful books upon agriculture have been
written by  physicians.  Witness the  essays of Dr. Home 
&>4          OBSERVATIONS ON THE

of Edinburgh, and of Dr. Hunter of Yorkshire, in Eng-
land.
  3.  The business of a farm will furnish you with em-
ployment in the  healthy seasons of the year,  and thereby
deliver you from the taedium vitae,  or, what is worse, from
retreating to low  or  improper company.   Perhaps one
cause of the prevalence of dram or grog drinking, with
which country  practitioners  are  sometimes charged, is
owing to their having no regular or profitable business  to
employ them, in the  intervals  of their attendance upon
their patients.
  4.  The resources of  a farm will create  such an inde-
pendence, as will enable you to practice with more dig-
nity, and at the same time screen you from the trouble of
performing unnecessary services to your patients.  It will
change the nature of the obligation between you and them.
While money is the only means of your subsistence, your
patients will  feel that they are the channels of your daily
bread; but while your farm furnishes you with the neces-
saries of life, your patients will feel, more sensibly, that
the obligation is on their side, for health and life.
  5.  The exigencies and wants of a farm, in  stock and
labour of all kinds, will enable you to obtain from your
patients a compensation for your services in those articles.
They all possess them,  and men part with that of which
money is only the sign  much more readily than they do
with money itself.
  6. The resources of a farm will prevent your cherishing,
for a moment, an impious wish for the prevalence of sick-
ness in your  neighbourhood.   A healthy season will ena-
ble you to add to the produce of your farm, while the re-
wards of an unhealthy season will enable you to repair the
inconvenience of your  necessary  absence from it.  By
these means your pursuits will be marked by that variety
and integrity, in which true  happiness is said to consist.
  7. Let your farms be small, and let your principal at-
tention be directed to grass and horticulture.   These af-
ford most amusement, require only moderate labour, and
will interfere least with your duties to your profession.
  II. Avoid singularities of every kind in your manners,
dress, and general conduct.   Sir Isaac Newton, it is said, 
DUTIES OF A  PHYSrciAtf.
255
could not be distinguished in company, by any peculiarity,
from  a common well bred gentleman.   Singularity, in
any thing, is a substitute for such great or useful qualities
as command respect;  and hence we find it chiefly in lit-
tle minds.   The profane  and indelicate combination of
extravagant ideas, improperly called wit, and the formal
and pompous manner, whether accompanied by a wig, a
cane,  or a ring, should  be all avoided,  as incompatible
with the simplicity of science, and the real dignity of phy-
sic.   There is more than one  way of playing the quack.
It is not necessary, for this purpose, that a man should ad-
vertise his skill, or his cures,  or that he should mount a
phaeton, and display his dexterity  in operating to an ig-
norant and gaping multitude.   A physician acts the same
part in a different way, who assumes  the character of a
madman or a brute in his manners, or who  conceals his
fallibility by an  affected gravity  and taciturnity in his in-
tercourse with  his  patients.   Both characters, like the
quack, impose upon the public.   It is true,  they deceive
different ranks of people; but we must remember  that
that there are two kinds of  vulgar, viz. the rich and the
poor; and that the rich vulgar  are often upon a footing
with^the poor, in ignorance and credulity.
   III. It has been objected to our profession, that many
eminent physicians have  been unfriendly to Christianity.
If this be true,  I cannot help ascribing  it in part to  that
neglect of public worship, with which the duties of our
profession are often incompatible;  for it has been justly
observed, that the neglect of this religious and social duty
generally produces a  relaxation, either  in  principles or
morals.   Let this fact lead you, in setting out in business,
to acquire such habits of punctuality in visiting your pa-
tients, as shall not interfere  with acts of public homage to
the Supreme Being.  Dr. Gregory has observed, that a
cold  heart is the most frequent cause of deism.  Where
this occurs in a physician,  it  affords  a  presumption that
he is deficient in humanity.   But I cannot admit that in-
fidelity is peculiar to our profession.   On the contrary, I
believe Christianity places among its friends more men of
extensive abilities and learning  in  medicine, than in any
other secular employment. Stahl, Hoffman,Boerhaave, Sy-
denham, Haller, and Fothergill, were all Christians. These 
256           OBSERVATIONS  ON  THE

enlightened physicians were considered as the ornaments
of the ages in which they lived, and posterity has justly
ranked them among the greatest benefactors of  mankind.
  IV. Permit  me to  recommend  to you a regard  to all
the interests of your country.   The education  of a phy-
sician gives  him a peculiar insight in the principles of
many useful arts,  and the practice of  physic  favours
his opportunities of doing good, by  diffusing knowledge
of all kinds.  It was in Rome, when medicine  was prac-
tised only by slaves, that physicians  were condemned by
their profession " mutam exercere artem." But in modern
times, and in free  governments, they should disdain an
ignoble silence upon  public  subjects.  The American
revolution has rescued physic  from its  former slavish rank
in society.  For the honour of our profession it  should be
recorded,  that  some of the most  intelligent and useful
characters, both in the cabinet and the field, during the
late war, have been physicians.  The illustrious Dr. Fo-
thergill opposed faction and tyranny, and  took the lead in
all public improvements  in his native country,  without
suffering thereby the least diminution of that reputation,
or business, in which, for forty years, he flourished almost
without a rival  in the city of London.
  V. Let me advise you, in your visits to the sick, never
to appear  in  a hurry, nor to  talk  of indifferent matters,
before you have made the  necessary  inquiries into the
symptoms of your patient's disease.
  VI. Avoid making light of any case. " Respice finem"
should be  the  motto of every  indisposition.  There  is
scarcely a disease so trifling, that has not, directly or in-
directly, proved an outlet to human life.  This considera-
tion should make you  anxious and punctual in your at-
tendance upon .every  acute disease,  and  keep  you from
risking your reputation by an improper  or hasty prognosis.
  VII.  Do not  condemn,  or oppose,  unnecessarily, the
simple prescriptions of your patients.  Yield to them  in
matters of little  consequence,  but maintain an  inflexible
authority over them in matters that are essential to life.
  VIII.  Preserve,  upon  all occasions,  a composed  or
cheerful countenance  in  the room of  your  patients, and
inspire as much hope of a recovery as you can, consistent 
DUTIES OF A  PHYSICIAN.          257
with truth, especially in acute diseases.   The extent of
the influence of the will over the human body has not yet
been fully ascertained.  I reject the futile pretensions of
Mr. Mesmer to the cure of diseases, by what fu  h:;^ .b-
surdly called animal magnetism.  But I am willing to de-
rive the same advantages from  his deceptions, v Inch the
chemists have derived from the delusions of the alchemists.
The facts which he has established clearly prove the influ-
ence of the imagination, and will, upon diseases.   Let us
avail ourselves  of the handle which those  faculties of the
mind present to us, in the strife between life and death.  I
have frequently prescribed remedies of doubtful efficacy in
the critical stage of acute diseases, but never till I had work-
ed up my patients into a confidence, bordering upon certain-
ty,  of their probably good effects.   The success of this
measure has much oftener answered, than disappointed my
expectations; and while my patients have  commended the
vomit, the purge,  or the blister, which was prescribed,  I
have been disposed to attribute their  recovery to the vi-
gorous  concurrence of the will in the action of the medi-
cine.   Does the will beget insensibility to cold, heat,  hun-
ger, and danger ?  Does it suspend  pain,  and raise the
body above feeling the  pangs of Indian tortures ? Let us
not then be surprized that it should enable the system to
resolve  a spasm, to open an obstruction,  or to discharge
an  offending  humour.  I have only time to  hint at this
subject.  Perhaps it  would lead us, if we could trace  it
fully to  some very  important discoveries in the  cure of dis-
eases.
   IX.  Permit  me to  advise you, in your  intercourse with
your patients,  to  attend to that principle in the human
mind, which constitutes the association of ideas.  A cham-
ber, a chair, a  curtain,  or even a cup, all  belong to the
means of life or dearth,  accordingly as  they are associated
with cheerful or distressing ideas, in the mind of a patient.
But this principle is of  more immediate application in
those chronic diseases  which  affect the mind.  Nothing
can be accomplished  here, till we produce a new associa-
tion of  ideas.   For this purpose a change  of place and
company are absolutely necessary.  But  we must some-
times proceed much further. I have heard of a gentleman
   vol.  i.                k  k 
258            OBSERVATIONS ON THE

in South  Carolina, who cured  his fits of low spirits by
changing his clothes.   The remedy was a rational  one.
It produced at once a  new train of ideas, and thus remov-
ed the paroxysm of his disease.
  X. Make it a rule never  to be angry at  any thing a
sick  man says or does to you. Sickness often adds to the
natural irritability of the  temper.  We are, therefore, to
bear the reproaches of our patients with meekness  and
silence.   It is folly to resent  injuries at any time, but it
is cowardice to resent an injury from a sick man, since,
from his weakness and dependence upon us, he is unable
to contend  with us  upon equal terms.  You will find it
difficult to  attach your patients to you  by the obligations
of friendship or gratitude.  You will sometimes have the
mortification of being deserted by those patients, who owe
most to your skill and humanity.  This led Dr. Turner
to advise physicians  never to  choose their friends from
among their patients.   But this advice can never be fol-
lowed by a heart that has been taught to love true excel-
lency, wherever it finds it.   I would rather advise you to
give the benevolent feelings of your hearts full scope, and
to forget the unkind returns they will often meet with, by
giving to human nature-----a tear.
  XI. Avoid  giving a patient over in an acute  disease.
It is impossible to tell in such cases where life ends,  and
where death begins.  Hundreds of patients have recovered,
who have been pronounced incurable,  to the great disgrace
of our profession.   I  know that the practice of predicting
danger and death, upon every occasion, is sometimes made
use of by physicians, in order to enhance the credit of
their prescriptions, if  their  patients recover, and to secure
a retreat from  blame,  if they  should die.   But this mode
of acting is mean and illiberal.  It is not necessary that we
should decide with confidence, at any time, upon the  issue
of a  disease.
  XII. A physician in sickness is always a welcome visi-
tor in a family; hence he is often solicited to partake of
the usual sign of hospitality in  this country,  by taking a
draught of  some strong liquor, every time he enters into the
house of a  patient.  Let me charge you to lay an early re-
straint upon yourselves, by refusing to yield to this practice. 
DUTIES OF A  PHYSICIAN.           259
especially in the forenoon.   Many physicians  have been
innocently led by it into habits of drunkenness. You will
be in the more danger of falling into this vice, from the
great fatigue and inclemency of the weather to which you
will be exposed in country practice.  But you have been
taught that strong drink affords only a  temporary relief
from  those evils, and that it afterwards renders the body
more sensible  of them.
  XIII. I shall now give some directions with respect to
the method of charging for your services to your patients.
  When we consider the expence of a medical education,
and the sacrifices a physician is obliged to make of ease,
society, and even health, to his profession; and when we
add to these,  the constant  and painful anxiety which is
connected with the important  charge of  the lives  of our
fellow-creatures, and, above all, the inestimable value of
that blessing which is the object of his services, I hardly
know how it is possible for a patient sufficiently and justly
to reward his  physician.  But when we  consider,  on the
other hand, that sickness deprives men  of the means of
acquiring money; that it  increases all the expences  of
living;  and that high charges often drive patients from
regular-bred physicians to quacks;  I say, when we attend
to these considerations, we should make our charges  as
moderate as possible,  and  conform them to the following
state of things.
   Avoid measuring your  services to your patients  by
scruples, drachms,  and ounces.  It is an illiberal mode
of charging.   On the  contrary, let the number and time
of your visits, the nature of your patient's disease, and his
rank in his family or society, determine the figures in your
accounts.  It is certainly just, to charge more for curing
an apoplexy, than an intermitting fever. It is equally just,
to demand more for risking your life by visiting a  patient
in a contagious fever,  than for curing a  pleurisy.  You
have likewise  a right to be  paid for your anxiety.  Charge
the same services, therefore, higher, to the master or mis-
tress of a family, or to an only son or daughter, who call
forth all your feelings and industry, than  to less important
members of a family and of society.  If a rich man  de-
mand more frequent visits than are necessary, and if  he 
260            OBSERVATIONS ON THE
impose the restraints of keeping to hours, by calling in
other physicians to  consult with you  upon every trifling
occasion, it will be just to make him pay accordingly for
it.   As this mode of charging is strictly agreeable to rea-
son and equity,  it seldom fails of according with the rea-
son and sense of equity of our patients.   Accounts  made
out upon these  principles are seldom complained of by
them.   I shall only remark further upon this subject, that
the sooner you  send in your accounts after your patients
recover, the better.   It is the duty of a physician to in-
form his patient of the amount of his obligation  to him at
least once a year.  But there are times when a departure
from this rule may  be  necessary.  An unexpected mis-
fortune in business, and a variety of other accidents, may
deprive a patient of the money he had allotted to pay his
physician.   In  this case, delicacy and humanity require,
that he should not know the amount of  his debt to his
physician, till time had bettered his circumstances.
   I shall only add, under this head, that the poor of every
description should be the objects  of your peculiar care.
Dr. Boerhaave  used to say,  " they were his best patients,
because God was their paymaster."  The first physicians
that  I have known have found the poor the steps,  by which
they have ascended to business and reputation.  Diseases
among the  lower class of people are generally simple, and
exhibit 10  a physician  the  best cases of  all epidemics,
which cannot fail of adding to his ability of curing the
complicated diseases of the rich and intemperate.  There
is an inseparable connection between a  man's  duty and
his interest.  Whenever you are called, therefore, to visit
a poor patient,  imagine you  hear  the voice  of  the good
Samaritan sounding in  your ears, "  Take  care of him,
and I will repay thee."
   I come now to the second part of this address, which was
to point out the best mode to be pursued, in the further
prosecution of your studies, and the improvement of me-
dicine.
   I. Give me leave to recommend to you, to open all the
dead bodies you can, without doing violence to the feel-
ings of your patients,  or the prejudices of the  common
people.  Preserve a register of the weather,  and of its in- 
              DUTIES OF A  PHYSICIAN.          261

fluence upon the vegetable productions of the year. Above
all,  record the epidemics  of every season; their times of
appearing and disappearing,  and the connection of the
weather with each of them.   Such records, if published,
will be useful to foreigners,  and a treasure to posterity.
Preserve, likewise, an account of chronic cases.  Record
the name, age, and occupation of your patient; describe
his disease accurately, and the changes produced in it by
your remedies;  mention the doses of every medicine you
administer to him.   It is impossible  to  tell how much
improvement and facility  in practice you will find from
following these  directions.   It has been remarked, that
physicians seldom remember more than the two or three
last years of their practice. The records which have been
mentioned will  supply this deficiency of memory,  espe-
cially in that advanced stage of life, when the advice of
physicians is supposed to be  most valuable.
   II.  Permit me to recommend to you further, the study
of the anatomy  (if I may be allowed the expression) of the
human mind, commonly called metaphysics.   The reci-
procal influence of the body and mind upon each other can
only be ascertained by an accurate knowledge of the facul-
 ties of the mind, and of their various modes of combina-
 tion and action. It is the  duty of physicians to  assert
 their prerogative, and to rescue the mental science from
 the usurpations of  schoolmen and divines.   It can only
 be perfected by the aid and discoveries of medicine. The
 authors I would recommend to you upon metaphysics arc,
 Butler, Locke,  Hartley,  Reid,  and Beattie.   These inge-
 nious writers have cleared this sublime science of its tech-
 nical rubbish, and rendered it both intelligible and useful.
    III. Let me remind you, that improvement in medicine
 is  not to be derived only from colleges  and universities.
 Systems of physic are the productions of men of genius
 and learning; but those facts which constitute real know-
 ledge are to be met with in every walk of life.  Remem-
 ber how many  of our most useful remedies have been dis-
 covered by quacks.  Do not be afraid, therefore, of con-
 versing with them, and of profiting by their ignorance and
 temerity in  the practice  of physic. Medicine has its Pha-
 risees, as well  as religion.   But the spirit of this sect is 
262            OBSERVATIONS ON THE
as unfriendly to the advancement of medicine, as it is to
Christian charity.  By conversing  with quacks,  we may
convey instruction to them, and thereby lessen the mischief
they might otherwise do to society.  But further.  In the
pursuit of medical knowledge, let me advise you to con-
verse with nurses and old women.  They will often sug-
gest facts in the history and  cure of diseases, which have
escaped the most sagacious observers of nature. Even Ne.
groes and Indians have sometimes stumbled upon disco-
veries in medicine. Be not ashamed to inquire into them.
There is yet one more means  of information in medicine
which should not be neglected, and  that is, to  converse
with persons who have recovered from indispositions with-
out the aid of physicians.   Examine the strength and ex-
ertions of nature in  these cases, and mark the plain and
home-made remedy  to which they ascribe their recovery.
I have  found this to be a fruitful source of instruction,
and have been led to conclude, that if every man in a city,
or a district, could be called upon to relate, to persons ap-
pointed to receive and publish his narrative,  an exact ac-
count of the effects of those remedies which accident or
whim has suggested to him, it would furnish a very use-
ful book in medicine.   To preserve the facts thus obtain-
ed, let me advise you to record them in a book to be kept
for that purpose.   There is  one more advantage that will
probably attend the inquiries that have been mentioned;
you may discover diseases, or symptoms  of diseases, or
even laws of the animal economy, which have no place in
our systems of nosology, or  in our theories of physic.
   IV. Study simplicity in the preparation of your medi-
eines.   My reasons for this  advice are as follow:
   1. Active medicines produce  the  most certain effects
in a simple  state.
   2. Medicines when mixed frequently destroy the efficacy
of each other.   I do not include chemical medicines alone
in this remark.  It applies likewise to Galenical medicines.
I do not say that all these medicines are impaired by mix-
ture,  but we can  only determine when they are  not, by
actual experiments and observations.
   3.  When medicines of the same class,  or even of dif-
ferent classes, are given together, the strongest  only pro-
duces an effect.  But what are we  to say to a compound 
DUTIES OF A PHYSICIAN.          263
of two medicines, which give exactly the same impression
to the system ? Probably, if we are to judge from analogy
the  effect of them will be such, as would have been pro-
duced by neither in a simple state.
  4. By observing simplicity  in your prescriptions, you
will always have the command of a  greater number of
medicines of the same  class, which may be used in suc-
cession to each other, in proportion as habit  renders the
system insensible of their action.
  5. By using medicines in a simple state, you will obtain
an exact knowledge of their virtues and doses, and there-
by  be able to decide upon the numerous and contradicto-
ry accounts which exist in our books, of the character of
the  same medicines.
  Under this head, I cannot help adding two more direc-
tions.
  1. Avoid  sacrificing too much  to the taste of your
patients in the  preparation of  your  medicines.  The na-
ture of a  medicine may be  wholly  changed, by being
mixed with sweet  substances.  The Author of Nature
seems to have had  a design, in rendering medicines un-
palatable.   Had they been more agreeable to  the taste,
they would probably have yielded long ago to the un-
bounded appetite of man, and by becoming  articles of
diet, or condiments, have lost their efficacy in deseases.
  2. Give as few medicines as possible in tinctures made
with distilled spirits.  Perhaps there  are few cases, in
which it is safe  to  exhibit medicines prepared in  spirits
in any other form than in drops.   Many people have been
innocently seduced into a love of strong drink, from ta-
king large or frequent  doses of bitters  infused  in spirits.
Let not our profession be reproached, in a single instance,
with adding to the calamities that have been entailed upon
mankind by this dreadful species of intemperance.
  V.  Let me  recommend to your particular attention
the indigenous, medicines of our country.  Cultivate or
prepare as many of them as possible,  and endeavour to
enlarge the materia medica, by exploring the untrodden
fields and forests of the United States.  The ipecacuanha,
the Seneka and  Virginia snake-roots, the Carolina pink-
root, the spice-wood, the sassafras, the butter-nut, the tho-
roughwort, the poke, and the stramonium, are but a small 
264              OBSERVATIONS, &C.
part of the medical productions of America.  I have no
doubt but there are many hundred other plants, which
now exhale invaluable medicinal virtues in the desert air.*
Examine, likewise,  the mineral waters, which are so va-
rious in their impregnation, and so common in all parts of
our country.  Let  not  the properties of the insects of
America escape  your investigation.  We have already
discovered among some  of them a fly,  equal in its blister-
ing qualities to the famous fly of Spain.   Who knows
but it may be  reserved for America to furnish the world,
from her productions, with cures for  some of those dis-
eases  which now elude the power of medicine? Who
knows but that, at the foot of the Allegany mountain there
blooms a flower, that is an infalliable cure for the epilepsy ?
Perhaps on  the  Monongahela,  or the Potowmac, there
may grow a root, that shall  supply, by its tonic powers,
the invigorating effects of the savage or military life in the
cure of consumptions.   Human misery of  every kind  is
evidently on the decline.   Happiness,  like truth, is a unit.
While the world, from the progress of intellectual, moral,
and political truth, is becoming a more safe and agreeable
abode for man,  the  votaries of medicine  should not be
idle.  All the  doors and  windows of the temple of na-
ture have been thrown  open, by the  convulsions of the
late American revolution.   This is the time, therefore, to
press upon her altars. We have already drawn from them
discoveries in morals, philosophy, and government; all
of which have human  happiness for their object.  Let
us preserve the unity of truth and happiness, by drawing
from the same source, in the present  critical moment, a
knowledge of antidotes  to those diseases which are sup-
posed to be  incurable.
   I have now, gentlemen, only to thank you for the at-
tention, with  which you have honoured the course  of
lectures which has been delivered to  you,  and  to assure
you, that I shall  be  happy in rendering you all the servi-
ces that lie in  my power,  in any way  you  are pleased to
command me.  Accept of my best wishes for your  hap-
piness, and may the blessings of hundreds and thousands,
that were ready to perish, be your  portion in life, your
comfort in death, and your reward in the world  to come.
               THE END OF VOLUME I. 
    MEDICAL INQUIRIES


                  AND


           OBSERVATIONS.




        BY BENJAMIN RUSH, M. D.
IR0FESSOR OF THS INSTITUTES AND PRACTICE OF MEDICINE AND OF CXlNlCAJj
       PRACTICE, IN THE UNIVERSITY OF PENNSYLVANIA.




         FOUR VOLUMES IN TWO.


                vol. n.
      THE FOURTH EDITION.









      PHILADELPHIA:



PRINTED FOB M. CAREY, No. 121, CHESNDT STBEET,


      Griggs & Dickinsons, Printer!,


           1815. 
 
CONTENTS OF VOLUME II.
                                               Page
AN Account of the Climate of Pennsylvania, and
  its influence upon the Human Body    -   -   -     3
An  Account of the Efficacy of common Salt  in
  the Cure of Hemoptysis.......31
Thoughts upon the Cause  and Cure of Pulmo-
  nary Consumption.........37
An Inquiry into the Cause  and  Cure of Pulmo-
  nary Consumption.........49
Observations upon the Cause and Cure  of Drop-
   sies   .............103
An Inquiry into the Cause  and  Cure of the In-
   ternal Dropsy of the Brain.....-  127
 Observations upon  the  Cause and  Cure  of the
   Gout.............147
 Observations upon the Cause and Cure of Hydro-
  phobia  ........  -----  193
 An Inquiry into the Cause and  Cure of the Cho-
   lera Infantum.......-__  215
 Observations upon the Cynanche Trachealis  -  -  225
 An Account of the Bilious  Remitting Fever,  as, 
                    CONTENTS
                                                Page
  it appeared in Philadelphia in  the Summer and
  Autumn  of the year  1780......231
An  Account of the  Scarlatina Anginosa, fcfc.    -  243
An  Account of the  Measles, as they appeared in
  Philadelphia in the Spring of1789  -   -  -   -  255
 An Account of the  Influenza, as it appeared in
  Philadelphia  in the Autumn of  1789,  in  the
  Spring of 1790, and in the Winter of 1791  -  265 
          AN ACCOUNT







              OF THE







CLIMATE  OF PENNSYLVANIA,






              AND ITS







   INFLUENCE UPON THE HUMAN BODY.
VOL. II. 
  t
I 
AN ACCOUNT
                       OF THE


CLIMATE OF PENNSYLVANIA, &c.
    IN order to render the observations upon the epide-i
mic diseases which compose the following volumes more
useful, it will be necessary to prefix to them a short ac-
count of the climate of Pennsylvania, and of its influence
upon the human body.  This account may perhaps serve
further, to lead to future discoveries, and more extensive
observations, upon this subject.
  The state of Pennsylvania lies between 39° 43' 25'', and
42° north latitude,  including, of course, 2° 16' 35", equal
to 157 miles from its southern to its northern  boundary.
The western extremity  of the state is in the longitude of
5° 23' 40", and  the eastern, is that of 27° from the meri-
dian of Philadelphia, comprehending in a due west course
311  miles  exclusive of the territory lately purchased by
Pennsylvania from the United States, of which as yet no
accurate surveys have been obtained. The state is bound-
ed on the south by part of the state of Delaware,  by the
whole  state of Maryland, and by Virginia to her western
extremity.  The last named state, the  territory lately ced-
ed to Connecticut, and Lake Erie, (part of which is in-
cluded in Pennsylvania) form the western and north-west-
ern boundaries of the state.  Part of New-York, and the
territory lately ceded to  Pennsylvania, with a part of Lake
Erie, compose the northern, and another part of New-
York, with a large extent of New-Jersey (separated from
Pennsylvania by the river Delaware), compose the eastern
boundaries of the state.   The  lands  which  form these
boundaries (except a part of the states of Delaware, Ma-
ryland, and New-Jersey) are in a state of nature.  A large
tract  of the western and north-eastern parts of  Penn- 
 4           ACCOUNT OF THE CLIMATE

 sylvania are nearly  in the  same uncultivated situation.
   The  state of Pennsylvania is intersected and diversi-
 fied with numerous rivers and  mountains.  To describe,
 or even to name them all,  would lar  exceed the limits I
 have proposed to this account of our climate.  It will be
 sufficient only to remark, that one of these rivers, viz the
 Susquehannah,  begins at the northern boundary of the
 state, twelve, miles from the river Delaware and winding
 several  hundred miles, through a variegated country, en-
 ters the state of Maryland on the southern line, fifty-eight
 miles westward of Philadelphia; that  each of these rivers
 is supplied  by numerous streams of  various  sizes; that
 tides flow in parts of two of them, viz in the Delaware
 and Schuylkill;  that the rest rise and fall alternately in wet
 and dry weather;  and that they descend with great rapi-
 dity, over prominent beds of rocks  in many places, until
 they empty themselves into the bays  of Delaware and
 Chesapeake on the east,- and into the Ohio on the western
 part of the state.
   The  mountains form a considerable part of the state of
 Pennsylvania.  Many of them appear  to be reserved  as
perpetual marks of the original empire  of nature  in this
country.  The Allegany, which  crosses the  state about
two hundred miles from Philadelphia,  in a north,  inclining
to an eastern course, is the most considerable and exten-
 sive of  these mountains.   It is called by the Indians the
the back-bone of the continent.   Its heighth,  in different
places, is supposed to be about 1,300 feet from the adja-
 cent plains.
   The  soil  of Pennsylvania is diversified by its vicinity
 to mountains and rivers.   The valleys and bottoms con-
 sist of a black mould, which extends from a foot  to four
feet in depth.   But in general a deep  clay forms the sur-
face of the earth.  Immense beds of limestone lie beneath
 this clay in many parts of the state.    This account of the
 soil of Pennsylvania is confined wholly to the  lands on
the east side  of the Allegany mountain.  The soil on the west
 side of this  mountain, shall be described in another place.
   The city  of Philadelphia lies in the latitude of 39° 57',
 in longitude 75° 8 from Greenwich,  and fifty-five miles
 west from the Atlantic ocean. 
                 OF PENNSYLVANIA.                5

  It is situated about four miles due north from the con-
flux  of the rivers Delaware and Schuylkill.   The build-
ings, which consist chiefly of brick, extend nearly three
miles north and south along the Delaware, and above half
a mile due west towards  the  Schuylkill, to which  river
the limits of the  city extend, the whole of which includes
a distance of  two  miles from the  Delaware.  The land
near the rivers, between  the  city and the  conflux of the
rivers,  is in general low,  moist, and  subject to be over-
flowed. The greatest part of it is  meadow ground.  The
land*to the northward and westward, in the vicinity of the
city, is high,  and in general well cultivated.  Before the
year 1778, the ground between the present improvements
of the  city, and the river Schuylkill, was covered with
woods.   These, together with large tracts of wood to the
northward of the city,  were cut down during the winter
the British army had possession of Philadelphia.  I shall
hereafter mention the influence which the cutting down
of these  woods,  and the subsequent cultivation of the
grounds in the neighbourhood of the city, have had upon
the health of its inhabitants.
  The mean  height of the ground on which the city
stands, is about forty feet above the river Delaware.  One
of the longest and most populous streets in the city rises
only a few feet above the river.  The  air at the north  is
much purer than at the south end of the city ; hence the
lamps exhibit  a fainter flame in its southern, than its nor-
thern parts.
  The tide of the Delaware seldom rises more than six
feet.  It flows four miles in an hour.   The width of the
river near the city is about a mile.
  The city, with the adjoining districts of Southwark and
the Northern  Liberties, contains between 90 and 100,000
inhabitants.
  From the accounts which have been  handed down to
us by our ancestors, there is  reason  to believe that the
climate of Pennsylvania has undergone a material change.
Thunder and lightning are less frequent, and the cold of
our winters and  heat of our summers are less uniform,
than they w»'re forty or fifty years ago.   Nor is this all.
The springs  are much  colder, and the autumns more 
6            ACCOUNT OF THE CLIMATE

temperate than formerly, insomuch  that cattle  are  not
housed so soon by one month as they were in former years.
Within the last eight years, there have been some excep-
tions to part of these observations. The winter of the year
1779-80, was uniformly and uncommonly cold.  The
river Delaware was frozen near  three months during  this
winter, and public roads for waggons and sleighs con-
nected the  city of Philadelphia  in  many places with the
Jersey shore.  The thickness of the ice in  the river near
the city,  was from sixteen  to  nineteen inches,  and the
depth of the frost in the ground  was from four to five feet,
according to the exposure of the  ground, and the quality of
the soil. This extraordinary depth of the frost in the earth
compared with its depth in more northern and colder coun-
tries, is occasioned by the long delay of snow, which leaves
the earth without a covering during the last  autumnal and
the first winter months.  Many plants were destroyed by the
intenseness of the cold during  this winter.  The ears of
horned cattle and the feet of hogs exposed to the air, were
frost-bitten; squirrels perished in their holes, and partridges
were often found dead in the neighbourhood of farm houses.
The mercury in January stood for  several hours  at 5° be-
low 0, in Fahrenheit's thermometer; and during the whole
of  this month (except on one day),  it never rose in the
city of Philadelphia so high  as to the freezing point.
   The  cold in the winter of  the  year 1783-4 was as
intense, but not so steady, as it  was in the winter that has
been  described.   It differed from it  materially in one
particular, viz. there was a thaw in the month of January,
which opened all our rivers  for a few days.
   The summer which succeeded the winter of  1779-80,
was uniformly warm.  The  mercury in the thermometer,
during this summer, stood on one day (the 15th of August)
at 95°, and fluctuated between 93°, and 80° for many weeks.
The  thermometer, in  every reference that has  been, or
shall  be made to it, stood in the shade in the open air.
   I know it has been  said  by many old people,  that the
winters in Pennsylvania are less cold, and the  summers
 less warm, than they were forty or fifty years ago.   The
 want of thermometrical observations before, and during
those years, renders it difficult to decide  this question. 
                 OF PENNSYLVANIA.                7

Perhaps the difference of clothing  and sensation between
youth and old age, in winter and summer, may have laid
the foundation of this opinion.   I  suspect the mean tem-
perature of  the air in Pennsylvania has  not altered, but
that the principal change in our climate consists in the heat
and cold being less confined than formerly to their natural
seasons. I adopt the opinion of DoctorWilliamson* respect-
ing the diminution of the  cold in the southern,  being oc-
casioned by the cultivation of the northern parts of Europe;
but no such cultivation has taken  place  in  the  countries
which  lie to the north-west of  Pennsylvania, nor do the
partial  and imperfect improvements which have been made
in the north-west parts of the state, appear to be sufficient
to lessen the cold, even in the city of Philadelphia. I have
been able to collect no facts, which dispose me to believe
that the winters were colder before the  year 1740, than
they have been since.   In the memorable winter of 1739-
40, the Delaware was crossed on the  ice, in sleighs, on
the 5th of March, old style, and did not open till the 13th
of the  same month.  The ground was covered during this
winter with i. deep snow, and the rays of the sun  were
constantly obscured by a mist, which hung in the upper
regions of the air.   In the winter of 1779-80,  the river
was navigable on the 4th of March; the depth of the snow
was moderate, and the gloominess of the cold was some-
time suspended for a few days by  a clieerful sun.   From
these facts,  it is probable  the winter of 1739-40 was colder
than the winter of 1779-80.  '
   The winter of 1804-5  exhibited so many peculiarities
that it deserves  a place in  the  history of the  climate of
Pennsylvania.   The navigation  of the Delaware was ob-
structed on the 18th of December.   The weather par-
took of every disagreeable and distressing property of every
cold climate on the globe. These  were intense cold, deep
snows, hail, sleet, high  winds, and  heavy rains.   They
generally occurred in succession,  but sometimes most of
them took place in the course of  four and twenty hours.
A  serene and star-light  evening,  often  preceded a tem-
pestuous day.  The mercury  stood for many days, in
 Philadelphia,  at 4° and  6° above  0 in Fahrenheit's ther-
           • American Philosophical Transactions, vol. T. 
8            ACCOUNT OF THE CLIMATE
mometer.  The medium depth of the snow was two feet,
but from its fall being accompanied with high winds, its
height in many places was three and four feet, particularly
in roads, which it rendered so impassible,  as  to interrupt
business and social intercourse, in many parts of the state.
From the great depth of the snow, the ground was so much
protected from  the cold,  that the  frost extended but six
inches below its surface.   The newspapers daily furnished
distressing accounts of persons perishing with the cold by
land and water,  and of shipwrecks  on every part of the
coast of the United States.   Poultry were found dead, or
with frozen  feet, in their  coops in many places.
   This intense cold  was  not confined to Pennsylvania.
In Norfolk,  in Virginia, the mercury stood at 18°  above
0 on the 22d of January.  At Lexington, in Kentucky,  it
stood at 0 on the 21st of the same  month.   In  Lower
Canada the snow was seven feet in depth,  which is three
feet deeper than in common  years.   And such was the
quantity of ice collected in the northern seas,  that a ship
was destroyed,  and several vessels injured, by large mass-
es of it, floating between the 41st and 42d degrees of north
latitude.
   Great fears were entertained of  an inundation in  Penn-
sylvania, from a sudden thaw of  the immense quantities
of snow and ice that had accumulated during the winter,
in every part of the state;  but happily they both dissolved
away so gradually, as scarcely to injure abridge or a road.
On the 28th of February the Delaware was navigable, and
on the 2d of March no ice was to be seen in it.
  Having premised these general remarks, I  proceed to
observe, that there are seldom more than twenty or thirty
days in summer or winter, in Pennsylvania, in which the
mercury rises above 80°  in the former, or falls below 30°
in the latter  season.  Some old people have remarked, that
the number of extremely cold and warm days in succes-
sive summers and winters, bears  an exact  proportion to
each other.   This was strictly true in the years 1787 and
1788.
   The warmest part  of the day in summer is at two, in
ordinary, and at three o'clock in the afternoon,  in extreme-
ly warm weather.  From these hours,  the heat gradually 
OF PENNSYLVANIA.                9
diminishes till the ensuing morning.  The coolest part of
the four and twenty hours, is at the break of day.  There
are seldom more than three or four nights in a summer in
which the heat of the  air is  nearly the same  as  in  the
preceding day.   After the warmest days, the evenings are
generally agreeable, and often delightful.  The higher the
mercury rises in the day time, the lower it falls the suc-
ceeding night. The mercury at 80° generally falls to 68°,
while it descends, when at 60°, but to 56°.  The dispro-
portion between the temperature of the  day and night, in
summer is  always greatest in the month  of August.
The dews at this time are heavy, in proportion to the cool-
ness of the evening.  They are sometimes so considerable
as to wet the clothes; and there  are instances in which?
marsh-meadows, and even creeks, which have been  dry
during the summer, have been supplied with their usual
waters from no other source,  than the dews which have
fallen in this month, or in the first weeks of September.
   There is another circumstance  connected with the  one
just  mentioned, which contributes very much to mitigate
the heat of summer, and that is, it seldom continues more
than two or three days  without  being  succeeded with
showers of rain,  accompanied sometimes by thunder  and
%htning, and afterwards by a north-west wind, which
produces a coolness in the air that is highly invigorating
and agreeable.
   The warmest  weather is generally in  the month of July.
But  intensely warm days are often felt in May, June, Au.
gust, and September.   In the annexed table of the wea-
ther  for the year 1787, there is an exception to the first of
these remarks.  It shows that the mean  heat of August
was  greater by a few degrees than that  of July.
   The transitions from heat to cold are  often very sudden,
and sometimes to very distant degrees.  After a day in
which the mercury has stood  at 86° and even 90°, it some-
times falls, in the  course  of a single night, to the 65th,
and even to the 60th degree, insomuch that fires have been
found necessary the  ensuing morning,  especially if the
change in the temperature of the air has been accompanied
by rain and a south-east wind.  In  a summer month, in the
year 1775, the mercury was  observed   to fall 20° in an
   VOL. II.                B 
10          ACCOUNT OF THE CLIMATE
hour and a half.   There are  few summers in which fires
are not agreeable during some parts of them.   My inge-
nious friend, Mr.  David  Rittenhouse, whose talent for
accurate observation extends alike to all subjects, inform-
ed me, that he had never passed a  summer, during his
residence  in the  country, without  discovering frost in
every month of the year, except July.
  The weather is equally variable in Pennsylvania during
the greatest  part of the winter.   The  mercury fell from
37° to 4i° below 0 in four and twenty hours, between the
fourth and fifth of February,  1788. In this season  nature
seems to play at cross purposes.  Heavy falls of snow are
often  succeeded in a few ctays by a general thaw,  which
frequently in a short time Laves no vestige of the snow.
The  rivers  Delaware,  Schuylkill,  and  Susquehannah
have sometimes been  frozen  (so i\s to bear horses and
carriages of all kinds)  and thawed so as to be passable in
boats, two or three times in the course of the same win-
ter.   The ice is formed for  the most part in a gradual
manner,  and seldom  till the water  has been previously
chilled by a fall of snow.   Sometimes its production is
more sudden.  On the  night of the 31st of December,
1764, the Delaw re was completely  frozen  over between
ten o'clock at night and eight the next morning, so as to
bear the weight of a man.  An unusual vapour like a fog
was seen  to rise from  the water, in its passage from a fluid
to a solid  state.
   This account of the variableness of the weather in win-
ter, does not apply to every part of Pennsylvania.  There
is a line about the 41° of trie state, beyond which the win-
ters are steady and regular, insomuch that the earth there
is seldom  without  a covering of snow during the three
winter months.  In this line the climate of Pennsvlvania
forms a union with the climate of the eastern and northern
states.
  The time in which frost and  ice begin to show them-
selves in the neighbourhood of Philadelphia, is generally
about the  latter end of October or the beginning of No-
vember.   But the intense cold seldom sets in till about
the 20th or 25th of December;  hence the common say-
ing, " as  the day lengthens,  the cold strengthens." The 
OF PENNSYLVANIA.           X   11
coldest weather is commonly in January.  The naviga-
tion of the river Delaware, after being frozen, is seldom
practicable for large vessels, before the first week in
March.
   As in summer there are often days  in which  fires are
agreeable, so there are sometimes days in winter  in which
they are disagreeable.   Vegetation has ben  observed in
all the winter months. Garlic was tasted in butter in Jan-
uary, 1781.  The leaves of the willow, the blossoms of
the peach tree, and the  flowers of the  dandelion and the
crocus, were all seen in  February,  1779;  and I  well re-
collect, when a school-boy, to have seen an apple orchard
in full bloom, and small apples on many of the  trees, in
the month of December.
   A cold day in winter  is often succeeded by a moderate
evening.   The coldest  part of the four and twenty hours,
is generally at the break of day.
   In  the most intense cold which has been  recorded in
Philadelphia, within the last twenty years, the  mercury
stood at 5° below 0.  But it  appears from the  accounts
published by Messieurs Mason and  Nixon,  in  the 58th
volume of the Transactions of the Royal Society of Lon-
don,  that the mercury stood at 22*  below 0,  on the 2nd
of January, 1767, at Brandywine, about  thirty  miles to
the westward of Philadelphia.  They inform us, that on
the 1st of the same month, the mercury stood at 20°, and
on the day before at 7° below 0.  I  have to lament that I
am not able to procure any record of the temperature of
the air in the same year  in Philadelphia.  From the varie-
ty in  the heighc and quality of the soil, and from »the dif-
ference in the currents of winds and the quantity of rain
and snow which fall in  different parts  of  the state,  it is
very probable this excessive cold may not have extended
thirty miles from the place where it  was first perceived.
   The greatest degree  of heat upon  record  in Philadel-
phia,  is 95°.
   The standard temperature of the  air in  the city of
Philade;phia is 52|°, which  is  the  temperature of our
deepest wells, as also the mean heat of our common spring
water.
   The spring in Pennsylvania is generally less pleasant 
12           ACCOUNT OF THE CLIMATE
than in many other countries.  In March the weather  is
stormy, variable, and cold.   In April, and sometime.-  in
in the beginning of May, it is moist, and accompanied by
a degree of cold which  has been called  rawness,  and
which, from its disagreeable  effects upon the  temper, has
been called the sirocco of this country7.   From the varia-
ble nature of the weather in the spring, vegetation advances
very differently in different years.   The colder the spring,
the  more favourable it  proves to the fruits of the earth.
The hopes of  the farmer from his fruit-trees in a warm
spring are often blasted by a frost in April and May.   A
fall  of snow is remembered with regret by many  of them,
on the night between the 3d and 4th of May, in the year
1774; also on the morning of  the 8th  of May,  1803.
Such was its quantity on the latter day, that it broke down
the  limbs of many poplar trees.   This effect was ascribed
to its not being accompanied with any wind.  The colder
the  winter, the greater delay we generally observe in the
return of the ensuing spring.
  Sometimes the weather during the spring months  is
cloudy and damp, attended occasionally with a gentle fall
of rain resembling the spray  from  a cataract of water.   A
day of this kind of weather is called, from its resemblance
to a damp  day in Great-Britain,  " an English day."  This
damp weather seldom continues more than three or four
days. The month of May, 1786, will long be remembered,
for  having furnished a very uncommon instance of the ab-
sence of the sun for fourteen days, and of constant damp
or rainy weather.
  The month of June is the only month in the year which
resembles a spring month in the southern  countries  of
Europe.  The weather is then generally temperate, the
sky is serene, and the verdure of the country is  universal
and delightful.
  The autumn is the most agreeable season in  the  year
in Pennsylvania. The cool evenings and mornings, which
generally begin about  the first week  in  September, are
succeeded  b) a  moderate temperature of  the air during
the  day. This kind of weather continues with an increase
of cold scarcely perceptible, till  the middle of October,
when the autumn is closed by rain, which sometimes falls 
OF PENNSYLVANIA.
13
in such quantities as to produce destructive freshes in the
rivers and creeks, and sometimes descends in gentle show-
ers, which continue, with occasional  interruptions by a
few fair days, for two or three weeks.   The rains are the
harbingers of the winter; and the Indians have long ago
taught the inhabitants of Pennsylvania,  that the degrees
of cold during the  winter, are in proportion to the quanti-
ty of rain which falls during the autumn*.
   From this account of the temperature of the air in Penn-
sylvania,  it is evident that there are seldom more than
four months in which  the weather  is  agreeable without
a fire.
   In winter the winds  generally come from the  north-
west in fair, and from the north-east in wet weather. The
north-west winds are uncommonly dry as well as cold.
It is in consequence of the violent  action of these winds
that trees have uniformly a thicker and more compact bark
on their northern than on their southern exposures.  Even
brick houses  are affected by the force and dryness of the
north-west winds:  hence it is much more difficult to de-
molish the northern than the southern walls ef an old brick
house. This fact was communicated to me by an eminent
bricklayer in the city of Philadelphia.
   The winds in fair weather  in the spring, and in warm
weather  in the summer,  blow from  the south-west and
from west-north-west.   The raw  air  before-mentioned
comes from the north-east.   The south-west winds like-
wise usually bring with them those showers of rain in the
spring and summer which refresh the earth. They more-
over moderate the heat of the weather, provided they are
succeeded by a  north-west wind.
  * I cannot help agreeing with Mr. Kirwan, in  one of his remarks upon
the science of meteorology, in the preface to his estimate of the temper-
ature of different latitudes.  " This science, (says he), if brought to per-
fection, would enable us at least to foresee those changes in the weather
which we could not prevent.  Great as is  the distance between such
knowledge and our own present attainments, we have no reason to think
it above the level of the powers of the human mind.  The motions of the
planets must have appeared as perplexed aid intricate to those who first
contemplated them ; yet, by persevering industry, they are now known to
the utmost precision. The present is (as the great Liebnitz expresses it)
in every case pregnant with the future; and  the  connexion nvust be found
by long and attentive observation"
  The inHuence which  the perfection of this science must havef upon
health, agriculture, navigation, and commerce, is too obvious to be men
tioned. 
14           ACCOUNT OF THE CLIMATE
   There is a common fact connected with the account of
the usual winds in Pennsylvania, which  it  may not  be
improper to mention  in  this place.   While the clouds
are seen  fl\ ing from the south-west, the scud, as it is call-
ed, or a light vapour, is seen at the same time flying be-
low the clouds from the north-east.
   The moisture of the air is much greater than formerly,
occasioned  probable  by  the exhalations  which in for-
mer years fell in the form of snow, now descending in the
form  of rain.  The depth of the snow is  sometimes be-
tween two  and  three feet, but in general seldom exceeds
between  six and nine inches.
   Hail frequently descends  with snow in winter.   Once
in four or five years large and heavy showers of hail fall
in the spring and summer.   They generally run in nar-
row veins (as they are called) of thirty or forty miles in
length, and two or three miles in breadih.   The heaviest
shower of hail that is remembered in Philadelphia, did not
extend in breadth more than half a mile north and south.
Some of the stones weighed half an ounce. The windows
of many  houses were broken by them.  This shower fell
in May,  1783.
   From  sudden changes in  the  air, rain and  snow often
fall together, forming what  is commonly called sleet.
   In  the uncultivated parts  of the state, the  snow some-
times lies on the ground till the first week in April. The
backwardness of the spring has  been ascribed to the pas-
sage of the air over the undissolved beds of snow and ice
which usually remain, after the  winter  months  are  past,
on the north-west grounds and waters of the state, and of
the adjacent country.
   The dissolution of the ice and snow in the spring is
sometimes so sudden as to swell the creeks and rivers in
every part  of the state to such a  degree, as not only to lay
waste the hopes of the husbandman from the produce of
his lands,   but  in  some instances to sweep his barns,
stables, and even his  dwelling house into their currents*.
  * The following account of the thaw of the river Susquehannah, in the
spring  of 1784, xvas published by the author in the Columbian Magazine,
for November, .1786. It may serve to illustrate a fact related formerly
in the  history o)t the winters in Pennsylvania, as well as to exhibit an
extraordinary instance of the destructive effects of a sudden thaw. 
OF PENNSYLVANIA.                   15
The wind, during a general thaw, comes from the south-
west or  south-east.

   The air, when  dry in Pennsylvania, has a peculiar elas-

ticity,  which renders the heat and cold less  insupportable

than the same degrees of both are in moister countries.  It


  " The winter of 1783-4 was uncommonly cold, insomuch that the mer-
cury in Fahrenheit's thermometer stood several times at 5 degrees below
0.   The snows were frequent, and, in many places, from two to three feet
deep, during the greatest part of the winter.  All the rivers in Pennsyl-
vania were frozen, so as to bear waggons and sleds with immense weights.
In the month of January a thaw came on  suddenly, which opened  our
rivers so as to set the ice a-driving, to use the phrase of the country.  In
the course of one night, during the thaw, the wind shifted suddenly to the
north-west, and the weather became intensely cold.  The  ice,  which  had
floated the day before, was suddenly obstructed; and in the river Susque-
hannah, the obstructions were  formed in  those places where the water
was most shallow, or where it had been accustomed to fall.  This river
is several hundred miles in length, and from half a mile to a mile and a
half in breadth, and winds through a hilly, and in many  places a fertile
and highly cultivated country.  It  has as yet a most difficult communica-
tion  with our bays and the sea, occasioned by the number and height of
the falls which occur near the mouth of the river. The ice in many places,
especially where there were falls, formed a kind of dam of a most  stu-
pendous height.   About the middle of March  our  weather moderated,
and  a thaw  became  general   The effects of it were remarkable in all
our rivers; but in none so much as in the  river I have mentioned. I shall
therefore endeavour in a few words to describe them.  Unfortunately the
dams of ice did not give way all at once,  nor those  which lay nearest to
the mouth of the river, first.  While the  upper dams were set afloat by
the warm weather, the lower ones, which were the largest, and in which,
of course, the ice  was most impacted, remained fixed.  In consequence of
this, the river rost in a few hours, in many places,  above 30 feet, rolling
upon its surface large lumps of ice. from 10 to 40 cubic feet in size.  The
effects of this sudden inundation were terrible.   Whole farms were  laid
under water.   Barns, stables,  horses, cattle, fences,  mills of every kind,
and, in one instance,  a large stone house, 40 by 30 feet, were carried down
the stream.  Large trees were torn up by the roots;  several small islands,
covered with woods, were swept away, and not a vestige of tiiem was left
behind.  On the barns which preserved their shape,  in some instances, for
many miles were to be seen living fowls;  and, in one dwelling, a candle
was seen to bum  for some time, after it was  swept from its foundation.
Where  the shore was level, the lump* of ice, and the ruins of houses and
farms, were thrown a quarter of  a mile from the ordinary height of the
river  In some instances, farms were ruined  by the mould bt ing swept
from them by the cakes of ice, or by depositions of sand; while others
were enriched by large depositions pf mud. The damage,  upon the whole,
done to the state of Pennsylvania by this fresh, was very  great.   In most
places it happened in the day time, or the consequences must have been
fatal to many thousands "
   " 1 know of but one use that can be derived  from  recording the history
of this inundation. In case of similar obstructions of rivers,  from the causes
such as have been described, the terrible effects of their being set in mo-
tion by means of  a general thaw  may in part  be obviated, by removing
such things out of the course of the water and  ice as are within our pow-
er ; particularly  cattle, hay,  grain, fences,  and farming utensils of all
kinds." 
16          ACCOUNT OF THE CLIMATE
is in those cases only when summer showers are not sue- "
ceeded by north-west winds,  that the heat of the air be-
comes oppressive and distressing, from being combined
with moisture.
  From tradition, as well as living observation, it is evi-
dent, that the waters in many of the  creeks in Pennsylva-
nia have diminished considerably within the last fifty years.
Hence many mills,  erected upon large and deep streams
of water, now stand idle in dry weather;  and many creeks;
once navigable in large boats,  are now impassable even in
canoes.   This diminution  of the waters has been ascribed
to the application of a part of them to the purpose of mak-
ing meadows.
  The mean elevation of the  barometer in Philadelphia,
is about 30 inches.   The  variations in the barometer  are
very inconsiderable  in the greatest changes of the wea-
ther, which occur in the city of Philadelphia.  During
the  violent and destructive storm which blew from  the
south-west on the 11th of  November,  1788, it suddenly
fell from  30 to 29T%.  Mr. Rittenhouse informs me, that
long and faithful observations  have satisfied him, that  the
alterations in the height of the mercury in the barometer
do not precede but always succeed changes in the wea-
ther.  It falls with the south  and south-west,  and rises
with the north and north-west winds.
  The quantity of water which falls in rain and snow, one
year with another, amounts to from 24 to 36 inches.  But
to complete the account of variable qualities  in the  cli-
mate, it  will be necessary to add, that  our summers and
autumns are sometimes marked by a deficiency, and some-
times by an excessive quantity of rain.  The summer and
autumn of 1782 were uncommonly dry.  Near two months
elapsed without a single shower of rain.  There were only-
two showers in the whole  months of September and Oc-
tober.  In consequence of this dry weather, there was no
second crop of hay. The Indian corn failed of its increase
in many places, and was cut  down for food for  cattle.
Trees newly planted,  died.  The pasture fields not only
lost their verdure, but threw up  small clouds of dust when
agitated by the feet  of men, or beasts.   Cattle in some
instances were driven many miles to be  watered,  every 
OF PENNSYLVANIA.               17
morning and evening.   It was remarked during  this dry
weather, that the sheep were uncommonly fat, and their
flesh well tasted, while all the other domestic animals lan-
guished  from the want of  grass and water.  The earth
became so inflammable in some places, as to burn above a
foot below its surface.  A complete consumption of the
turf by an accidental fire kindled in the adjoining state of
New-Jersey,  spread terror  and distress through a large
tract of country.  Springs of water and large creeks were
dried up in many parts of the state.  Rocks appeared in
the river Schuylkill, which had never been observed be-
fore, by the oldest persons  then alive.  On one of them
were cut the  figures 1701.   The atmosphere, during part
of this  dry weather,  was often filled, especially in the
mornings, with a thin mist, which, while it deceived with
the expectation of rain, served the  valuable purpose of
abating the heat of the sun.  A similar mist was observed
in France by Dr. Franklin, in the summer of 1782. The
winter which succeeded  it was  uncommonly  cold in
France, as well as in Pennsylvania.   I am sorry that I am
not able to furnish the  mean heat of each of the summer
months.   My notes of the weather enable me to  add
nothing further upon this subject, than that the summer
was  ** uncommonly cool."
   The summer of the year 1788 afforded a remarkable
instance of excess in the quantity of rain which sometimes
falls in  Pennsylvania.   Thirteen  days are marked with
rain in July,  in  the records  of the weather  kept at Spring-
Mill.  There fell on the 18th and 19th of August seven
inches of rain in the city of Philadelphia. The wheat suf-
fered greatly  by the constant rains of July in the eastern
and middle parts of the state.  So unproductive a harvest
in grain, from wet weather,  had not been known, it is said,
in the course of the last 70 years.   The heat of the air,
during these summer months  was  very  moderate.  Its
mean temperature at Spring-Mill was 67,8 in June, 74,7
in July, and only  70,6 in August.
   It is some consolation to a citizen of  Pennsylvania, in
recording facts which seem to militate against our climate,
to reflect that the difference  of the weather, in different
parts of the state, at the same season, is happily accom-
   VOL. II.                 c 
18
ACCOUNT OF THE CLIMATE
modated to  promote an increase of the same objects of
agriculture; and hence a deficiency of crops has never
been known in one year throughout the whole state.
   The aurora borealis and meteors are seen  occasionally
in Pennsylvania.  In the present imperfect state of our
knowledge of their influence  upon the  human body, it
will be for ign to the design of this history of our climate
to describe them.
   Storms and hurricanes are not unknown in Pennsylva-
nia.   They  occur once in four or five years,  but they are
most frequent and destructive in the autumn.  They are
generally accompanied by rain.   Trees  are  torn up by
their roots, and the rivers and creeks are sometimes swell-
ed so suddenly as to do considerable  damage to the  ad-
joining farms.  The wind, during these storms, generally
blows from the south-east and south-west.  In the storms
which occurred in September,  1769, and in  the  same
month of the year 1785, the wind veered round contrary
to its usual course, and blew from the north.
   After what has been said, the character of the climate
of Pennsylvania may be  summed up in a  few words.
There are no two successive years alike.  Even the same
successive seasons and months differ from each other every
year.  Perhaps there is but one steady trait  in the cha-
racter of our climate, and that is, it is uniformly variable.
   To furnish the reader with a succinct  view of the wea-
ther in  Pennsylvania, that  includes  all  the  articles that
have been mentioned, I shall here subjoin a table contain-
ing the result of meteorological  observations made near
the river Schuylkill, for one year, in the neighbourhood
of Philadelphia, by an ingenious French gentleman, Mr.
Legeaux, who divides his time between rural employ-
ments, and useful philosophical pursuits.  This table is
extracted from the Columbian Magazine, for  February,
1788. The height of Spring-Mill above  the city of Phila-
delphia, is supposed to be about 70 feet. 
METEOROLOGICAL OBSERVATIONS, made at Spring-Mill, 13 miles NNW											of Philadelphia. Result ot" the year 1787-		
	THERMOMETER.		BAROME-	S 1	DAYS					WATER			
3			TER.	33	Si	o o o			o				
							•"»!	—■,					
o 2	Fahrenheit, 1	de Reaumur,	mean height		&5 c *1	1	r— ET S	3 O •5-	3	of and	RAIN SNOW.		WEATHER.
	mean degree degr^smoyens			0 s • as 0	5T		a						
	d TV 0 |	•> tV 0	in pts. TV		7*		ji			in.	pts.	i T3"	
Jaouaiy	35 1 i	1 4	29 9 9 j	Variable still		7	1 4			S	10	it	Fail-, still, cold, and snow.
February	33 8	8	29 9 9	NE		o		3	?	3	7		Fair, overcast.
March	45 1	5 8	29 9 7	iy		6		3		2	4	_	Fair, windy.
April	54 3	9 9	29 9 6	Still, SW		3	2	1	9	1	2	15	Fair, and very dry.
May	61 2	13	29 9 2	Still, WSW	1	14	6		2	4	11	e,	foggy, cold, and wet.
.tune	70 7	17 2	29 8 2	WNW		9	1			I	10	4	Very fair and growing weatiier.
July	72 2	17 9	29 9 10	WWSWvar	1	5	2			3	1	11	Fair, and overcast.
August	74 5	18 9	29 10 6	W		11	4		1	5	2	3	v ery fair, and cloudy.
September	64 7	14 5	29 10 4	WNW		6	1		1	2	7	8	Fair weather.
()ctober	51 I	8 5	29 11 9	WNW vari.	1	4					7	10	F°5gy» fair, and dry weather.
November	45 1	5 8	29 11 1	Still vari.	1	5				2	6	10	Very fair.
December	34	9	129 7 7	•VNW				1	1		9		Very fair, and very dr..
	10 Feb. great-	10 Feb. D. du	8 Mar. great-										
	est D. ot cold	plus gr. froid.	est elevation.										
	5	12 0	30 10										
H													TEMPERATURE OF
	3 July greatest D. of heat.	3 July plus G. D. de Chaud.	2 Febr, least.										
J			elevation.										
Pi	96 1	28 5	29	WNW	4	73		12	9	32	8	14	THE YEAR 1787. Very fair, dry, abundant in
	Variation.	Variation.	Variation.										
	91 1 40 5		1 10										every thing, and healthy.
	Temperature. [Temperature.		Mean elevat.										
	53 5 | 9 6		20 9 9										
 
20           ACCOUNT OF THE CLIMATE
   It is worthy of notice, how near the mean heat of the
year, and of the month of April, in two successive years,
are to each other in the same place.   The mean heat of
April,  1787,  was 54°3, that  of April, 1788,  was 52°2.
By the table of the mean heat of each month in the year,
it appears that the mean heat of 1787 was 53°5  at Spring-
Mill.
   The following accounts of the climates of Pekin and
Madrid,  which lie within a few minutes of  the same la-
titude  as  Philadelphia,  may  serve to  show how much
climates  are altered by local and  relative circumstances.
The account of the temperature of the air at Pekin will
serve further to show, that with all the advantages of the
highest degrees of  cultivation which have taken place in
China, the winters  are colder, and the summers  warmer
there than in Pennsylvania, principally from a cause which
will probably operate upon the winters of Pennsylvania
for many centuries  to come,  viz. the  vicinity  of an un-
cultivated northwest country.
   " Pekin, lat. 39° 54', long. 116° 29' W.
   " By live years  observations, its annual mean tempe-
rature  was found to be 55° 5'.
January      -      20°, 75     July       -       84°,8
February     -    32         August           83
March       -      48         September        63
April       -        59         October           52
May     -    -    72         November        41
June       -        83,75      December        27
   " The temperature of the Atlantic under this parallel
is  62,  but the standard of this part of the  globe is the
North Pacific, which is here 4  or 5 degrees colder  than
the Atlantic.   The yellow  Sea is the  nearest to Pekin,
being about 200  miles  distant- from it;  but it  is  itself
cooled by the mountainous country of Corea,  which in-
terposes between it and the ocean, for a considerable part
of its extent.   Besides,  all the northern parts of China
(in which Pekin lies) must be cooled by the  vicinity of
the moantains of Chinese Tartary among which the cold
is  said to be excessive.
   " The  greatest  cold usually experienced during  this
period was 5°, the  greatest heat 98°:  on the 25th of July, 
OF PENNSYLVANIA.               21
1773, the heat arose to 108' and 110°;  a N. E. or N.W.
wind produces the greatest cold, a S. or S. W. or S. E.
the greatest heat."*
   "'Madrid, lat. 40° 25', long. 3° 20' E.
   " The usual heat in summer is said to be from 75° to
85°; even at night it seldom falls below 70°; the mean
height of the barometer is 27,96.  It seems to be about
1900 feet above  the level of the sea."f
   The above accounts are  extracted from Mr. Kirwan's
useful and elaborate estimate of  the  temperature  of dif-
ferent latitudes.
   The history which has been given  of  the climate of
Pennsylvania, is confined chiefly to the country on the east
side of the Allegany mountain.  On the west side of this
mountain, the climate differs materially from that of the
south-eastern parts of the state in the temperature of the
air, in the effects of the winds upon the weather, and the
quantity of rain and snow which falls  every year.  The
winter seldom breaks up on the mountains before the 25th
of March.   A fall of snow was  once perceived upon it,
which measured an inch and a half, on the 11th day of
June.   The  trees which grow upon it are small, and In-
dian corn  is with difficulty brought  to maturity,  even at
the foot of the east side of it.   The south-west winds on
the west side of the mountain are accompanied by cold
and rain.   The  soil is rich, consisting of  near a foot, in
many places, of black mould. The roads in this country
are muddy in winter, but seldom dusty in summer.  The
arrangement of strata of the earth on the west side differs
materially from  their arrangement  on the east  side the
mountain.  " The country (says Mr. Rittenhouse, in a
fetter to a friend in  Philadelphia 1;), when viewed from the
western ridge of the Allegany, appears to be one vast ex-
tended plain. All the various strata of stone seems to lie
undisturbed  in  the  situation in which they were first
formed, and  the layers of stone, sand, clay,  and coal, are
nearly horizontal."
   The temperature of the air on the west is seldom so
hot, or so cold,  as on the east side of the  mountain.   By
   * «« 6. Mem. Scav. Etrang. p. 528."    |" Mem. Par. 1777, p. 146."
   ± Columbian Magazine, for Octobtr, 1786. 
22
ACCOUNT OF THE CLIMATE
comparing the state of a thermometer examined by Dr.
Bedford at Pittsburg, 284 miles from Philadelphia, 'it ap-
pears that the weather was not  so cold by twelve degrees
in that town, as it was in Philadelphia, on the 5th of Feb-
ruary, 1788.
 - To show the difference between the weather at Spring-
Mill and in Pittsburg, I shall here subjoin an account of
it, m both places, the first taken by Mr. Legaux, and the
other by doctor Bedford. 
METEOROLOGICAL OBSERVATIONS, made at Spring-Mill, 13 miles NNW. of Philadelphia. April, 1788.													
q	THERMOMETER.				BAHOMETEK.	•B	DAYS					WATER.	
a, P" n	of Fahrenheit,		de Reaumur,		mean height	ft* 5 ■£ ^		5"	C 3	3	s •n	Of RAIN.	WEATHER.
3	mean degr. i		degre'.moyens			O E	o		n		a	and snow.	
	D JW 0 " 10		d. Tv o		in. pts. ^	5$ o	3					in. pts. TV	
1	58 1		11 6		29 10 5	w.							Overcast, fair.
2	46 9		6 9		30 1	Calm.							Overcast and windy.
3	40 3		3 7		30 3	Changeable.		1				1 15	Overcast, rainy.
4	51 3		8 6		29 11 7	SW.							Overcast.
5	51 1		8 5		30 7	E.							Overcast, fair.
6	55 7		10 5		29 11 7	Calm.		1				1 3	Overcast, rainy.
7	51 3		8 6		30 2	NE.		1				2 7	Overcast, rainy.
8	42 1		4 5		29 11	E.		1				1 4	Rainy.
9	63 5		14		29 8	W.							Overcast, windy.
10	s46 7		6 5		29 10	W.							Fair.
11	53 8		9 7		30 2	w.							Very fair.
12	44 5		5 5		29 10	Calm.		1				1 11	Overcast, rainy,
13	60 5		12 7		29 10 3	SW.							Very fair
14	50 2		8 1		29 9	E.		1				1 14	Fair, overcast, rainy.
15	58 1		11 6		29 9	SW.		1				2 13	Foggy, rainy. j
METEOROLOGICAL OBSERVATIONS, madeat Pittsburg, 284 miles W. oiPhiladelphia. April, 1788. j													
1	46					SW.		1					Cloudy.
2	42					NE. by N.							Clear. ]
3	43					SE.		1		—			Cloudy.
4	64					Calm.							Clear. i
5	80					SE. by S.		1	1				Cloudy. j
6	52					SW-		1					Cloudy. !
7	48 ""					NE. by N.							Cloudy.
8	66					SE. by S.		1	1				Cloudy.
9	56					NW. by N.							Cloudy.
10	60					SW.							Cloudy, with wind
11	62					Calm.							Clear.
1?	67					SW.							Cloudy, with wind
13	62					Calm.				•			Clear.
1*1	60					Variable.		l					Cloudy.
15	5>					W.						Cloudy.	
 
24
ACCOUNT OF THE CLIMATE
   From a review of all the facts which have been  men-
tioned,  it appears that the climate of Pennsylvania is  a
compound of most  of the climates  in the wo|ld.  Here
we have the moisture of Britain in the spring, the heat of
Africa in summer, the temperature of Italy in  June,  the
sky of Egypt in the autumn, the cold and snows of Nor-
way and the ice of  Holland  in the winter,  the  tempests
in a certain degree  of the West-Indies  in every season,
and the  variable winds and weather  of  Great-Britain in
every month  of the year.
   From this  history of the climate of Pennsylvania, it is
easy to ascertain what degrees of health, and what diseases
prevail in the state.  As we have the climates, so we have
the health,  and the acute diseases, of all the countries that
have been mentioned. Without attempting to enume-
rate the diseases, 1 shall only add a few  words  upon  the
time and manner in  which they are produced.
   I. It  appears from the  testimonies of many aged per-
sons, that pleurisies  and inflammatory diseases of all kinds
are less  frequent now  than they were forty  or fifty years
ago.
   II.  It is a well known fact, that intermitting and bilious
fevers have increased in Pennsylvania in proportion  as the
country has been cleared of  its wood, in many parts of
the state.
   III.  It is equally certain that these fevers  have lessened
or disappeared,  in proportion as the country  has been
cultivated.
   IV.  Heavy rains and freshes in the spring seldom pro-
duce fevers,  unless  they are succeeded  by  unseasonably
warm weather.
   V.  Sudden changes from great heat  to cold, or cool
weather, if they occur before the 20th of August, seldom
produce fevers.  After that time, they are  generally  fol-
lowed by them.
   VI.  The same state of the atmosphere, whether cold
or warm, moist or dry, continued for a long time,  with-
out any material changes, is always healthy    Acute and
inflammatory  fevers  were in vain looked  for in the cold
winter of 1779-80.   The dry summer of 1782, and  the
wet summer of 1788,  were likewise uncommonly healthy 
OF PENNSYLVANIA.              25
 ki the city of Philadelphia.   These  facts extend only to
 those diseases which depend upon the sensible qualities
 of the air, for diseases from  miasmata and contagion, are
 less influenced by the  uniformity of the weather.   The
 autumn of  1780 was very sickly in Philadelphia, from
 the peculiar situation of the grounds in the neighbourhood
 of the city, while the country was uncommonly healthy.
 The dry summer and autumn of 1782 were uncommonly
 sickly in the country, from the extensive sources of mor-
 bid exhalations which were left by the diminution of the
 waters in the creeks and rivers.
  VII. Diseases are often generated in one  season and
 produced in another.  Hence  we frequently observe fe-
 vers of different kinds to follow every species of the wea-
 ther that was mentioned in the last observation.
  VIII.  The excessive heat in Pennsylvania has some-
 times proved fatal to prrsoris who have  been much ex-
 posed to it.  Its morbid effects discover themselves by a
 difficulty of breathing, a general languor, and, in some
 instances, by a numbness and immobility of the extremi-
 ties.  The excessive cold in Pennsylvania has more fre-
 quently proved fatal, but it has been chiefly to those per-
 sons who have sought a defence from it, by large draughts
 of spirituous liquors. Its operation in bringing on sleepi-
 ness previous to death,  is well known.   On  the 5th of
 February, 1788, many people were affected by the  cold.
 It produced a violent pain in  the head; and, in one in-
 stance, a sickness at the stomach, and a vomiting appear-
 ed to be the consequence of it. I have frequently observ-
 ed that a greater number of  old people  die,  during the
 continuance of extreme cold and warm weather, than in
 the  same number of days in  moderate weather.
  IX.  May and June are  usually the healthiest months
 in the year.
  X. The influence of the winds upon  health, depends
 very much upon the nature of the country over  which they
 pass.   Winds which pass  over mill-dams and  marshes
 in August and September, generally carry with them the
seeds of fevers.
  XI.  The country in the neighbourhood of Philadelphia
was formerly more  sickly than the central  parts of the
  VOL. II.                   D 
26         ACCOUNT  OF THE CLIMATE

city, after the 20th of August.  Since the year 1793, the
reverse of this has been the case.
  XII.  The night-air is always unwholesome from the
20th of August, especially during the passive state of the
system in sleep.  The  frequent and sudden  changes of
the air from heat to cold render it  unsafe to sleep with
open windows,  during the autumnal months.
  XIII.  Valetudinarians always enjoy the most health m
Pennsylvania in the summer  and winter months.  The
spring, in a particular manner,  is very unfavourable to
them.
   I shall conclude the account of the influence of the climate
of Pennsylvania upon the human body, with the following
observations.
   1. The sensations of heat  and cold are influenced so
much by outward circumstances, that we often  mistake
the degrees of them byineglecting to use such convenien-
cies as are calculated to obviate the effects of their excess.
A native of Jamaica often complains less of the heat, and
a native of Canada of the cold in their respective coun-
tries, than they  do under certain circumstances in Penn-
sylvania.  Even  a Pennsylvanian frequently  complains
less of the heat in Jamaica,  and of  the cold in Canada,
than in his native state.   The reason of this  is plain.  In
countries where heat and cold  are  intense  and regular,
the inhabitants guard themselves, by accommodating their
houses and dresses to each of them.  The instability and
short duration of excessive heat and cold in Pennsylvania,
have unfortunately led its inhabitants in  many instances,
to neglect adopting customs, which are used in  hot and
cold countries to guard  against them. Where houses are
built with a southern or a south-western front exposure,
and where other accommodations to the climate are observ-
ed in their construction, the disagreeable  excesses of heat
and cold  are rendered much less perceptible in Pennsyl-
vania.  Perhaps the application of the principles of philo-
sophy and taste to the construction  of our houses, within
the last thirty or forty years, may be another reason why
some old people have supposed that the degrees of heat and
cold are less in Pennsylvania than they were in former years.
   2. The variable nature of the climate of Pennsylvania 
OF PENNSYLVANIA.               27
  does not render it necessarily unhealthy.  Doctor Hux-
  ham has taught us,  that the healthiest seasons in Great-
  Britain have often been accompanied by the most variable
  weather. His words  upon this subject convey a reason for
  the fact.  " When the constitutions of the year are frequent-
  ly changing, so that  by the contrast a sort of equilibrium
  is kept up, and health with it;  and that especially if per-
  sons are careful to guard  themselves well against  these
  sudden  changes."*  Perhaps no climate or country is
  unhealthy, where men acquire from experience, or tradi-
  tion, the arts of accommodating themselves  to it.  The
  history of all the nations  of the world,  whether savage,
  barbarous, or civilized, previously to a mixture of their
  manners by an intercourse with strangers, seems to favour
  this opinion.   The climate  of  China appears, in  many
  particulars to resemble that of Pennsylvania.   The  Chi-
  nese wear loose garments of different lengths, and increase
  or diminish the number of  them, according  to the fre-
  quent and sudden changes of their weather;  hence  they
  have very few acute diseases among them.   Those  in-
  habitants of Pennsylvania who have acquired  the arts of
  conforming to the changes and  extremes of our weather
  in dress, diet,  and manners, escape most of those acute
^ diseases which are occasioned by the sensible qualities of
  the air; and faithful  inquiries and observations have prov-
  ed, that they attain to as great  ages as the same number
  of people in any part of the  world.

      * Observations on the Air and Epidemic Diseases, vol. i. p. $.■. 
 
         AN ACCOUNT






              OF







THE EFFICACY OF COMMON SALT,







             IN THE







       CURE OF HEMOPTYSIS. 
 
AN ACCOUNT,  &c-
  FROM the present established opinions and practice
respecting the cause and cure of haemoptysis, the last
medicine that would occur to a regular-bred physician for
the cure of it, is common salt ; and yet I have seen and
heard- of a great number of cases, in which it has been
administered with success.
  The mode of giving it is to pour down from a tea to a
table-spoonful of clean fine salt,  as soon as possible after
the haemorrhage begins from the lungs. This quantity ge-
nerally stops it; but the dose must be repeated daily for  '
three or four days, to prevent a return of the disease.  If
the bleeding continue, fnc salt must be continued till it is
checked, but in larger doses.  I have heard of several in-
stances in which two table spoons-full were taken at one
time for several days.
  It sometimes  excites a sickness at the stomach, and
never fails to produce a burning  sensation  in the  throat,
in its  passage into the stomach, and  considerable thirst
afterwards.
  I have found  this remedy to succeed equally well  in
haemorrhages,  whether they occurred in young or in old
people, or with a weak or active pulse.
  I had prescribed it for several years before I could satisfy
myself with a theory, to account for its extraordinary ac-
tion upon the human body.   My inquiries led me to at-
tend more particularly  to the following facts:
   1. Those persons who have  been early instructed in
vocal music, and who use their vocal organs moderately
through life, are seldom affected by a haemorrhage from the
lungs.
  2. Lawyers, players, public cryers, and city watchmen,
all  of whom exercise  their lungs either by long or loud
speaking, are less affected by this disease, than  persons of
other occupations. 
32        THE EFFICACY OF COMMON SALT
  I acknowledge I cannot extend this observation to  the
public teachers of religion. I have known several instances
of their being affected by haemoptysis; but never but one
in which the  disease came on in the pulpit,  and that was
in a person who had been recently cured of it.  The cases
which 1 have seen, have generally been brought on by
catarrhs.
  To this disease, the practice of some of our American
preachers disposes them in a peculiar manner; for it is
very common with this class of them, to expose themselves
to the cold or evening air, immediately after taking what
a celebrated and eloquent preacher used to call a pulpit
sweat.
  3. This haemorrhage chiefly occurs in debilitated habits,
or in persons afflicted by such a predisposition to consump-
tion, as indicates a weak and relaxed state of the lungs.
  4. It generally  occurs when the lungs are in a passive
state; as in sitting, walking, and more frequently in lying.
Many of the cases that I have known, have occurred during
sleep, in the  middle of the night.
  From these facts,  is  it not probable that the common
salt, by acting primarily, and with great force upon  the
throat, extends its stimulus to the bleeding vessel, and by
giving it a tone, checks  the further effusion of blood ?
  I shall only add to this conjecture, the following obser-
vations :
  1. I have never known the common salt perform a cure
where the haemorrhage from the lungs  has  been a symp-
tom of a confirmed consumption.  In this case, however,
it gives a certain temporary relief.   But the bleeding,  so
unfavourable in the close of this disease, often prevents
consumption when it occurs in its early stage, by deplet-
ing directly from the lungs.
  2. The exhibition of  common salt in the haemoptysis,
should by no means supersede the use of occasional bleed-
ing when indicated by plethora, nor of that diet which the
state of the pulse or of the stomach, may require.
  3. I have given the common salt in one case with suc-
cess, in a haemorrhage from the stomach, accompanied by
a vomiting;  and  have heard of several cases in which it
has been supposed to have checked a discharge of blood 
           IN  THE CURE OF HAEMOPTYSIS.         33

from the nose and uterus, but I can say nothing further
in its favour in these last haemorrhages, from my own ex-
perience.
   It may perhaps serve to lesson the prejudices of physi-
cians against adopting improvements in medicine, that are
not recommended by the authority of colleges or univer-
sities, to add, that we  are indebted to an old woman, for
the discovery of the efficacy of common salt in the cure
of haemoptysis.
vol. ir.
k 
 
        THOUGHTS







           UPON






     THE CAUSE AND CURE







           OF THE








PULMONARY CONSUMPTION. 
 
THOUGHTS, &c.
  THE  ancient Jews  used to say,  that a man does not
fulfil his duties  in life who passes  through it, without
building a house, planting a tree, and leaving a child be-
hind him.  A physician  in like manner, should consider
his obligations to his profession and society as undischarg-
ed, who has not attempted to lessen the number of incur-
able diseases  This is my apology for presuming to make
the consumption the object of a medical inquiry.
  Perhaps I may suggest an idea, or fact, that may awaken
the ideas and tacts which now lie useless in the memories
or common-place books of other  physicians; or  1 may
direct their attention to some useful experiments upon this
subject.
  I shall begin  my observations upon the consumption,
by remarking,
  1. That  it is  unknown among the Indians in North-
America.
  2. It is scarcely known by those citizens of the United
States, who live in the first stage of civilized life, and who
have lately  obtained the title of the first settlers.
  The principal occupations of the Indians consist in war,
fishing, and hunting.   Those of the first settler, are fish-
ing, and hunting, and the laborious employments of sub-
duing  the earth,  cutting down forests, building a house
and barn, and distant excursions in all kinds of weather,
to mills and courts, all which tend to excite and preserve
in the system, something like the Indian vigour of con-
stitution.
  3. It is less common in country places than in cities,
and  increases in both, with intemperance and sedentary
modes of life.
  4. Ship  and house  carpenters, smiths, and all those
artificers whose business requires great exertions of strength
in the  open air, in all seasons of the  year, are less subject 
38       THOUGHTS ON THE  CONSUMPTION."

to this disease than men who work under cover, and at
occupations which  do not require the constant action of
their limbs.
  5. Women, who sit more than  men, and whose  work
is connected with less exertion, are most subject to  the
consumption.
  From these facts it would seem, that the most probable
method of curing the consumption, is to revive in the consti-
tution, by means of exercise or labour, that vigour which
belongs to  the Indians, or to mankind in their hrst stage
of civilization.
  The efficacy of these means of curing consumption will
appear, when we inquire into the relative merit of the se-
veral  remedies  which  have  been used by physicians in
this disease.
  I shall not produce among these  remedies the numerous
receipts for syrups, boluses,  electuaries, decoctions,  in-
fusions,  pills, medicated waters, powders, draughts, mix-
tures, and diet-drinks, which have so long and so steadily
been used in this disease; nor shall I mention as a remedy,
the best accommodated diet, submitted to with the most
patient self-denial; for not one of them all, without the aid
of exercise, has ever, I believe, cured a single consumption.
  1. Se a-voy ages have cured consumptions; butithas
been only when they have been so long ;  or  so frequent,
as to substitute the long continuance of gentle, to violent
degrees  of  exercise of a shorter duration,  or where they
have been accompanied by some degree of the labour and
care of navigating the ship.
  2. A  change  of climate has often been prescribed
for  the  cure  of consumptions, but  I do not recollect an
instance of  its having succeeded, except when it has been
accompanied by exercise, as in travelling, or  by some ac-
tive laborious pursuit.
  Doctor Gordon of  Maderia, ascribes the  inefficacy of
the air of Madeira in the consumption, in part to the dif-
ficulty patients find of using  exercise in carriages,  or
even on horseback, from the badness of the roads in tliat
island.
  3. Journeys have often performed cures in the con-
sumption, but it has  been chiefly when they have been 
         thoughts on  the consumption.       39

long,  and accompanied by difficulties which have roused
and invigorated the powers of the mind and body.
  4. Vomits and nauseating medicines have been
much celebrated for the cure of consumptions.   These,
by procuring a temporary determination to the surface of
the body, so far lessen  the pain and cough, as to enable
patients to use profitable exercise.  Where this has  not
accompanied or succeeded the exhibition of vomits, I
believe they have seldom  afforded any permanent relief.
  5. Blood-letting has often relieved consumptions;
but it has been only by removing the troublesome symp-
toms of inflammatory diathesis, and thereby enabling the
patients to use exercise, or labour, with advantage.
  6. Vegetable bitters and some of the stimulat-
ing gums  have in some instances afforded relief in con-
sumptions;  but they have  done  so  only in those cases
where there was  great  debility, accompanied by a total
absence of inflammatory diathesis. They have most pro-
bably acted by their tonic qualities, as substitutes for la-
bour and exercise.
  7. A plentiful and  regular perspiration, ex-
cited by means of a flannel shirt, worn next to the skin,
or by means of a stove-room, or by a warm climate,  has
in many instances prolonged life in consumptive habits;
but all these remedies have acted  as palliatives only,  and
thereby have enabled the  consumptive patients to enjoy
the more beneficial effects of exercise.
  8. Blisters,  setons,  and issues, by determining
the perspirable matter from the lungs to the surface of the
body, lessen pain and  cough,  and thereby prepare  the
System for the more salutary effects of exercise.
  9. The effects of swinging upon the pulse and respira-
tion, leave  us no room to doubt of its being a tonic  re-
medy, and therefore a safe and agreeable substitute for ex-
ercise.
  From all these facts is  evident, that the remedies  for
consumption must be  sought for in those exercises and
employments which give the greatest vigour to the consti-
tution   And litre I am happy in being able to  produce
several facts which demonstrate  the  safety and certainty
of this method of cure. 
40       thoughts on the consumption.

  During the late war,  I saw three instances of persons
in confirmed consumptions, who were perfectly cured by
the  hardships of a military life.   They had  been my pa-
tients previously to their entering into the army. Besides
these, 1 have heard of four well-attested cases of similar
recoveries from nearly the same remedies.  One of these
was the son of a farmer in New-Jersey,  who was sent to
sea  as the last  resource  for  a consumption.  Soon after
he  left the American shore,  he was  taken  by a British
cruiser, and compelled to share in all  the duties and hard-
ships of a common sailor.  After serving in this capacity
for  twenty-two months,  he  made his escape, and landed
at Boston, from whence  he travelled on foot to his father's
house (nearly four hundred miles), where he  arrived in
perfect  health.
  Doctor Way of Wilmington informed me,  that a cer-
tain Abner Cloud, who  was reduced  so low by a pulmo-
nary consumption as to  be  beyond all relief from medi-
cine,  was so much relieved by sleeping in the open air,
and by the usual toils of building a hut, and improving a
farm, in the unsettled parts of a new country in Pennsyl-
vania,  that  he  thought  him in a fair way of  perfect re-
covery.
  Doctor Latimer of Wilmington had been long afflicted
with a cough and an occasional haemoptysis. He entered
into the American army as a surgeon, and served in that
capacity till near the end of the war; during which time
he was  perfectly free from  all pulmonary disease.  The
spitting of blood returned soon after  he settled in private
practice.  To remedy this complaint, he had recourse to
a low diet, but finding it ineffectual, he partook liberally
of the usual diet of healthy men,  and he now enjoys a
perfect exemption from  it.
  It would be very easy to add  many other cases, in
which  labour,  the employments of agriculture,  and a life
of hardship by sea and land, have prevented, relieved, or
cured, not only the consumption, but pulmonary diseases
of all kinds.
  To the cases that have been mentioned, I shall add only
one more, which was communicated to me by the vener-
able Doctor Franklin, whose conversation at all times con- 
thouchts on the consumption.     4l
veyed instruction,  and not less in medicine  than upon
other subjects.  In travelling, many years ago, through
New-England, the doctor  overtook the post-rider;  and
after some inquiries into the history of his life, he inform-
ed him that he was bred a shoemaker; that his confine-
ment, and other circumstances,  had brought  on a con-
sumption, for which he was  ordered  by a physician to
ride  on horseback.  Finding  this mode of exercise too
expensive,  he made interest, upon  the death of an old
post-rider,  to succeed to his  appointment, in which he
perfectly recovered his health in  two years.   After  this
he returned to his old trade, upon which his consumption
returned.  He again mounted his horse, and rode post
in all seasons and weathers, between New-York and Con-
necticut river  (about 140  miles), in which employment
he continued upwards of thirty years, in perfect health.
   These facts, I hope, are sufficient to establish the ad-
vantages of restoring the original vigour of the constitu-
tion,  in  every attempt to effect  a  radical  cure of con-
sumption.
   But how shall these remedies be applied in the time of
peace, or in a country where the want of woods, and brooks
without bridges,  forbid the attainment of the laborious
pleasures of the Indian mode of  hunting;  or where the
universal extent of civilization does not admit of our ad-
vising the toils of  a new settlement, and  improvements
upon bare creation ?  Under  these circumstances, I con-
ceive substitutes  may  be obtained for each of them,
nearly of equal efficacy, and attainable with much less
trouble.
   1  Doctor Sydenham pronounced riding on horseback,
to be as certain a cure for  consumptions as bark is for an
intermitting fever.   I have no more doubt  of the truth of
this  assertion, than I have that  inflammatory fevers are
now less frequent in London  than they were  in the time
of Doctor  Sydenham.  If riding on  horseback in con-
sumptions has ceased to be a  remedy in Britain, the fault
is in the patient, and not  in  the  remedy.^ "It is a sign
that the stomach requires  milk (says  Doctor Cadogan),
when it cannot bear it."   In  like manner,  the inability of
the patient to bear this manly and wholesome exercise,
   VOL. II.                  f 
42       thoughts on the consumption.
serves only to demonstrate  the necessity and  advantages
of it.  I suspect the same objections to this exercise
which have been made in Britain,  will not occur in the
United States of America; for the Americans, with re-
spect to the symptoms and degrees of epidemic and chro-
nic diseases, appear to be nearly in the same state that the
inhabitants of England were in the seventeenth century.
We  find, in proportion to the decline of the vigour of the
body, that many occasional causes produce fever and in-
flammation,  which  would  not have done it a hundred
years ago.
   2.  The laborious employments of agriculture,  if stea-
dily  pursued, and  accompanied at the same time by the
simple,  but wholesome diet of a farm-house,  and a hard
bed, would brobably afford a good substitute for the toils
of a  savage or military life.
   3.  Such occupations or professions as require constant
labour or exercise in the open air, in all kinds of weather,
may be easily chosen for a young man who,  either  from
hereditary predisposition, or an accidental  affection of the
lungs, is in danger of falling into  a consumption.  In this
we should imitate the advice given by some wise  men,
always to prefer those professions for our sons, which are
the least  favourable to the  corrupt inclinations of their
hearts. For example, where an undue passion for money,
or a crafty disposition, discover themselves in early life,
we are directed to oppose  them by the less  profitable or
more disinterested professions of divinity or physic, rather
than cherish them  by trade, or the practice of the law.
Agreeably to this  analogy, weakly children should  be
trained to the laborious, and the robust, to the sedentary
occupations. From a neglect of this practice, many hun-
dred apprentices  to taylors, shoemakers, conveyancers,
watchmakers, silver-smiths, and  mantua-makers,  perish
every year by consumption.
   4. There is  a  case recorded by Dr. Smollet, of the
efficacy of the  cold  bath in a  consumption; and I have
heard of its having been used with success, in the case of
a negro man, in one of the West-India Islands.   To ren-
der  this remedy useful, or even safe, it will be necessary
to join it with  labour, or to use  it in degrees that shall 
thoughts on the consumption.
43
  prevent the alternation of the system with vigour and de-
  bility ; for I take the cure of consumption  ultimately to
  depend upon the simple and constant action of  tonic re-
  medies.   It is to be lamented that  it often requires  so
  much time, or such remedies to remove the inflammatory
  diathesis,  which attends the first stage of consumption,
  as to reduce the  patient too low  to make  use of those
  tonic remedies afterwards,  which would  effect  a  radical
  cure.
    If it were possible to graduate the tone of  the  system
  by means of a scale, I would add, that to cure consump-
  tion, the system  should be raised to the highest degree
  of this scale.  Nothing short of an equilibrium of tone,
  or free and vigorous action of every muscle and viseusin
  the  body,  will fully come up  to a radical cure  of this
  disease.
    In regulating the diet of consumptive patients,  I con-
  ceive it  to  be as necessary to feel  the pulse, as it is in de-
  termining  when and  in what  quantity  to draw blood.
  Where  inflammatory diathesis  prevails,  a vegetable diet
  is certainly proper; but where  the patient  has escaped,
  or passed this stasje of  the disease, I believe  a vegetable
  diet alone to be injurious;  and  am sure a moderate quan-
  tity of animal food may be taken  with advantage.
    The presence or absence of this  inflammatory  diathe-
  sis, furnishes the indications  f< r administering or  refrain-
  ing from the use of the bark  and  balsamic  medicines.
  With all the testimonies  of  their having done mischief,
  many of which I could produce, I have known several
  cases in which they have  been given  with  obvious  ad-
•  vantage;  but it was only  when there was a total absence
  of inflammatory diathesis.
    Perhaps the remedies I have  recommended, and  the
  opinions 1 have delivered, may derive some support from
  attending to the analogy of ulcers  on the legs, and in other
  parts of  the body.  The first  of these  occur chiefly in
  habits debilitated by spirituous liquors, and the last fre-
  quently in habits debilitated by the scrophula.  In curing
  these diseases, it is in vain  to depend upon internal or
  external medicines. The whole system must  be strength- 
 44       thoughts on the consumption.

 ened, or we do nothing ; and  this is to be effected only
 by exercise and a generous diet.
   In relating the facts that are contained in this inquiry,
 I wish I could have avoided reasoning  upon  them :  es-
 pecially as I am confident  of the certainty of the facts,
 and somewhat doubtful of the truth of my reasonings.
   I shall only add, that if the cure of consumptions should
 at last be affected by remedies in  every respect the op-
 posites of those palliatives which are now fashionable and
 universal, no more will  happen than what we  have alrea-
 dy seen in the tetanus,  the small-pox,  and the manage-
 ment of fractured limbs.
   Should this be the case, we shall not be surprised to
 hear of physicians, instead of prescribing any one, or all
 of the medicines formerly enumerated for consumptions,
 ordering their patients to  exchange  the amusements, or
 indolence of a city, for the toils of a country life;  of their
 advising farmers to exchange  their plentiful tables, and
 comfortable fire-sides, for the scanty but solid subsistence,
 and midnight exposures of the herdsman; or  of their re-
 commending,  not so much the exercise of a passive  sea
 voyage, as the active labours  and dangers of  a common
 sailor.  Nor should it surprise us,  after what we have
 seen, to hear patients relate the pleasant adventures of their
 excursions or labours, in quest of  their recovery from
 this disease, any more than it does now to see  a strong or
 well-shaped limb that has been broken ; or to  hear a man
 talk of his studies,  or pleasures, during the time of  his
 being inoculated and attended for the small-pox.
   I will not venture to assert, that  there does not exist a
 medicine  which  shall supply, at least in some degree, the
 place of the labour or exercises, whose usefulness in con-
 sumptions has been  established by the facts that have
 been mentioned.  Many  instances of the analogous effects
 of medicines, and of exercise upon the human body, for-
 bid the supposition.   If there does exist in nature such
a medicine, I am disposed to believe it will be found in
the class of tonics.   If this should be the case, I con-
ceive its strength, or its dose, must far exceed the pre-
sent state of our knowledge or practice,  with  respect  to
 the efficacy or dose of tonic medicines.. 
         thoughts on the consumption.       45

  I except the disease, which arises from recent abscesses
in the lungs, from the general observation which has been
made, respecting the inefficacy of the remedies that were
formerly enumerated for the cure of consumptions with-
out labour  or exercise.  These abscesses often occur
without being preceeded by general debility, or  accom-
panied by a consumptive diathesis, and are  frequently
cured by nature, or by very simple medicines. 
 
        AN INQUIRY






            INTO






      THE CAUSE AND CURE







            OF THE








PULMONARY CONSUMPTION. 
 
AN  INQUIRY, &c.
  IN the  preceding Inquiry,  I attempted  to show that
this disease was the effect of causes which induce 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 de-
tail of facts and reasonings, at which I only hinted in the
foregoging pages.
  The method I have  chosen for this  purpose, is to de-
liver, and afterwards to  support, a few general propositions.
  I shall begin by remarking,
  I. That the pulmonary consumption is induced by pre-
disposing 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 stomach, liver,  and kidneys, ner-
vous and intermitting fevers,  measles,  repelled humours
from the surface of the body, the venereal disease, obstruc-
ted menses, sudden growth about the age of puberty, grief,
and all other debilitating passions of the mind ; hypochon-
driasis,  improper  lactation, excessive  evacuation of all
kinds,  more especially by stool*,  cold  and  damp air,  a
cough,  external violence actirg upon   the  body ;f and
finally, every thing that tends, directly or indirectly, to di-
minish the strength of  the system.

  * Sir George Baker relates, in the second volume of the Medical Trans-
actions, that Dr. Blanchard had informed him, that he had seen the con-
sumption brought on ten persons out of ninety, by excessive purging used
to prepare the body for the small-pox.  I have seen a case of consump-
tion in a youth of 17, from the spitting produced by the  intemperate use
of segars.
  f Dr. Lind says, that out of 360 patients whom he attended between
July 1st, 1758, and July 1st, 1760, in consumptions, the disease was br.<ught
on one fourth of them by falls, bruises, and strains, received a year or two
before the disease made its appearance.
   VOL. II.                   O 
50        ON PULMONARY  CONSUMPTION.

  The most frequent exciting cause of consumption 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,  operate 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 troublesome and obstinate cough.
  2.  From the debilitating occupations and habits of per-
sons who are most liable to this disease. These are studi-
ous men, and mechanics who lead sedentary lives in con-
fined places; also women, and all persons of irritable hab-
its, whether of body or mind.
   3.  From the period in which persons are most liable
to be affected by this disease  This is generally between
the 18ih and 36th year of life, a  period in which the sys-
tem is liable, in a peculiar manner, to most diseases which
induce  it,  and in 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 busi-
ness 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  appears  in children,
and frequently 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 quick pulse, especially towards  evening; a heat and
 burning in the palms  of the hands; faintness, head-ach,
 sickness at stomach, and an occasional diarrhaea.  I have
 frequently  observed each of these symptoms  for several
 months before I have heard of a single complaint in the
 breast.
   3. From the pulmonary consumption alternating with
 other diseases which  obviously belong to the whole sys-
 tem. I shall  briefly mention these diseases. 
ON PULMONARY CONSUMPTION.
51
     The rheumatism.  I have seen many cases in which
   this disease and the consumption have alternately, in dif-
   ferent 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 observa-
   tion.   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 complaints.
     The gout  has  often been observed to alternate with
   the pulmonary consumption, especially in persons in  the
   decline of life.   Dr  Sydenham  describes a short cough
   continuing  through the whole winter, as a symptom of
   gouty habits.   A gentleman 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 frequently alternated with pains and a swelling in his
   feet.
     The pulmonary consumption has been observed to al-
   ternate 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 under  my
   notice, the symptoms of consumption returned before the
   death of the patient.
     I have likewise witnessed  two cases in which the return
   of reason after  madness,  was suddenly succeeded by a
   fatal pulmonary consumption. Perhaps 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 universal are the delusions and hopes of pa-
   tients, with  respect to the nature and issue of this disease,
   that I have never met with but one man, who, upon be-
   ing asked what was the  matter with him, answered un-
   equivocally, " that he was in a consumption."
     Again: Dr. Bennet mentions a case of " A phthisical
,  " patient, who  was seized with a violent pain in the
   " teeth for two days,  and  in whom, during that time. 
52        ON PULMONARY consumption.
" every symptom of a consumption, except the leanness of
" the1 body, altogether  vanished:" and he adds further,
" that a deduction on the lungs had often been relieved
" by salivary evacuations."*
  I have seen several instances in which  the pulmonary
symptoms have alternated with he ad ac Hand dyspepsia;
also with pain and noise in one ear.  This affection  of
the ears sometimes continues throughout the whole dis-
ease, 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 alter-
nately relieved and reproduced by the appearance or ces-
sation of a diarrhaea, or pains in the bowels ?
  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  1 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
connexion 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 apoplexy is a
general debility of the system, produced by intemperance
in eating and drinking.  The phenomena of the disease
are produced by an effusion of blood or serum, inconse-
quence of a morbid distension, 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 situation and structure of the  brain and lungs.  After

  * Treatise of the Nature and Cure of Consumptions.  Exercitation X 
           ON PULMONARY CONSUMPTION.         53

the production of predisposing debility from the action of
the remote causes formerly enumerated, the fluids are de-
termined 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 produced
which has been called haemoptysis. An effusion of blood
it>the brain, brought on by the operation of general debili-
ty, has been called by Dr.  Hoffman, with equal propriety,
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 rup-
ture of a  blood vessel is produced, death is  nearly as
speedy and certain in the one case as in the  other.  Dis-
sections show many cases of suffocation and death, from
the lungs being preternaturally filled with blood or serum.
From  this great analogy  between the  remote and proxi-
mate causes of the two diseases which have been describ-
ed, 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 not fall down as if by an ex-
ternal  stroke, which is  most  frequently the case in the
apoplexy of the brain.
   The history of the remote  and proximate causes of
pneumony will furnish us with a still more remarkable
analogy  of the  connexion  between a local affection, and a
 general  disease of  the system.  The pneumony is pro-
 duced by remote exciting causes which act on the whole
 system.   The 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 dis-
 ease in health,  is always the effect of effusions produced
 by a general disease, and even the vomicas, which some-
 times succeed a deficiency of bleeding, always depend up-
 on the same general cause. From this view of the analogy
 between pneumony and pulmonary consumption, it would
 seem that the two diseases differed from each other  only 
54        ON PULMONARY CONSUMPTION.
by the shorter or longer operation of the causes which in-
duce them, and by the greater or less violence and dura-
tion  of their  symptoms.   The pneumony appears to be
an acute consumption, and the consumption a chronic
pneumony.   From the analogy of the pulmonary  con-
sumption  with the diminutive  term of certain fevers, I
have taken the liberty of calling it a pneumonicula.
   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  Lan-
cashire, that the consumption was  a very common disease
on the sea coast of that country; but that it was not ac-
companied either by previous inflammation or  ulcers in
the lungs.  It was generally attended, he says, by an un-
usual peevishness of temper.
   6. I infer that the pulmonary consumption is a disease
of the whole system, from its being relieved,  or cured,
only by remedies which act upon the whole system.  This
will appear, I hope, hereafter,  when we come to treat of
the cure of this disease.
   Let us now enquire how far  the principle I have laid
down will apply to the supposed causes of consumption.
These causes  have been said to be, an abscess in the lungs,
haemoptysis,  tubercles, without and with ulcers, catarrh,
hereditary diathesis, contagion, and the matter of cutane-
ous  eruptions,  or sores repelled, and thrown upon the
lungs.   I shall  make a few observations upon each of
them.
   1. An abscess in their lungs is generally the  consequ-
ence of a neglected, or half-cured pneumony.  It is seldom
fatal, where it is not  connected with a predisposition to
consumption  from general debility, or where general de-
bility is not previously induced  by the want of appetite,
sleep, and exercise,  which  sometimes accompany  that
disease of the lungs. This explanation of the production of
consumption  by an abscess in the lungs, will receive fur-
ther support from attending to the effects of wounds in the
lungs.  How seldom are they followed by pulmonary con-
sumption ; and  this only because they are as seldom ac- 
           on pulmonary consumption.         55

Companied by predisposing general debility. I do not re-
collect 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 recoveries which have
succeeded such wounds,  and frequently under the  most
unfavourable circumstances,  show how very improbable
it is that  a  much slighter  affection of the lungs should be-
come the cause of a pulmonary consumption.
  A British officer, whom I  met in the British camp, 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  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 continue
for many years without inducing a consumption.  I have
never known but one instance of the whooping-cough
ending in consumption, and all our books of medicine con-
tain 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 original 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 particles 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, system.  When it
 is local,  or when it is the effect of causes  which induce  a
 temporary or acute debility only in the system, it is sel-
 dom followed by consumption. The accidental discharge
 of blood from the lungs, from injuries, and from an ob-
 struction 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 
 56        ON  pulmonary consumption.

 exposed to any of the causes which induce sudden de-
 bility, and yet no consumption has followed it.  The late
 king of Prussia  informed Dr Zimmerman that be 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 is only
 in persons who labour under chronic  debility,  that hae-
 moptysis 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
 discharged by 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 fre-
 quently secreted into  the  substance of the lungs, where
 it produces  those tumours we call tubercles.  When this
 occurs, there is either no cough* or a very dry one. That
 tubercles are formed in this way,  1 infer from the dissec-   *
 tions and experiments of Dr. Starkf,  who  tells  us, that
 he found them to consist of inorganic  matter; that he
 was unable to discover any connexion 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 dis-
charged 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 gleet.
   I am aware that these tumours  in the lungs have been
ascribed to scrophula.   But the  frequent  occurrence of
consumptions in persons in whom no scrophulous taint
existed, is sufficient to refute this  opinion.   I  have  fre-
quently directed my inquiries after this disease in con-
sumptive  patients,  and have met with very  few cases

  * See Med. Com. Vol.  II.
  f Clinical and Anatomical Observations, p. 26, 27.  See also Morgag-
ni, letter xxii. 21. 
           ON  pulmonary consumption.        57

which were produced by it.  It is probable  that it  may
frequently  be  a predisposing cause  of consumption  in
Great Britain, but I am sure it is not in the United States.
Baron Humboldt informed me,  that the scrophula 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 on the intestines  by the dysentery,
and on the omentum  by a yellow fever.  Cases of the
former are to be met with in the dissections of Sir John
Pringle,  and one of the latter is  mentioned by Dr. Mac-
kittrick,  in his inaugural  dissertation upon the yellow
fever, published in Edinburgh in the year 1766.*
   4. The catarrh is of two kinds, acute and chronic,  both
of which are  connected with general debility,  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  weather, fatigue,
and, above all, by old age, and relieved or cured by ex-
ercise, and every thing else which invigorates the whole
system.  This  species of catarrh often continues for twen-
ty or thirty years without inducing pulmonary consump-
tion,  in persons who pursue active occupations.
   5.  In  the hereditary consumption there is cither a here-
ditary debility of the whole system, or a hereditary mal-
conformation of the breast.  In the latter case,  the con-
sumption is the effect of  weakness communicated to the
whole system, by the long continuance  of difficult respi-
ration, or of such injuries  being done to the lungs as are
incompatible with health and life.   It is remarkable, that
the consumptive diathesis is more frequently derived from
paternal, than maternal ancestors.
   6.  Physicians, the most distinguished characters, have
agreed,  that the pulmonary consumption may be com-
municated by contagion.  Under the  influence of this
belief, Morgagni informs us, that Valsalva, who was pre-
disposed to  the consumption,  constantly avoided being
present at the dissection  of the  lungs of persons who had
died  of that disease.  In some  parts of  Spain and Portu-
                       > Pages 7, 8.
      VOL. II.              H 
58         on  pulmonary consumption:

gal,  its contagious  nature is so generally believed, that
cases of it are reported to the magistrates of those coun-
tries, 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 adopt-
ed this opinion, with respect  to the consumption, in the
early part of my life; but I have lately been led  to  call
its truth in question, especially in the  unqualified man-
ner 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. Mai-conformation of the hreast, in all the branches
of the  diseased family.  It is not necessary that this or-
ganic predisposition should be hereditary,
  2. Upon the debility which is incurred by nursing and
the grief which follows the loss of relations  who die of it.
  3. Upon some local  cause undermining  the constitu-
tions of a whole family.  This  may be exhalations 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 render the  consumption a kind
of family epidemic.  I was  consulted,  in  the month of
August,  1793,  by a Mr. Gale, of Maryland, in a pulmo-
nary complaint.  He informed me, that he had lost se-
veral brothers and sisters with the consumption, and that
none of his ancestors had died of it.  The  deceased per-
sons, five in number,  had lived in a place  that had been
subject to the intermitting fever.
  4. Upon some peculiar and  unwholesome article of
diet, which exerts slowly debilitating effects upon all the
branches of a family.
  5. Upon a fearful and debilitating apprehension enter-
tained  by  the surviving  members of a  family, in which
one or two have died of consumption, that they shall per-
ish 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, 
           ON PULMONARY CONSUMPTION.        59

and subsequent disease, are so numerous, as to leave no
doubt of the operation of this cause, in producing a num-
ber of successive deaths in the same family, from pulmo-
nary consumption.
  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 occur in  families
from consumptions,  and this we know never takes place
in any disease which is admitted to be contagious.
  2. The consumption is not singular in affecting seve-
ral branches of  a  family.  I  was lately consulted  by a
young physician from Maryland, who informed me, that
two  of  his brothers, in common with himself,  were af-
flicted with epilepsy.  Madness, scrophula,  and  a dispo-
sition to haemorrhage, often affect, in succession, several
branches of the  same family;  and who will  say that  anj
one  of the above diseases is propagated by contagion ?
  The practice  of the Spaniards and Portuguese,  in burn-
ing the  clothes of persons who die of consumptions, no
more proves the disease to be contagious, than the same
acts sanctioned by the  advice or order 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  acid  and  foetid vapour,  which is dis-
charged by breathing from an ulcer or abscess in the lungs,
nor  of  the hectic sweats, when rendered putrid  by stag-
nating in sheets, or blankets, communicating this disease
to persons who  are long  exposed to them,  by  sleeping
with consumptive patients;  but that such cases rarely oc-
cur I infer, from the persons affected often living at a dis-
tance 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 disease from  the white branches of a family in
Connecticut, and which was  mentioned, upon the author-
ity of Dr. Beardsley, in a former edition of this  inquiry.
Admitting the above morbid matters  now and then to 
60        ON PULMONARY CONSUMPTION.
act as a remote cause of consumption, it does not militate
against the theory I have aimed to establish, for if it fol-
low 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 indicated by
general languor   The influenza and the  measles  are al-
ways accompanied by general debility, but the small-pox
furnishes an analogy to the case in question more directly
in point. The contagion 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 which the
contagion produced its first operation.
   7. I grant that cutaneous humours, and the matter  of
old sores, when repelled, or suddenly healed, have in some
cases fallen upon the lungs,  and produced consumption.
But I believe, in every case where this has happened, the
consumption was preceded by general debility, or that it
was not induced,  until  the whole system had been pre-
viously 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 pulmo-
nary 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 into the quality of the dis-
charge from the lungs, are as fruitless as an attempt would
be to discover the causes or cure of dropsies, by  an ex-
amination of the qualities of collections  of water, or  to
find out the causes and cure offevers, by the quantity  or
quality of the discharges which take place-  in those diseases
from the kidneys and skin.   It is to be lamented,  diat 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 the trachea, and a preternatural se-
cretion of bile, have been accused of producing hydroce-
phalus internus, cynanche  trachealis, and  bilious fever,
whereas we now  know they are the effects of those dis-
eases only, in the successive order in which each of them
has been mentioned. It is high time to harness the steeds 
           QN PULMONARY CONSUMPTION.        61

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 the cough, tubercles, and ulcers, after they are form-
ed, 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  con-
stitute no part of the diseases that produce them,  frequent-
ly induce symptoms, and a termination of them, wholly
unconnected 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 pul-
monary consumption. Dr. Lind tells us, that the last stage
of the jail fever was often marked by a cough.  I have sel-
dom been disappointed  in looking  for a cough and a co-
pious excretion of mucus  and phlegm after the 14th or
15th days of a chronic  typhus fever.   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 debility which precedes
death,  generally discovers its last symptoms in the lungs.
Hence  most people  die with what are called the rattles.
They are produced by a sudden and copious effusion of
mucus 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 con-
siderable 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 disease  under my care,
in the year 1801, in consequence of the discharge of pus
from an ulcer  which  followed a  haemorrhage from the
trachea being suddenly suppressed.   I have seen another
case of the same kind in a lady in this city, in the year 
 62         ON PULMONARY CONSUMPTION*

 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 consumption.
 He calls it, very  properly, " phthisis trachealis."  I have
 met with two cases of death from this disease, in which
 there were tubercles in the trachea.  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 rather than  in any
 other parts of the body ?  I answer that it seems to be the
 law of the system, that general debility should always pro-
 duce some local disease.   This local  disease sometimes
 manifests itself  in  dyspepsia, as in the general debility
 which follows  grief;  sometimes  it discovers  itself in a
 diarrhoea, 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 constant or violent
 exercise of the understanding, or of stimulating passions;
 but it more frequently appears in the lungs, as  the conse-
 quence of general debility.  It would seem as if the de-
 bility 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 nervous and arterial
 system.   What  makes it  more probable that the arterial
 system is materially affected in the consumption is, that
 the disease most frequently occurs in those periods of life,
 and in those habits  in which a peculiar state of irritability
 or excitability 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 weather.
It has been observed,  that the debility in the inhabitants
of the West-Indies, whether produced by  the heat of the
climate or the excessive pursuits of business or pleasure,
generally terminates in dropsy,  or  in some disease of the
alimentary canal.
  I have said, that it seemed to be a law of the system, 
ON  PULMONARY CONSUMPTION.          63
that general debility should always  produce some local
affection.  But to this law there are sometimes exception :
the atrophy appears to be a consumption without an af-
fection 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 white parents.   The hectic fever,
and even  the night sweat, were as obvious in several of
these  cases, as in those consumptions, 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 admits of an early and very
important application to  practice.
   If the consumption  be preceded by general debility,  it
becomes us to attempt  the cure of it before it produce
the active symptoms  of cough, bloody or purulent dis-
charges from the lungs,  and inflammatory or hectic fever.
The symptoms which  mark its first stage,  are too seldom
observed; or if observed, they are too often treated with
equel neglect by patient and physicians.   I shall briefly
enumerate these symptoms.  They are a  slight fever in-
creased by the least exercise; a burning  and dryness in
the palms of the hands, more especially towards evening;
rheumy eyes upon waking from sleep;  an increase of
urine ;  a  dryness  of the skin, more especially of the feet
in  the  morning* ; an  occasional flushing in  one, and
sometimes in  both cheeks;  a  hoarsenessf; a slight or
acute pain in  the breast; a  fixed pain in  one side, or
shooting  pains  in both sides; head-ach ;  occasional sick
and fainty fits ; a deficiency of appetite, and a general in-
disposition 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
  * The three last-mentioned symptoms are taken notice of by Dr. Ben-
net, in his Treatise upon the  Nature and Cure of the Consumption, as
precursors of the disease.  Dr. Boerhaave used to tell his  pupils that
they had never deceived him.
  f I have  seen the hoarseness in one  case the  first symptom  of ap-
proaching consumption.  In this symptom it preserves the analogy of
pneumony, which often comes  on with a hoarseness, and sometimes with
paraphonia. 
 64         ON  PULMONARY CONSUMPTION.

 within my own observation.  I wish them to be commit-
 ted to memory by young practitioners ;  and if they de-
 rive 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 proxi-
 mate  cause of this disease, they will not derive much re-
 putation 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 effec-
 tual until he acquire a  perfect indifference to his own in-
 terest and fame.
  The remedies for consumption, in this stage of the
 disease, are simple and  certain.  They consist in a deser-
 tion of all its remote  and exciting causes,  particularly se-
 dentary employments, damp or cold situations, and  what-
ever 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 improper,  or even
dangerous,  these remedies  may be after  the  disease as-
 sumes an inflammatory or hectic type,  and produces an
 affection of the lungs, they are perfectly safe and extreme-
 ly useful in the state  of the system which has been des-
 cribed.  The use of  the bark will readily  be admitted by
all  those practitioners who believe the pulmonary  con-
 sumption  to  depend  upon a scrophulous  diathesis.
 Should even the lungs be affected by scrophulous tu-
 mours, it is no objection to the use of the bark, for there
 is no reason why it should not be as useful in scrophulous
 tumours of the lungs, as of the glands of the throat, pro-
vided it be  given before those tumours  have produced
 inflammation ; and in this  case, no prudent practitioner
 will ever prescribe it in scrophula, when seated  even in
 the external parts  of the body.   To   these remedies
 should  be  added a  diet  moderately stimulating,  and
 gentle exercise,   i shall hereafter mention  the different
 species  of  exercise,  and the manner in  which  each of
 them should be used, so as to derive the utmost advan-
 tage from  them.  I  can say nothing of  the  use of salt 
ON  PULMONARY CONSUMPTION.        65
water or sea air in this stage of the consumption, from
my own experience.   1 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  ihe  simple remedies which have  been mentioned
have been  neglected,  in the first stage of the disease, it
generally terminates, in different periods of  time, in pul-
monary affections, which show themselves  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 occa-
sionally hard.  The  discharges from  the lungs,  in  this
state of the disease, are frequently purulent.
   3. A fever with a weak frequent pulse, a troublesome
cough, and copious purulent discharges 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 pulmonary
consumption there  are  occasional deviations.   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 accomplished 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
 nights  sweats.   A similar case is  recorded in the Me-
 moirs 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. Benjamin Loxley, in the  year 1785.  She
 had complained of a pain in her right side,  and  had fre-
 quent  chills with a fever  of the hectic kind.   They all
 gave way to frequent and gentle bleeding.   In the sum-
 mer of 1786, she was seized with the  same complaints,
 and as she had great objections to bleeding, she consult-
    vol. n.                 i 
66        ON PULMONARY CONSUMPTION.

ed a physician who gratified  her, by attempting to cure
her by recommending exercise and country air.   In the
autumn she returned 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 without the
least cough or  fever.  Her  pulse was preternaturally
slow.  She could lie only on  her left side.  She some-
times 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 little hecking cough, but without
any discharge from the lungs.  Upon my first  visit to
her in the preceding autumn,  I told her friends that I  be-
lieved she had an abscess in her lungs.  The want of
fever and cough afterwards,  however,  gave me reason to
suspect that I had been mistaken.   The  morning after
her death, 1 received a message from her father, informing
me that it had been among the last requests of his daugh-
ter, 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 contain-
ed about half a pint of purulent matter, and which had
nearly destroyed the whole substance of the right lobe of
the lungs.
  I have never seen a dry tongue in any of the forms or
stages of this disease.
  The three  different forms  of the pulmonary  affection
that I have mentioned, have  been  distinguished by the
names  of the  first, second, and third stages of the con-
sumption ;  but as they  do not always succeed each other
in the order in which they have been mentioned, 1 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 
           ON PULMONARY CONSUMPTION.       67

of inflammatory action, appeared in the last hours of life.
It is agreeable to pursue the analogy of this disease 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
Frequendy  attacks with  inflammatory  symptoms;  but
it sometimes occurs with smyptoms which forbid blood-
letting, and I have  more than once seen  it attended by
symptoms  which required the  use of wine and bark.
The 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 attend-
ed by a  discharge of blood from the lungs, which is
more copious than in the pneumony,  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  absence of that symptom in pulmonary con-
sumption.
   The pneumony terminates in different periods,  ac-
cording to the degrees of inflammation, or the nature of
the effusions  which take place in the lungs: the same
observation applies  to  the pulmonary  consumption.
The symptoms of the different forms of pneumony fre-
quently run into  each other;  so do the symptoms of the
three forms of consumption which have been mentioned.
In short, the  pneumony  and consumption are alike in so
many particulars, that they appear to resemble shadows
of the same  substance.  They differ  only  as  the pro-
tracted shadow of the evening does from that of the noon-
day sun.
   I know that it will be objected here that the consump-
tion  is sometimes produced  by scrophula, and that this
creates an essential difference between 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. 
68         ON PULMONARY CONSUMPTION.
  No more happens  in the cases of acute  and chronic
pneumony, than what happens in dysentery  and rheuma-
tism.  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 of  them in patients who go
about  their ordinary business,  and in some  instances,
carry their diseases with them for two or three years.
  The parallel which has been drawn between the pneu-
mony and consumption, will enable us to understand the
reason  whv the latter disease terminates 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 dis-
ease compounded of different degrees of consumption and
pneumony.  It terminates frequently in two  or  three
months, and  without many of the  symptoms  which
usually attend  the last stage of  pulmonary consumption.
But there  are  cases in  which patients 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
inflammation of the  lungs, so as to live two  years after-
wards.
   It would seem from these facts,  as if nature had pre-
ferred  a certain gradation in diseases,  as well as in other
parts of her works. There is scarcely a disease in which
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 ^ipon the cure
of  the different states of pulmonary consumption.   The
remedies for this purpose are of two kinds, viz. pallia-
tive and  radical.  I shall first mention the palliative
remedies which belong to each  state,  and then mention
those which are alike proper  in  them all.   The palliative
remedies for the 
ON PULMONARY CONSUMPTION.        69
  1. Or INFLAMMATORY  STATE, are
  1. Blood-letting.  It may seem strange to recom-
mend 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 pulmonary 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 arte-
ries, as to render a diminution of the stimulus of the blood
absolutely necessary to reduce it.  I have  used this re-
medy with great success, in every case of consumption
attended 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 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
Philadelphia  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. Tracey of Connecticut in-
formed 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 ascribed his recovery chiefly to this frequent use of
the lancet.  To these cases 1 might  add many others of
consumptive  persons who have been perfectly cured by
frequent, and of many others whose  lives have been pro-
longed  by occasional bleedings.   But I am sorry to add,
that I could relate many more cases of  consumptive pa-
tients, who have died martyrs to their prejudices against
the use of this invaluable remedy. A common objection 
70        ON PULMONARY CONSUMPTION.
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 con-
sumption which have been mentioned, for it has unfor-
tunately been too fashionable  among physicians to pre-
scribe  the same remedies 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 physicians,
are either inert or instruments of mischief,  are,  in the
hands of others, used with more or less success in  every
ease in which they are prescribed.  Another objection to
bleeding in the inflammatory state of consumption, is de-
rived 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 ena-
ble him to walk about his house,  and even  to attend to
his ordinary business.  The difference between the  de-
bility in  the two  diseases, consists in its being acute in
the one, and chronic in the other.   It  is true, the preter-
natural or convulsive excitement of the arteries is some-
what greater in the pneumony,  than in the  inflammatory
consumption ;  but the plethora, on which the necessity of
bleeding is partly founded, is  certainly greater in  the in-
flammatory consumption than  in  pneumony.  This- is
evident from women, and even nurses, discharging from
four to six ounces 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 appe-
tite is frequently unimpaired, and the generation of blood
continues to be the same as in perfect health.
   Dr.  Cullen recommends the use of bleeding in con-
sumptions, in order to lessen the inflammation of the ul-
cers in the lungs, and thereby to dispose them to heal.
From the testimonies of the relief which bleeding  affords
in external ulcers and tumours accompanied by inflam-
mation, I  am disposed to expect the same benefit from it
in inflamed ulcers and tumours in the lungs: whether,
therefore, we adopt Dr. Cullen's theory of consumption, 
           ON  PULMONARY CONSUMPTION.        ?1

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 consumption,
attended by a haemorrhage 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 sudden-
ly 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 deci-
sions of reason 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 die symptoms as enables the patient to
use exercise with advantage as soon as the weather be-
comes so dry and settled, as to admit of his going abroad
 every day.
   The relief obtained by bleeding, is so certain in this
 state of consumption, that I often use  it as a palliative re-
 medy, where I do not expect  it will perform a cure.  I
 was  lately made happy in finding, 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 deplorable scrophula, without entertaining the least
 hope of its perfdrming a cure.*  In those cases 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, wbom I had declared to be
 within a few hours of his dissolution, in order to relieve
  him of uncommon pain, and difficulty in breathing. His
  pulse was  at the  same time hard. The evacuation, though
             *  Observations on Scrophulous Affections. 
72         ON PULMONARY CON-SUMPTION.
it consisted of but four ounces of blood,  had the wished
for effect, and his death,  I have  reason  to  believe, was
rendered more easy by it.   The  blood, in this case, was
covered with a buffy coat.
   The quantity of blood drawn  in every case of inflam-
matory consumption,  should be  determined by the force
of the pulse, and the habits of the patient. I have seldom
taken more than eight, but more frequently 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 bleed-
ing in this state of consumption,  I feel myself authorized
to assert, that where a greater proportion of persons die
of consumption when  it makes its first appearance in the
lungs, with symptoms of inflammatory diathesis, than die
of ordinary pneumonies (provided exercise  be used af-
terwards), it must, in nine cases  out of ten,  be ascribed
to the ignorance, or erroneous theories of physicians,  or
to the obstinacy or timidity of patients.
   In speaking thus confidendy of the necessity and bene-
fits of bleeding in the inflammatory state of consumption,
I confine myself to observations  made chie'y in the state
of Pennsylvania.   It is possible the inhabitants of Euro-
pean  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  advantage in the middle and northern states.
   In reviewing the prejudices against this  excellent re-
medy in consumptions, I have frequently wished to dis-
cover such a substitute for it as would with equal safety
and  certainty  take  down  the  morbid 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 con- 
           ON PULMONARY CONSUMPTION:         73

sumption should be sought for in a milk and vege-
table 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 without its cheesy or  oily parts,  as in
whey or  butter-milk, or it should be taken without skim-
ming ; 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 solution of its euro's
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 abstraction of nourishment. The vegetables
which are eaten in this state of the disease, should contain
as  little stimulus as possible.  Rice, in all the ways in
which it is usually prepared for aliment, should  be pre-
ferred 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 vegetable aliment.  Where  there is no morbid
affection of the stomach, I have seen the white meats eaten
without increasing the inflammatory symptoms of the dis-
ease.  The transition  from a full diet to milk and  vege-
tables 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 con-
 sumptions.
   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 sys-
 tem,  and less chyle is mixed with the blood in  a  given
 time.   Of so much importance do I conceive this  direc-
 tion 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 indiscriminate use in  every
    VOL. II.                   k 
74        ON PULMONARY CONSUMPTION.
state of consumption, I believe 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 always  be  substituted  in its  room with
great advantage.   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 sometimes been
useful in this disease; but it has been only when the dis-
ease has appeared  with inflammatory symptoms.   Care
should be taken not to persevere too long in the use of
this remedy, as it is apt to impair the appetite.  1 have
known one case in which it produced an obstinate dys-
pepsia,  and a disposition to the cholic ; but  it removed,
at the same time, the symptoms of pulmonary consump-
tion.
  5.  Cold and dry air, when combined with the ex-
ercise of walking,  deserves  to  be  mentioned as an anti-
phlogistic remedy.   I have repeatedly  prescribed it in
this species of the  consumption with  advantage,  and
have  often had the pleasure of finding 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.
  I come now to treat of the palliative remedies which
are  proper in the
  II.  Or 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 puerperile  fevers,  and of course the same
difficulty in  treating  it successfully ;  for the same reme-
dies do good and harm, according as the former or latter
diathesis prevails in the system.
  All that 1 shall say upon  this state is, that the treat-
ment of it should be accommodated to the predominance
of  inflammatory or  typhus  symptoms, for the  hectic
state  presents  each of them alternately every week, and
sometimes  every day to the hand, or  eye of a  physi-
cian.  When  a hard pulse  with acute pains in the side 
           ON PULMONARY CONSUMPTION.         75

and  breast occur, bleeding and other remedies for the
inflammatory state must be used; but when the disease
exhibits a predominance of typhus symptoms, the re-
medies  for that  state  to  be  mentioned  immediately,
should be prescribed in moderate doses.  There are se-
veral palliative medicines which have been  found useful
in the  hectic state, but they are such as belong alike to
the other two  states ; and therefore will be mentioned
hereafter in a place assigned to  them.
   I am sorry, however, to add, that where bleeding 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 metallic tonics to no  purpose.
Even arsenic has failed in my  hands of  affording the
least alleviation of the hectic  fever.  I conceive the re-
moval of this fever  to be the  great desideratum in the
cure of consumption; 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 efficacy, than they
are in the hectic fever of the pulmonary consumption.
   I  proceed now to speak of the palliative remedies
which are proper in the
   III.  Or Typhus  state of  the pulmonary consump-
tion.
   The  first  of these are stimulating  medicines.
However  just the complaints of Dr. Fothergill may be
against  the use  of  balsams in  the  inflammatory and
mixed states of  consumption,  they  appear to be  not
only safe, but useful likewise,  in mitigating  the  symp-
toms of weak  morbid action in  the arterial system.  I
have therefore  frequently prescribed opium, the balsam
of copaivae,  of Peru, the oil  of amber,  and  different
preparations  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
* Prunus Virginiana. 
70        ON PULMONARY CONSUMPTION.
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 al-
ways innocent,  and frequently  active remedies, where
there is a total absence  of inflammatory diathesis 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 improper,
when taken alone,  in this state of consumption.   I be-
lieve 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  low-
est stage of this state of consumption, by the use of ani-
mal 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 Museum.  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 dis-
eases of weak  morbid action.  To the cordial articles
of diet  belong sweet vegetable matters.  Grapes,  sweet
apples,  and the  juice of  the  sugar maple  tree,  when
taken  in large quantities,  have all  cured  this  disease.
They all appear to act by filling the blood-vessels, and
thereby imparting  tone  to the whole system.   I  have
found  the same  advantage from dividing the meals in
this  state of consumption, that I mentioned under a
former 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 gentle action in the whole  system.   For 
ON PULMONARY CONSUMPTION.         77
this reason, 1 have frequently advised my patients never
to suffer their stomachs to be empty, even for a single
hour.  I have sometimes aimed to keep up  the influ-
ence of a  gentle action in  the  stomach upon the whole
system, by advising them to eat in the night, in order to
obviate 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  medicines
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 exercise.   Even  under this  favourable
circumstance,  they are often ineffectual;  for  there fre-
quently  occurs,  in this  state  of consumption,  such a
destruction of the substance and functions  of the lungs,
as to  preclude the possibility  of a  recovery by the use
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  consump-
tion do not observe  any regular course in succeeding
each other.   They are not only  complicated 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 weather, dress, diet, and the passions
 upon  the system.   The great secret, therefore, of treat-
 ing this disease consists in accommodating all the reme-
 dies  that have been  mentioned to the predominance of
 any of the three different  states of the system, as  mani-
 fested chiefly 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 some-
 times  wished that it were possible to abolish the sc.
 ducing nomenclature of disease altogether, in order, there- 
78        ON PULMONARY CONSUMPTION.
by to oblige physicians to conform exactly to the fluctu-
ating state of the system in all their prescriptions ;  for it
is not more certain, that, in all cultivated languages,
every idea has  its appropriate  word, than  that  every
stare 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 palliative
remedies which  are alike proper in nearly every state  of
the pulmonary consumption.
  The first remedy under this head is  a  dry  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 in-
crease, a pulmonary consumption.  1 have often observ-
ed a peculiar paleness  (the first symptom  of general de-
bility) 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 situa-
tion  which  is chosen /or  the  purpose of enjoying the
benefit of this  remedy, the better.   Situations exposed
to the  sea, should  be  carefully  avoided;  for it is  a
singular fact, that while consumptive persons are bene-
fited  by  the sea-air, when they breath  it on the  ocean,
they are always  injured by that  portion of it which they
breathe on the  sea-shore.   To  show its influence, not
only  in aggravating 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 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 of 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 the inhabitants  of the
town.  Eight  more died of what is called  a  lung fever,
probably of what is called in Pennsylvania the  galloping
grade of that disease.   Consumptions are more frequent
in Boston, Rhode-Island,  and  New-York,  from their 
          ON PULMONARY CONSUMPTION.         79

damp winds, and vicinity to the sea-shore, than they are
in Philadelphia.  In the neighbourhood of Cape  May,
which lies near the sea-shore of New-Jersey, there are
three religious societies, among whom the influenza pre-
vailed in the year 1790.   Its mortality, under equal cir-
cumstances, was in the exact ratio to their vicinity to
the sea.   The deaths were most numerous in that  socie-
ty 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 above pulmonary diseases, do not appear to be
produced simply by its  moisture.   Consumptions are
scarcely known in the moist atmosphere  which  so  gene-
rally prevails in Lincolnshire, in England, and in the in-
land 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 ad-
ding a fact which was communicated to me by Dr. Mat-
thew 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.
   3. A change  of  climate.   It is remarkable that
climates uniformly cold or warm,  which seldom 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.
   4. Loose dresses, and a careful accommoda-
tion OF THEM TO  THE  CHANGES IN THE WEATHER.
Many facts might be mentioned to show the influence of
compression and of tight  ligatures 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  wfjich affect the lungs.
Tight stays, garters, waistbands, and collars, should all be
laid aside in the consumption, and the quality of tne cloth-
ing should be suited to the weather. A citizen of Mary- 
80        ON pulmonary consumption.

land informed me, that he twice had a return of a cough
and spitting of blood,  by wearing his summer  clothes a
week after the weather became cool in the month of Sep-
tember.  But it is not sufficient to vary the weight or
quality of dress with the seasons.  It should  be varied
with the changes which take place in the temperature of
the air every day,  even in the summer months,  in middle
latitudes.  I know a citizen of Philadelphia, who has la-
boured under a consumptive .diathesis near thirty years,
who believes  that  he has lessened the frequency and vio-
lence of pulmonic complaints during that time,  by a care-
ful accommodation of his dress to the weather.   He has
been  observed frequently to  change his waistcoat and
small clothes  twice or  three times in a day, in a summer
month.
  A repetition of colds and  thereby  an increase of the
disease, will be prevented by wearing flannel next to the
skin in winter, and muslin in the summer, either in the
form of a shirt or  a waistcoat:  where these  are objected
to, a piece of flannel, or of soft sheepskin, should be worn
next to the  breast.  They not only prevent colds, but
frequently remove chronic pains from that part of the body.
  5. Artificial  evacuations, by  means of blis-
ters and issues.  I suspect the usefulness of these re-
medies  to be chiefly  confined to  the inflammatory 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 preter-
natural 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 be-
tween 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
external parts of the body as had been previously affected
by those diseases.
   6. Considerable relief will often be obtained from the
patient's sleeping between blankets in winter, and 
ON PULMONARY CONSUMPTION.        81
on a mattrass in summer.   The former prevent fresh
cold from night sweats; the latter frequently checks them
altogether. In cases where a sufficient weight of blankets
to keep up an agreeable warmth cannot be borne, without
restraining easy and  full acts of inspiration, the 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-camber 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 climate.
   7. The moderate  use  of the lungs, in reading,
public speaking, laughing, and  singing.   The
lungs,  when  debilitated, derive equal  benefit  with the
limbs, or other parts of the body ; from moderate exercise.
I have mentioned, in another place,* several facts which
support this  opinion.   But too  much  pains cannot be
taken  to  inculcate upon our patients to avoid all excess
in the use of the lungs,  by long, or loud reading, speak-
ing, or singing, or by sudden and violent bursts of laugh-
ter. I shall long lament the death of a female patient, who
had discovered many hopeful signs  of a recovery from a
consumption, who relapsed, and died, in consequence of
 bursting a blood-vessel in her lungs, by a sudden  fit of
laughter.
   8. Are there any advantages to be derived  from the
excitement of certain passions in the treatment of con-
 sumptions?  Dr.  Blane tells us, that  many consumptive
persons were relieved, and that some recovered, in con-
sequence 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
  * An Account of the Effects of Common Salt in the Cure of Hxmoptysis.
   VOL. II.                    L 
82        ON PULMONARY CONSUMPTION.

are recorded by Dr. Blane;  but we  learn enough from
them to inspire the invigorating passions of hope and con-
fidence in the minds of our patients,  and to recommend
to them such exercises as produce exertions of body and
mind analogous to those  which are produced by terror.
Van Sweiten and Smollet relate cures of consumptions,
by patients falling into streams  of cold water.   Perhaps,
in both instances,  the  cures were performed only by the
fright and consequent exertion produced by the fall.  This
is only one instance out of many which  might be  men-
tioned, of partial and unequal action being suddenly chang-
ed into general and equal excitement in every part of the
system. The cures of consumptions which have been per-
formed by a camp life, have probably been much assisted
by the commotions in the passions which were excited by
the various and changing events of war.
   9. Salivation has lately been prescribed in this dis-
ease  with success  An accident first suggested its advan-
tages,  in  the Pennsylvania hospital,  in the year 1800.*
Since that time, it has performed many cures in different
parts of the United States.  It is to be  lamented, that in a
majority 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 recent cases, which is more
than can  be said of any,  or of all other remedies for this
disease.  In its hectic state, a salivation frequently cures,
and even in its typhus and last stage,  1  have more than
once prescribed it with success. The same regard to the
pulse should  regulate the use of this new remedy in con-
sumption, that has been recommended in other febrile dis-
eases.  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  influence ot all
those debilitating and irritating  causes which induced the
disease.  1 have said elsewhere that decayed teeth are one
of them.  These should be extracted where there is reason
to suspect they have produced,  or that they increased the
disease.
          • Medical Repository of New-York.  Vol V. 
ON PULMONARY CONSUMPTION.
83
  I have hitherto said nothing of the digitalis as a pallia-
tive remedy in pulmonary consumption.  I am sorry to
acknowledge that, in many cases in which  I have pre-
scribed it,  it has done no good, and in some  it has done
harm.  From the opposite 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
difference 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 which I
have endeavoured  to establish be admitted,  that  uncer-
tain and unsafe medicine will be rendered unnecessary by
the  remedies that have been enumerated,  provided they
are administered 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 men-
tioned, many persons have been recovered,  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
necessary or voluntary exercise.
  It is truly surprising  to observe how long some per-
sons have  lived  who have  been affected by a consump-
tive  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 symptoms of consumption appear-
ed with but little variation  or abatement from his early
youth  till  the 70th year of his  age.  The widow of the
celebrated  Senac lived to  be 84 years of age, thirty  of
which she passed in a pulmonary  consumption.  Dr.
Nicols was subject to occasional attacks of this disease
during his whole life,  and he lived to be above  eighty
years of age.  Bennet says he knew an instance in  which
it continued above sixty years.  I prescribed  for my first
pupil, Dr. Edwards, in  a consumption in the year 1769. 
 84         ON PULMONARY CONSUMPTION.

 He lived until 1802, and seldom passed a  year without
 spitting blood, nor a week without a cough, during that
 long interval of time.   The fatal tendency of his disease
 was constantly 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 instances of long protracted con-
 sumptions, 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 ana-
 logy 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 German 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 intervals 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 ori-
 ginated  exclusively in a morbid state of the lungs; on
 the contrary,  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, produce the pul-
, monary consumption.   The name of pneumony is taken
 from the principal symptom of this disease,  but it as cer-
 tainly belongs to  the  whole arterial system as the con-
 sumption ; and I  add further,  that it is  as certainly pro-
 duced  by  general  predisposing debility.  The hardness
 and  fuilness  of the pulse do  not militate against this
 assertion,  for they are altogether the effect  of a  morbid
 and  convulsive  excitment 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 pathology,  which  are
 universally admitted,  would open to us a new theory of 
ON  PULMONARY CONSUMPTION.
85
fevers, but this would lead us 'oo far  from the subject
before  us.   I shall only remark,  that all that has been
said of the influence of general debilitating  causes upon
the lungs,  both in pneumony and consumption, and of
the alternation  of the  consumption  with  other general
diseases, will 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 surface 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.
   There are several distressing symptoms  which occur
in pulmonary consumption  that call for relief.   These
are chiefly a cough, night sweats,  and a diarrhoea.  The
medicines for the cough should be
   1.  Demulcent  teas,   syrups,  and  lozenges:
These are too common and too numerous to be men-
tioned. They should be more or less stimulating accord-
ing to the state of the pulse.
   2. Opiates.   It is a mistake in practice, founded
upon a partial knowledge of the  qualities  of opium to
apminister it only at nights,  or to suppose that  its  ef-
fects  in composing a  cough depend wholly  upon its
inducing sleep.   A dose of the same strength should be
given  every  morning,  that is given  at night, and small
doses  of it should be given during the day and night,
when the cough is troublesome.  The  practice of giving
laudanum in pulmonary consumption early in the morn-
ing is strongly recommended by Dr. Sydenham.  It is
founded alike upon the nature of  the disease, and a law
in the  animal  economy mentioned in the Lectures upon
animal life, that  is,  the system in its diurnal revolutions
is always  in a state of the greatest debility immediately
after  waking in  the morning.  A great advantage will 
86
on pulmonary consumption.
 arise from giving the dose of laudanum that is intended
 to compose the cough at night, early in the evening be-
 fore the system is excited by an exacerbation  of fever.
 The  quantity of this medicine taken at all times should
 be  proportioned  to the degrees of action in the arterial
 system.   The less  this action  the more of it  may  be
 taken with safety  and advantage.  It  does most service
 when given in succession in the different forms  of pills,
 liquid laudanum,  and paregoric  elixir.
  3.  Certain  fumigations and vapours.  An acci-
 dental cure of a  pulmonary consumption by the smoke
 of rosin in a  man who bottled liquors, raised for a while
 the credit of  fumigations.  I have tried them, but with-
 out much  permanent effect.  A vapour produced from
 pouring boiling water upon equal parts of tar and bran,
 received into  the lungs  has sometimes given great relief.
 The sulphurous and saline air of Lybia between mount
 Vesuvius,  and the  Mediterranean sea, and the effluvia
 of the pine forests  of  Lybia were supposed  in ancient
 times to  be  powerful  remedies in consumptive  com-
 plaints ; but  it is probable the exercise  used in travel-
 ling to those  countries, contributed chiefly to the cures
 which were ascribed to foreign matters acting upon  the
 lungs.
  4.  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 free-
dom from  coughing,   I have heard of an instance  in
which a cough that threatened a return of haemorrhage
from  the  lungs,   was perfectly composed for two weeks
by keeping the patient nearly in one posture in bed, but
relief is more generally obtained from coughing, by an
erect posture  of the body.
  5. Silence.   However much  moderate  speaking,
reading, and  singing may contribute  to  strengthen  the
lungs, there  are  cases  in  which a cough  is suspended
by refraining  from them to such a degree, as to employ
 speech Only for the most important purposes of life.
  II.  Night sweats are  to  be checked by the elixir
of vitriol;  the nitric acid, drinking a pint of lime water 
ON PULMONARY CONSUMPTION.        87
daily, or  instead of it, taking every night at bed time
a small tea spoonful of the fine powder of calcined oyster
shells, and lastly by eating water melons.   The  last re-
medy acts as a  diarrectic, and  thus diverts the fluids
from  the  skin to the kidnies.   The seeds of that plea-
sant fruit  bruised and  made  into a  tea, might be sub-
stituted for it at every season of the year,  and in every
country.
   III. A  diarrhoea should be  restrained by the chalk ju-
lep, prepared with laudanum and the tincture of cinna-
mon, by injections of  laudanum into the bowels, and by
astringent aliments  and drinks.
   Thus have I  mentioned the usual palliative remedies
for the consumption.  Many of these remedies, 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 na-
ture  between a  pneumony  and a true  pulmonary  con-
sumption.  Such connecting shades, appear between the
extreme  points  of  many  other  diseases.   In a former
essay,* I endeavoured to account for the transmutation
(if I may be  allowed the expression)  of the  pneumony
into the consumption, by ascribing  it to the  increase
of the  debilitating refinements of civilized  life.   This
opinion has derived constant support from every obser-
vation I have made connected with this subject, since its
first publication  in  the year 1772
   I come now to treat of the radical remedies for the
pulmonary consumption.
   In a preceding  inquiry!,  I mentioned the effects of
labour, and the hardships of  a camp or naval life, upon
this disease.  As  there must frequently cccur such ob-
jections to each of these remedies, as to forbid their being
recommended or adopted, it will be necessary to seek
for substitutes for them in the different species of exer-
cise.   These are, active, passive, and mixed.   The ac-
tive,  includes walking, and the exercise of the hands and
feet in working or dancing.   The passive includes rock-
   * Inquiry into the Diseases and Remedies of the  Indians of North-
 Amt rica , and  a comparative view of their diseases and remedies with
 those  of civilized nations. Vol. I.
   f On the Pulmonary Consumption. 
88        ON PULMONARY CONSUMPTION.

ing in a cradle, swinging, sailing, and riding in carriages
of different kinds.  The mixed is confined chiefly to rid-    <
ing on horseback.
   I  have mentioned all the different  species of exercise,
not because I think they all belong to the class of radi-
cal remedies for the consumption, but because it is often    |
necessary to use those which  are passive, before we re-
commend those of a mixed or active nature.  That phy-    ^
sician does not err more  who advises a patient to  take
physic, without specifying its qualities and doses,  than    J
the physician does who  advises a patient, in a consump-
tion, to use exercise, without specifying its species and
degrees.  From the neglect of this direction, we after find    I
consumptive patients injured instead of being relieved by    ™
exercises,  which,  if used with judgment, might have
been attended with the happiest effects.
   I  have before suggested  that the stimulus of every
medicine, which is intended to excite action in  the  sys-
tem, should always be in an exact ratio to its excitability.
The same rule should be applied to  the  stimulus of ex-
ercise  I have heard  a well-attested case of a young lady,
upon whose consumption the  first salutary impression
was made by rocking her in a cradle ; and  I know  ano-
ther case in which a young lady,  in the lowest state of that
debility which precedes an affection of the lungs, was pre-
pared 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 the case of
a gardener,  who was far advanced in a consumption, in
the Pennsylvania hospital, I had the pleasure of observing
its good effects, in an eminent degree.  It so far restored
him, as to enable him to complete his recovery by work-
ing at his former occupation.
   In cases of extreme debility, the following order should
be recommended in the use of the different  species of
exercise.
   1. Rocking in a cradle, or riding on an elastic board,
commonly called a chamber-horse.
   2. Swinging.
   3. Sailing. 
           ON PULMONARY CONSUMPTION.         89

  4. Riding in a carriage.
  5. Riding on horseback.
  6. Walking.
  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 horseback,  the exercise will be less or greater
according as the horse walks, paces, canters, or trots, in
passing over the ground.
  I have good reason to believe, that an English sea-cap-
tain, who was  on the verge  of the  grave with the con-
sumption, in the spring of the year 1790, owed his per-
fect 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
exercise to debility;  and I am sorry to add, that I have
seen many cases in which, from the  neglect of this man-
ner 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  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  so-
ciety for that portion of evil which I might have prevent-
ed 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 Pennsylvania, 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 perfectly cured by working steadily at a print-
ing press in this city.  A  French physician in Mirtinque
cured this disease, by simply rubbing the arms between
   vol. ii.                   m 
90        ON PULMONARY CONSUMPTION.             Jj

the shoulders and the elbows, until they inflamed.  The ^|
remedy is strongly recommended, by the recoveries from
pulmonary consumption which  have followed abscesses V
in the arm-pits.  Perhaps the superior advantages of rid-  .1
ing on horseback, in this disease,  may arise in part from   ]
the  constant and gentle use of the arms in the manage- ^J
ment of the bridle and the whip.                        *|
  Much has been said in favour of  sea voyages  in con-  ^
sumptions.  In the mild degrees of the disease they cer-
tainly have done service, but I suspect the relief given, or   .-j
the cures performed by them, should be confined chiefly   ^
to seafaring people, who add to  the benefits of a constant   j
change of pure air, a share of the invigorting exercises of  j
navigating the ship. I have frequently heard of consump-
tive  patients reviving at sea,  probably from the transient
effects of sea sickness upon the  whole system, and grow-
ing 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 con-
dition 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. 1 crossed the Atlantic
ocean, in the year 1766, with a  sea captain, who announ-
ced 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 water.  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  soon after arrival from sea,  who
have informed me,  that they had enjoyed  good health
during the greatest part of their voyage, and that they had
contracted their indispositions after they came within sight
oi the land.   1 mention these facts  only to show the ne-
cessity  of advising consumptive patients, who undertake
a sea voyage for the recovery of their health, not to expose
themselves upon deck in the morning and at  night, after 
           ON PULMONARY CONSUMPTION.         91

they arrive within 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 de-
claration 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 tuber-
cles have no malignity in them which 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.
   There are two methods of riding for health in this dis-
ease.   The first is by short excursions; the second is by
long journeys. In slight consumptive affections, and after
a recovery from an acute illness,  short excursions are suf-
ficient to remove  the existing debility; but in the more
advanced stages of consumption, they are seldom effectual,
and frequently do harm, by exciting an occasional appetite
without adding to the digestive powers. They, moreover,
keep the system constantly vibrating by their unavoidable
inconstancy,  between distant points of tone and debility,*
and they are unhappily accompanied  at all  times, from
the want of a 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 journeys on horseback are the most effectual modes of
exercise.   They afford a constant succession of fresh ob-
jects and company, which divert the mind from dwelling
upon the danger of the existing malady; they are more-
over attended by a constant change of air, and they are not
liable to be interrupted by company, or transient changes
in the weather, by which means appetite and digestion,
action and power, all keep pace with each other.   It is to
be lamented  that the use of this excellent remedy is fre-

  • 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 thin
disease, it does harm. 
02
ON PULMONARY CONSUMPTION.
quently opposed 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  increased  by sickness,
is liable to be offended at every stage; and, lastly, they
sooner relax in their exertions to prolong their lives than
rm n   Of the truth of the last  observation, sir William
Hamilton  has furnished us with a striking illustration.
He tells us, that in digging into the ruins produced by the
late earthquake in Calabria,  the women who perished in
it, wen found with their arms folded, as if they abandon-
ed 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 related, that a capacity of bearing
pain and distress with fortitude and resignation, was the
distinguishing characteristic of the female mind; while a
disposition to resist and overcome evil, belonged in a more
peculiar manner to the mind of man.   I have  mentioned
this peculiarity of circumstances  and temper in female
patients, only for the sake of convincing physicians  that
it will be  necessary for them to add all the  force of elo-
quence to their advice, when they recommend journeys
to women in preference  to all  other remedies, for the
recovery of their health.
  Persons, moreover, who pursue active employments,
frequently object to undertaking journeys, from an opin-
ion that their daily occupations are sufficient to produce
all the salutary effects we expect  from artificial exercise.
It will be  highly necessary to correct this mistake,  by as-
suring such persons that, however useful the habitual ex-
ercise  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 con-
sumpiion.
  As travelling is often rendered useless, and even hurt-
ful in this disease, from being pursued in  an improper 
           ON PULMONARY CONSUMPTION.         93

manner,  it will be necessary to furnish our patients with
such directions as will enable them to derive the greatest
benefit from their journeys.  I shall, therefore, in this
place, mention the substance of the directions which I
have given in writing for many years to such consump-
tive patients as undertake journeys by my advice.
   1. To avoid fatigue.   Too much cannot be said to en-
force this direction. It is the hinge on which the recovery
or death  of a consumptive patient frequently turns.  I re-
peat 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 neglecting this
practice, many persons have returned from journeys 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 consump-
tive patient.  They are often crowded; they give  too
much  motion; and they afford by their short delays and
distant stages, too  little  time for rest,  or for  taking  the
frequent refreshment  which was formerly recommended.
   2. 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 middle of the
day.   The sooner a patient breakfasts after he leaves his
bed the  better;  and in no case should he leave his morn-
ing 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 un-
dress 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 with a head-ach or sick stomach;
and generally out of humour.  The surveyors are so sen-
sible of the truth of this remark,  that they always undress
themselves when they sleep in the woods.  An intelligent
 gentleman of this profession informed me, that he  had 
 94        ON PULMONARY CONSUMPTION.

 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, whether in the
 day time or at night, never to lie down in damp sheets.    <
 Dr. Sydenham excepts  the  danger  from  this quarter,  jM
 when he speaks of the efficacy of travelling on horseback    i
 in curing the consumption.
   4. Patients  who travel  for health in this disease should    I
 avoid all large companies, more especially evening and
 night parties.  The  air  of a contaminated room, phlo-    +
 gisticated by the breath of fifteen or twenty persons, and
 by the same number of  burning candles, is poison to a
 consumptive patient.   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-Carolina, and the summer in New-
 Hampshire, Massachusetts, 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, particularly the less
 avoidable one  of heat; for 1 have constantly found the
 hot month of  July to be as unfriendly to consumptive
 patients in Pennsylvania, as the variable month of March.
 By these means too he will enjoy nearly an equable tem-
 perature  of air  in every month  of the year; and his
 system will be free  from  the inconvenience of  the alter-
 nate action of heat and  cold  upon  it.   The autumnal
 months  should be spent  in New-Jersey or Pennsylvania.
  In these journeys from north to south, or from south
 to north, he should  be careful,  for reasons before men-
 tioned, 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 bim, 
«N  PULMONARY CONSUMPTION;        95
-whether more advantages would not accrue to his con-
 sumptive patients from advising them to cross the Adan-
 tic 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 miti-
 gation of the violence of  the disease, in consequence of
 the length of their sea voyage, as will enable them imme-
 diately to begin their journeys on horseback.  Here they
 will be  exposed to fewer temptations to intemperance,
 or to unhealthy amusements,  than  in old  European
 countries.   And, lastly, 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  ancient or
 modern ties of citizenship.  Long journeys for the reco-
 very of health, under circumstances, so agreeable, should
 certainly  be preferred to travelling among strangers of
 different nations, languages, and  manners, on the continent
 of Europe.
   6.  To r ender travelling on  horseback  effectual in a
 consumption, it should be continued with moderate inter-
 vals from six to twelve  months.   But  the cure should
 not be rested upon a single  journey.   It should bo re-
 peated 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  constantly,
 both at home and abroad; or, to  use the words of Dr.
 Fuller " he must,  like a Tartar, learn  to live on horse-
 " back, by which means  he will acquire in time the con-
 stitution of a Tartar."*
   Where benefit is expected from a change of climate,
 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 residence for a shorter time in a
 foreign climate do much service.
   To secure a  perfect obedience to medical advice,  it
 would be extremely useful if consumptive patients 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  imposed upon  their appetites.    Madness
                * Medicina Gynroastica, p. 116. 
 96        ON PULM0NARYC0NSUMPTI0N.

 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 suc-
 cessful practice would probably follow the treatment  of
 consumptions,  if patients were constantly kept under the
 eye and authority  of their  physicians.  The keenness
 of appetite, and great  stock of animal spirits, which those
 persons frequently  possess, hurry them  into many ex-
 cesses which defeat the  best concerted plans of a reco-
 very ;  or, if they escape  these  irregularities, they are
 frequendy seduced from our directions by every  quack
 remedy which  is recommended to them.  Unfortunately
 the cough becomes a signal of their disease, at every
 stage of their journey,  and  the easy or  pleasant pre-
 scriptions of even hostlers and ferrymen, are often substi-
 tuted to the self-denial  and exertion  which have been
 imposed by physicians.  The  love of life in these cases
 seems  to  level all capacities;  for I have observed per-
 sons of the most cultivated  understandings to yield  in
 common with  the vulgar,  to  the  use  of  these pre-
 scriptions.
   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
 °f Dr.  Coxe's Medical  Museum, of a clergyman and
 his wife, in Virginia,  being cured by the voluntary use
 of that remedy.
   The following  circumstances and symptoms, indicate
 the longer or shorter  duration  of this disease, and its
 issue in life and death.
   The consumption from  gout, rheumatism, and scro-
phula,  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 predisposed
to it, have acted upon the body.
   It is  more dangerous  when  a predisposition to it has 
ON  PULMONARY CONSUMPTION.          97
been  derived from  ancestors,  than when it has been
acquired.
  It is generally fatal when accompanied with a bad con-
formation of the breast.
  Chilly fits occurring in the forenoon, are more favour-
able than when they occur in the evening.   They indi-
cate the disease to partake a litde 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 favourable ; 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 become
much obstructed,  or ulcerated, it  is  most  commonly
fatal.
   A pleurisy, occuring  in the low state of  the disease,
generally kills, but I have seen a case  in  which it sud-
denly removed the cough and hectic fever, and thus be-
came the means of prolonging the patient's life for seve-
ral years.
   The  discharge  of  calculi from the lungs by coughing
and  spitting, and of a  thin watery liquid, with a small
portion of pus swimming on its  surface,  are  commonly
signs of an incurable consumption.
   No prediction unfavourable  to life can be drawn from
pus being discharged from the lungs.   We see many re-
coveries after it has taken place, and many deaths where
that symptoms has been  absent.  Large quantities of pus
are discharged in consumptions attended with abscesses,
and yet few die of them, where  they have not been pre-
ceded by long continued debility of the  whole system.
No pus is expectorated from tubercles, and how generally
fatal is the disease,  after they 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 consump-
 tion  probably becomes uniformly fatal.  I suspect these
 ulcers are sometimes of a cancerous nature.
    VOL. II.                 n 
 98        ON PULMONARY CONSUMPTION.

   A sudden cessation  of  the  cough, without a  super-
 vening diarrhoea, indicates  death to be at hand.
   A cantstant vomiting iri  a consumption,  is generally a
 bad  sign.
   Feet obstinately cold, also a swelling of the feet during
 the day, and of the face in  the night, commonly indicate
 a speedy and fatal issue of  the disease.
   Lice, and  the falling off of the  hair, often precede
 death.
   A hoarseness,  in the beginning of the diseases, is al-
 ways alarming, but it is more so in 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 peo-
ple,  is a sign of speedy dissolution.
   I  have never  seen a recovery  after an apthous sore
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.
   3. A rupture of an abscess.
   4. A rupture of a large blood-vessel in the lungs at-
tended with external or internal haemorrhage.   Sudden
and  unexpected death in a consumption is generally in-
duced  by this or the preceding  cause.
   5. Madness.   The  cough  and  expectoration cease
with this disease.  It generally carries off the patient in a
week or ten days.
   6. A pleurisy, brought on by exposure to cold.
   7. A typhus fever, attended with tremors, twitchings
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 spas-
modic 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, that  death  resembled a
 quiet transition from a waking, to  a sleeping state. 
          ON PULMONARY CONSUMPTION.         99

  I cannot conclude this inquiry without adding,  that
the author of it derived from his  paternal ancestors a pre-
disposition to the  pulmonary  consumption,  and  that
between the 18th and 43d years of his age, he has occa-
sionally been afflicted with many of the symptoms of that
disease  which he has described.  By  the constant and
faithful use of many of the remedies which he has recom-
mended, he now, at an advanced age, enjoys nearly an
uninterrupted  exemption from  pulmonary complaints.
In humble gratitude, therefore, to that Being, who con-
descends to be called the preserver of men, he thus pub-
licly devotes this result of his experience and inquiries to
the benefit of such of his  fellow-creatures as may be
afflicted with the same disease,  sincerely wishing that
they may be as useful to them, as they nave have been to
the author. 
 
   OBSERVATIONS






         ON







THE CAUSE AND CURE






         OP







     DROPSIES. 
 
OBSERVATIONS, &c.
    WHETHER we admit the exhaling and absorbing
vessels to be affected in general dropsies by preternatural
debility, palsy, or rupture, or  by a retrograde motion of
their fluids, it is certain that their exhaling and absorbing
power  is materially affected by too much, or too little
action in the arterial system.   That  too little action in
the arteries should favour dropsical effusions,  has been
long observed;  but it has been less obvious,  that the
same  effusions are  sometimes promoted,  and their ab-
sorption prevented,  by too much action in these vessels.
That this fact should have escaped our notice is the more
remarkable, considering how long we have been  accus-
tomed to  seeing  serous swellings in the  joints in the
acute  rheumatism, and copious, but partial effusions of
water in the form of sweat, in every species of inflamma-
tory fever.
   It is nothing new that the  healthy action of one part,
should depend upon the healthy action of another part of
the system.  We see it in many of the diseases of the
nerves and brain.   The  tetanus  is cured by exciting a
tone in the arterial system ; madness is cured by lessen-
ing the action of the arteries  by copious  blood-letting;
and epilepsy and  hysteria are often mitigated by the
moderate use of the same remedy.
   By too  much action in the arterial system, I mean a
certain morbid excitement in the arteries, accompanied
by preternatural force, which  is obvious to the sense of
touch.  It differs from  the morbid  excitement of the
arteries,  which  takes  place  in common  inflammatory
fevers, in being attended  by  less febrile heat, and with
little  or no pain in the head  or limbs.  The thirst is
nearly the same in this state of dropsy, as in inflammatory
fevers.  I include here those dropsies only in which the 
104                ON DROPSIES.
 whole  system is affected by what is cslled a hydropic
 diathesis.
   That debility should,  under certain  circumstances,
 dispose  to  excessive  action, and  that excessive action
 should  occur in one part of the body, at the same  time
 that  debility  prevailed  in  every other,  are abundantly
 evident  from  the history and phenomena of many dis-
 eases.   Inflammatory fever,  active haemorrhages,  tonic
 gout, astma,  apoplexy, and palsy,  however much  they
 are accompanied by excessive action in the arterial  sys-
 tem,  are always preceded  by original debility, and are
 always  accompanied by obvious debility in every other
 part of the system.
   But it has  been  less observed by physicians that an
 undue force or excess of  action occurs in the arterial
 system  in  certain  dropsies, and that the  same  theory
 which explains the union  of predisposing  and  nearly
 general  debility,  with a  partial  excitement and preter-
 natural action in the arterial system,  in the diseases before-
 mentioned,  will explain the symptoms and cure of certain
 dropsies.
   That debility predisposes to every state of dropsy,  is
 evident from the history of  all the remote and occasional
 causes which  produce them.  It will be unnecessary to
 mention these causes,  as  they are to be found in all our
systems of physic.   Nor  will" it be necessary to mention
any proofs of the existence of debility in nearly every part
of the body.   It is too plain to be denied.   I shall  only
mention the symptoms which indicate a  morbid excite-
ment  and  preternatural  action  of  the arterial system.
These are,
   1. A hard,  full,  and quick pulse.   This symptom, I
believe,  is  more  common in  dropsies than is generally
supposed, for  many physicians visit and examine patients
in these diseases, without feeling the pulse.  Dr. Home
mentions the frequency of the pulse, in the patients whose
cures he has  recorded,*  but he takes no  notice of its
force  except  in  two  cases.  Dr.  Zimmerman,  in his
account of the dropsy  which  terminated the life of  Fre-
derick II. of Prussia, tells us that he found his pulse hard
                    "*" Medical Facts. 
on  dropsies:                105
and full. I have repeatedly found it full and hard in every
form of dropsy, and more especially in the first stage of
the disease.  Indeed I have seldom found it otherwise in
the beginning of the dropsy of the breast.
   2. Slzy blood. This has been taken notice of by many
practical writers, and has very justly been ascribed, under
certain  circumstances of blood-letting,  to an excessive
action of  the vessels upon the blood.
   3. Alternation of dropsies with certain diseases which
were evidently accompanied by excess of action  in the
arterial system,  I have seen anasarca alternate with vertigo,
and both ascites and anasarca alternate with tonic madness.
A case  of nearly the same kind is related by Dr.  Mead.
Dr. Grimes, of Georgia, informed me that he had seen a
tertian fever,  in which  the  intermissions  were attended
with dropsical swellings all over the body, whieh sudden-
ly disappeared in every accession of a paroxysm  of the
fever.
   4. The occasional connexion of certain dropsies  with
diseases evidently of an inflammatory  nature, particularly
pneumony, rheumatism, and gout.
   5. Spontaneous haemorrhages from the lungs, haemorr-
hodial  vessels,  and nose, cases  of which shall be men-
tioned hereafter, when we come  to treat of the cure of
dropsies.
   6. The appearance of dropsies in the winter and spring,
in habits  previously affected by the intermitting  fever.
The debility produced by this  state of fever, frequently
disposes to inflammatory diathesis,  as soon as the body
is exposed to the alternate action of heat and cold, nor is
this inflammatory diathesis always laid aside, by the transi-
tion 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
a letter to Dr. Haller,  ** De Variolis,  apoplexia, et  hyd-
"  rope,"  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,
   vol. n.                o 
Jf36                ON DROPSIES.
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 dropsies 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 ascer-
tained by  many observations.  Dr. Wilkes relates,* that
after " an epidemical fever, which began in Kidderminster,
in 17-8, and soon afterwards spread, not only over Great
Biitam, but  all Europe, more people died  dropsical in
three years, than did perhaps in twenty or  thirty  years
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 accident 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
suecess in dropsies of a weak action in the arteries. I  have
constantly proposed  to treat only ol the theory and  cure
of dropsies in general,  without specifying any of  the
numerous names it derives from the different parts of the
body in which they  may be  seated; but in speaking of
the remedies which have been used with advantage in both
the tonic  and atonic states, I shall occasionally mention
the name  or seat of the dropsy in  which the remedy has
done service.
   The  first  remedy that I shall mention for dropsies is
blood-letting.   Dr. Hoffman and Dr. Home both cured
dropsies accompanied by pulmonic congestion by means
of this  remedy.   Dr. Monroe quotes  a case of dropsy
fn;m Sponius,  in which bleeding succetded,  but not till
after it had been  used  twenty times.*  Mr. Cruikshank
relates a ca^ef 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,
   * Historical Essay on the Dropsy, p. 326.
   t Treatise on the* Dropsy.     % Treatise on the Lymphatics. 
ON DROPSIES.                 107
in stooping to bdckle his shoes, he bursted a blood-vessel
in his lungs, from which he lost a quart of blood; in con-
sequence of which, both the swellings and the hoarseness
went off gradually, and he continued well two years after-
wards. I have known one case in which spontaneous hae-
morrhages from the haemorrhodial vessels, and from the
nose, suddenly reduced universal dropsical swellings.  In
this patient there had been an uncommon tension and ful-
ness in the pulse.
   I could add the histories of many cures of anasarca and
ascites, performed by means of blood-letting, not only by
myself,  but by a number of respectable physicians in the
United  States.  Indeed  I conceive this remedy to be as
much indicated by a tense and full pulse in those forms
of dropsy, as it is in a pleurisy,  or in any other common
inflammatory disease.
   In those deplorable cases of hydrothorax, which do not
admit of a radical cure,  I have given temporary relief,
and thereby protracted life, by taking away occasionally a
few ounces of blood.   Had Dr. Zimmerman  used this
rernedy 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 plentiful 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 depress-
ed, or a low or weak pulse.   Two cases of this kind are
 related by Dr. Monroe, one of which was cured by bleed-
 ing.   The same symptom of a low and  weak pulse is
 often met with in the first stage of pneumony, and apo-
 plexy,  and is only  to be removed by the plentiful use of
 the same remedy.
   II. Vomits have often  been  given  with advantage in
 dropsies.  Dr. Home  says,* that squills were useful in
 these diseases only when they produced a vomiting.  By 
108
ON DROPSIES.
 abstracting excitement and action from the  arterial sys-
 tem,  it disposes the lymphatics to absorb  and discharge
 large quantities of water.  The efficacy of vomits in pro-
 moting the absorption of stagnating fluids  is  not confined
 to dropsies.  Mr. Hunter was once called to visit a pa-<
 tient 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 board of a vessel, where he  was se-
 verely affected by sea-sickness and  vomiting; in conse-
 quence of which the  bubo  disappeared, and the patient
 recovered without the use of the knife.
   Mr. Cruikshank further mentions a case* of a  swelling
 in the knee being nearly cured by a patient vomiting eight
 and forty hours, in consequence of his taking a large dose
 of the salt of tartar instead of soluble tartar.
   111. Purges.  The efficacy of this remedy, in  the cure
 of dropsies,  has  been acknowledged by physicians  in  all
 ages and countries.  Jalap, calomel, scammony, and gam-
 boge, are often  preferred  for this  purpose;  but I  have
 heard of two cases of ascites being cured by a table spoon-
 ful of sweet oil taken every day.  It probably acted only
 as a gentle laxative. The cream of tartar, so  highly com-
 mended 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 circumstances,  it is most  probably they were  drop-
 sies of great morbid action  in the  arterial system.   He
 adds  further, that the persons who were  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 Edin-
 burgh.   Dr. Sydenham prefers gentle  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 absorption,
 we learn not only from their effects in dropsies, but from

               * Letter to Mr. Clare, p. 166. 
ON DROPSIES.                  109
an experiment related by Mr. Cruikshank,* of a man who
acquired several ounces of weight after the operation of
a purge.   The absorption  in this case was  from the
atmosphere.  So great is  the the effect of purges in pro-
moting absortion, that  Mr. Hunter supposes the matter
of a  gonorrhoea,  or of topical  venereal  ulcers 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 evacu-
ation  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 come under my notice.  I think I have cured two
persons of anasarca, by giving one  scruple of the same
medicine three  times a-day for several weeks.   The two
last cures  were evidently dropsies of violent action in
the arterial system.   Where nitre has been  given in
atonic dropsies it has generally been useless, and some-
times done harm.   I have seen one instance of an incu-
rable  diarrhoea  after tapping, which  I suspected arose
from  the  destruction of  the tone  of  the  stomach and
bowels, by large  and  long continued  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  inconvenience 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 giyen  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 fox-glove in  dropsies.   From the cases related by Dr.
Withering,  it  appears  to  have done  good;  but from
               * Letter to Mr. Clare, p. 117. 
110                 ON DROPSIES.
those related by Dr. Lettsom* it seems to have  done
harm.   I suspect  the different accounts of those  two
gentleman have arisen from their having given it in dif-
ferent states of the system, or perhaps from a difference
in the quality of the plant  from causes mentioned  in
another place, f  I am sorry to add further, that after
many trials of this medicine 1 have failed in  most  of the
cases in which I have given  it.  I have discharged the
water in three  instances by it, but the disease returned,
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 after-
wards fall into disrepute,  as was the case  with the fox-
glove, I suspect the cases in which they were useful,  to
have been eitheir few or doubtful, and that  the  cases  in
which they have done harm,  were so much more nume-
rous 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 Phila-
delphia dispensary was cured  by walking to Lancaster,
sixty-six 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 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 pro-
duced by labour or exercise, in reducing the tone of the
arterial system.
    * Medical Memoirs, vol. II.
    7 Inquiry into the  Causes and Cure of Pulmonary  Consumption. 
ON  DROPSIES.                 Ill
   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 nothing 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 debilitating
the system in two ways :  1st, by abstracting the stimulus
of  distension  ;  and, 2dly, by preventing  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 of fasting in  the
dropsy.   If the fact alluded  to stood  alone under the
present head of this essay, it would be sufficient to esta-
blish the  existence of too much action,  and the efficacy
of debilitating remedies  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 laby-
rinth of empirical practice, in which I had been bewil-
dered  for many years, and finally led  me to adopt the
principles and practice which I am now endeavouring to
establish.   The passage which contains this interesting
fact is as follows :  " A few days after (says sir John)  he
"  [meaning Dr.  Johnson]  sent for me, and informed
"  me, that he had discovered in himself the symptoms
" of a dropsy, and, indeed, his very much increased bulk
" and the swollen appearance of his legs, seemed to indi-
" cate no  less.  It  was on  Thursday that  I  had this
"  conversation with him  ; in the course thereof he de-
" clared,  that he intended  to  devote  the  whole of the
" next day to  fasting, humiliation, and such other  devo-
" tional exercises as became 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  serenity as  indicated, that some  remarkable  crisis
" of his disease had produced a change in his feelings.
"  He told me that, pursuant to the  resolution  he had
"  mentioned to  me,  he  had spent the preceding day in
" an abstraction from all  worldly concerns ;  that to pre- 
112                ON DROPSIES.
" vent 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.
u He then men- ioned to me, that in the course of this
" exercise, he  found  himself  relieved from  the disease
" 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 experi-
" enced."  Sir John Hawkins ascribes this immense dis-
charge of water to the influence of Dr. Johnson's prayers;
but  he neglects to take notice,  that these prayers were
answered, in this instance, as they are in  many others, in
a perfect consistence with the  common  and established
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 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,  exhibited  proofs in
the presence of many of the students of the university,
equally satisfactory of the  efficacy of fasting in suddenly
increasing the quantity of urine.
  IX. Fear.   This passion is  evidently of a debilitating
nature, and, therefore,  it has frequently afforded an acci-
dental aid in the cure of dropsies, of  too much action.
I suspect,  that the fear of  death, which was so distin-
guishing 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 discharging 
ON  DROPSIES.                 113
water from  the body in  dropsies, I shall mention the
following facts.
  In a  letter which I received from Dr. John Penning-
ton, dated Edinburgh, August 3, 1790, I was favoured
with the following communication   " Since the conver-
" sation I had with you on the subject 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  favour of your doctrine.  A  sailor  in  an
" ascites,  fell off the end of the  yard into the sea; the
" weather being calm, he was taken up unhurt, but, to
" use the sailor's words,  who told me the story, he was
** frightened  half to death,  and as soon as he was taken
" out of the water, he discharged a gallon of urine or
" more.  A doctor on board ascribed this large evacua-
" tion  to sea bathing, and accordingly ordered the man
" to be dipped in the sea every morning,  much against
" his  will,  for, my informant adds, that he had not for-
" gotten his fall, and that in four weeks he was perfectly
" well.   I think this fact can only be explained on your
" principles.  The sedative operation of  fear was,  no
" doubt, the cause of his cure."
  There is an account of an ascite being cured by a fall
from an open chaise,  recorded in the third volume of the
Medical Memoirs, by M. Lowdell.   I have heard of a
complete recovery from dropsy, having suddenly followed
a fall from a horse.  In both these cases, the cures were
probably the effects of fear.
  Dr. Hull, of York-town, in Pennsylvania, informed
me,  that he had  been called  to  visit a young woman
of 19 years of age, who had taken all the usual remedies
for ascites without effect.   He at once proposed to her
the operation of tapping.   To this she objected, but so
great  was the fear  of this operation, which  the proposal
of it suddenly excited in  her mind,  that it brought on a
plentiful discharge of urine,  which in a few days perfectly
removed her disease.
  On  the  27th of August, 1790,  I  visited a gentle-
woman in this city with the late Dr. Jones, in an ascites.
Wre told  her for  the first  time,  that  she  could not be
   VOL. II.                    p 
114
ON DROPSIES.
relieved without  being tapped.   She  appeared to  be
much terrified upon hearing our opinion, and said that
she would consider of it.  1 saw her two days afterwards,
when she told me, with a smile on her countenance, that
she hoped she should  get well without tapping, for that
she had discharged two  quarts of water in the course
of the  day after we had  advised her to submit to that
operation.  For  many days before, she had not dischaged
more than two or three gills in twenty-four hours.   The
operation,  notwithstanding, was still indicated,  and she
submitted to be tapped a  few days afterwards.
  I  tapped  the same  gentlewoman a  second time, in
January,  1791.   She  was  much terrified while I was
preparing for the operation, and fainted immediately after
the puncture was  made.  The second time that I visited
her after the operation  was performed,  she told me
(without being interrogated on that subject), that she had
discharged a pint and a half of urine, within twenty
minutes after I left the room on the day I tapped her.
What made this discharge the more remarkable was, she
had not made more than a table spoonful of water in a
day, for several  days before she was tapped.
  I  have  seen  similar discharges of urine in two other
cases of tapping which have come under my notice, but
they resembled so nearly those which have been mention-
ed, that it will be unnecessary to record them.
  But the influence  of  fear upon  the  system, in the
dropsy, extends  far  beyond the effects which I  have
ascribed to it.   Dr. Currie, of this city, informed me
that he called, some years ago,  by appointment, to tap a
woman.  He no sooner entered the room than he observ-
ed  her, as he thought, to faint away.   He attempted to
recover her,  but  to no purpose.*   She died of a sudden
paroxysm of fear.
  It is a matter of surprise,  that we should have remain-
ed  so  long ignorant  of  the influence of fear upon the
urinary organs  in dropsies, after having  been so long
familiar with the same  effect  of that  passion in the
hysteria.
  X. A  recumbent posture of the body.  It is  most
useful  when the dropsy is seated in the lower limbs.  I 
ON DROPSIES.                115
have often seen, with great  pleasure, the happiest effects
from this prescription in a few days.
  XI. Punctures.   These, when made in  the legs and
feet, often discharge in eight and forty hours the water of
the whole body.  I have never seen a mortification pro-
duced by them.  As they are not followed by inflamma-
tion, they should be preferred to blisters, which are some-
times used for  the same purpose.
  I cannot dismiss the remedies which discharge water
from  the body through the urinary passages,  without
taking notice,  that they furnish  an additional argument
in favour of blood-letting in dropsies, for they act, not by
discharging the stagnating water, but by creating such a
plentiful secretion in the kidneys from  the serum of the
circulating blood, as to make room for the absorption
and conveyance  of the stagnating water in the blood-
vessels.
   Now the same effect may be  produced in all tonic or
inflammatory dropsies, with more certainty and safety, by
means of blood-letting.
   In recommending the antiphlogistic  treatment of cer-
tain dropsies,  I must here confine myself to the dropsies
of  such climates as dispose to  diseases of  great  morbid
action in the system.  I am satisfied that it will often be
proper in the middle and eastern states of America; and
I have lately  met  with two observations,  which  show
that it has been used with success at Vienna, in Germany.
Dr. Stoll tells  us, that, in the  month of January, 1780,
** Hydropic and asthmatic patients discovered more or
" less marks  of inflammatory  diathesis, and that blood
" was drawn from them with a  sparing hand with advan-
" tage;" and  in the month of  November, of the same
year, he says,  " The stronger diuretics injured dropsical
" patients in  this  season;  but  an  antiphlogistic driilk,
 " composed of a quart of the  decoction of grass,  with
 " two  ounces of simple oxymel, and nitre and cream
 " of tartar,  of each  a drachm, did  service."*  It is
probable that the same difference should be observed
 between the  treatment of dropsies  in warm  and  cold
   * Ratio Medendi Nosocomio Practico Vindobonensi. vol. iv. p. 56
 and 99. 
116
ON  DROPSIES.
climates that is observed in the treatment of fevers. The
tonic action probably exists in the system in both coun-
tries. In the former it resembles the tides which are sud-
denly produced by a shower of rain,  and as suddenly
disappear; whereas, in the latter, it may be compared to
those tides which are produced by the  flow and gradual
addition of water from numerous streams, and which con-
tinue for days and  weeks  together to exhibit  marks of
violence in every part of their course.
   I come now to say a few words upon atonic dropsies,
or such as are accompanied with a feeble morbid action
in the blood-vessels.  This morbid action  is essential to
the nature of dropsies,  for we never see them take place
without it.  This is obvious from  the  absence of swel-
lings after famine, marasmus, and in extreme old age, in
each of which there exists the lowest degree of debility,
but no morbid action in the blood-vessels.  These atonic
or typhus  dropsies may easily be distinguished from those
which have been described, by occurring in habits natural-
ly weak; by being produced by the operation of chronic
causes; by a weak  and quick pulse ; and by little or no
preternatural heat or thirst.
   The remedies for atonic  dropsies are all such stimulat-
ing substances as increase the action of  the arterial sys-
tem, or determine the fluids to the urinary organs. These
are,
   I. Bitter and aromatic substances of all kinds, exhibit-
ed in substance or in infusions of wine, spirit,  beer,  or
water.
   II. Certain acrid  vegetables, such  as  scurvy-grass,
horse-radish,  mustard, water-cresses, and garlic.  I knew
an old man who was perfectly cured of  an  anasarca,  by
eating water-cresses, on bread and butter.
   III. Opium.  The efficacy of this  medicine in drop-
sies has been attested by Dr. Willis, and several other
practical writers.   It seems to possess almost  an exclu-
sive power of acting alike upon the arterial, the lympha-
tic, the glandular, and the nervous systems.
   IV. Metallic tonics, such as chalybeate  medicines  of
all kinds,  and the mild preparations of copper  and mer-
cury.  I once cured an  incipient ascites and anasarca  by 
ON  DROPSIES.                  H7
large doses  of the rust of iron ; and I have cured many
dropsies by giving mercury in such quantities as to ex-
cite a plentiful salivation.  I have, k is true, often given
it without effect, probably from my former ignorance of
the violent action of the arteries, which so frequently oc-
curs in dropsies, and  in which cases  mercury must ne-
cessarily have done harm.
  V. Diuretics, consisting of  alkaline  salts,  nitre,  and
the oxymels of squills and colchicum.  It is difficult to
determine how far these medicines produce their salutary
effects by acting directly upon the kidneys.  It is remar-
kable that these organs  are seldom affected in dropsies,
and  that their diseases  are rarely followed  by dropsical
effusions in any part of the body.
  VI.  Generous diet, consisting of animal food, render-
ed cordial by spices; also sound old wine.
  VII. Diluting drinks taken in such large quantities as
to excite the action of the vessels by the stimulus of dis-
tention.  This effect has  been produced, sir George Baker
informs us, by means of large draughts of simple water,
and of cyder and water.*  The  influence of distention in
promoting  absorption is evident in the urinary and gall
bladders, which frequently return  their contents to the
blood  by the lymphatics, when they are  unable to dis-
charge  them through their usual emunctories.   Is it not
probable that the distention produced by the large quan-
tities of liquids which we are  directed to administer after
giving the foxglove, may have  been  the means of per-
forming some of those cures of dropsies, which have been
ascribed to  that remedy ?
   VIII. Pressure. Bandages  bound  tightly around the
belly and limbs, sometimes prevent the increase or return
of dropsical swellings.  The influence of pressure upon
the action of the lymphatics appears in  the  absorption of
bone which frequently follows the pressure of contiguous
tumours, also in the absorption of flesh which follows the
long pressure of certain parts of the body upon a sick bed.

  * The remark upon this fact by sir George, is worthy of notice, and
implies much more than was probably intended by it.  " When common
means have failed, success has sometimes followed a  method directly
" contrary to the established practice."  Medical Transactions, vol. II. 
118                ON DROPSIES.
   IX.  Frictions, either by means of a dry,  or oiled
hand, or with linen or flannel impregnated  with volatine
and other stimulating substances.   I have found evident
advantages from following the advice of Dr. Cullen, by
rubbing the lower extremities upwards, and that only iii
the morning.  I have been at a loss to account for the
manner in which sweet oil acts,  when applied to dropsical
swellings. If it act by what is improperly called a sedative
power upon the blood-vessels,  it will be more proper in
tonic  than atonic dropsies; but if it act by closing the
pores, and thereby preventing the absorption of moisture
from  the air, it will be very proper in the state of dropsy
which is now under consideration.  It is in this manner
that Dr. Cullen supposes that sweet oil, when applied to
the body, cures that state diabetes in which nothing but
insipid water is discharged from the bladder.
   X.  Heat, applied either separately or combined  with
moisture in the form of warm or vapour baths, has  been
often  used with success in dropsies of too litde action.
Dampier,  in his voyage round the world, was cured of a
dropsy by means of a copious sweat, excited by burying
himself in a bed of warm sand.   Warm fomentations to
the legs, rendered moderately stimulating by the addition
of saline or aromatic substances,  have often done service
in the atonic dropsical swellings in the lower extremities.
   XI. The cold bath.  I can say nothing in favour of the
efficacy  of this remedy in dropsies, from my own experi-
ence.   Its good effects seem to  depend wholy on its in-
creasing the excitability of the system to common stimuli,
by the diminution of its excitement.  If this be the  case,
I would ask,  whether fear  might not be employed for the
same  purpose,  and thus become as useful in atonic,  as it
was formerly proved to be in tonic dropsies ?
   XII.  Wounds, whether excited by cutting instruments
or by  fire, provided they excite inflammation and action
in the arteries, frequently cure atonic dropsies.  The good
effects of  inflammation and action in these cases, appear
in the cure of hydrocele by means of the needle, or the
caustic.
   XIII. Exercise.  This is probably as necessary in the
atonic dropsy as it is in the consumption, and should never 
ON  DROPSIES.                 119
be omitted when a patient is able to take it.  The passive
exercises of swinging, and riding in a carriage, are most
proper in the lowest stage of the disease; but as soon as
the patient's strength will admit of it, he should ride  on
horseback.  A journey should be preferred, in this dis-
ease, to short excursions from home.
   XIV. A recumbent posture of the body should always
be advised during the intervals of exercise,  when the
swellings are seated in the lower extremities.
   XV. Punctures in the legs and  feet afford the same
relief in general dropsy, accompanied with a weak  action
in the blood vessels, that has been ascribed to them in
dropsies of an opposite character.
   In the application of each of the remedies which have
been  mentioned,  for the cure of  both  tonic and  atonic
dropsies, great care should be taken to  use them in such
a  manner,  as to  accommodate them to the  strength and
excitability of the patient's system.  The most powerful
remedies have often been rendered hurtful, by being given
in too large doses in the beginning, and useless, by being
given  in too small doses in the subsequent  stages of  the
disease.
   I have avoided saying any thing of the usual operations
for discharging water from the different  parts of the body,
as my design was to treat only of the symptoms and cure
of those dropsies which affect the whole system.   I shall
only remark, that if tapping and punctures have been more
successful in the early,  than in the late stages of these
diseases,  it is probably because the sudden or gradual
evacuation of water takes down that excessive action in
the arterial system, which is most common in their early
stage,  and thereby favours  the  speedy restoration  of
healthy action in the exhaling or lymphatic  vessels.
   Thus have I endeavoured to prove,  that  two different
 states of action take place in dropsies, and have mentioned
 the remedies which are proper for each of them under
 separate heads.  But I suspect that dropsies  are often con-
 nected with a certain intermediate or mixed action in the
arterial system,  analogous to, the typhoid  action which
 takes  place  in certian  fevers.  I  am  led  to adopt  this
 opinion,  not only from  having observed mixed action to 
120                ON DROPSIES.
be so universal in most of the diseases of the arterial and
nervous system, but because I have so frequently observed
dropsical swellings to follow  the scarlatina, and the puer-
perile fever,  two diseases which appear  to derive  their
peculiar  character  from  a  mixture  of  excessive and
moderate force, combined with irregularity of action  in
the arterial system.   In dropsies of mixed action, where
too much force prevails in the action of some, and too
little in the  action of  other of the arterial fibres, the
remedies must be debilitating or stimulating  according
to the greater  or less predominance of tonic  or atonic
diathesis in the arterial system.
  I shall  conclude  this history of dropsies, and of the
different and  opposite remedies which  have cured them,
by the following observations.
  1. We learn, in the first  place, from  what has  been
said,  the  impropriety and even danger of prescribing
stimulating medicines indiscriminately in every case  of
dropsy.
  2. We are taught,  by the facts which have been men-
tioned, the reason why  physicians have differed so much
in their accounts of the same remedies, and why the same
remedies have operated so differently in the hands of the
same physicians.  It is because they have been given with-
out a reference to the different states of the system, which
have been described.  Dr. Sydenham says, that he cured
the first  dropsical patient he was called to, by frequent
purges.  He began to exult in the discovery, as he thought,
of a certain cure for dropsies, but his triumph was of short
duration.   The same remedy failed  in the  next case  in
which he prescribed  it.   The  reason  probably was, the
dropsy in the first case was of  a tonic, but in the second
of an atonic nature; for the latter was an ascites from a
quartan ague. It is agreeable, however, to discover, from
the theory of dropsies which  has been  laid down, that  all
the different remedies for these diseases have been proper
in their nature, and improper only in the state of the sys-
tem in which they have been given.  As the discovery of
truth  in  religion  reconciles  the  principles of  the  most
opposite  sects,  so the discovery of truth in mtdicine re-
conciles the most opposite modes of practice.  It would 
ON  DROPSIES.                 121
be happy if the inquirers after truth in medicine should
be taught, by such discoveries, to treat each other with
tenderness and respect,  and to wait  with patience till ac-
cident, or time, shall combine into one perfect and con-
sistent system, all the  contradictory facts  and opinions,
about which physicians have been so long divided.
  3. If a state of great morbid action in the arteries has
been demonstrated in dropsies, both from  its symptoms
and remedies, and if these dropsies are evidently produ-
ced by previous debility, who  will deny the existence of a
similar action in certain  haemorrhages,  in gout,  palsy,
apoplexy, and madness, notwithstanding they are all the
offspring of predisposing debility ?   And who will deny
the efficacy of bleeding,  purges, and other debilitating
medicines in certain  states of those diseases, that has seen
the same medicines administered with success in certain
dropsies?  To reject bleeding, purging, and the  other
remedies  for violent  action in the system, in any of the
above diseases, because that action was preceded by ge-
neral debility, will lead us to reject them in the most acute
inflammatory fevers, for these are as much the offspring
of previous debility as dropsies or palsy.   The previous
debility of the former  differs  from  that of the latter dis-
eases, only in being of a more acute, or, in other words,
of a shorter duration.
  4. From the symptoms of tonic dropsy  which have
been mentioned,  it follows, that the distinction of apo-
plexy into serous and sanguineous,  affords  no rational in-
dication for a difference in the mode of treating that dis-
ease.   If an effusion of serum in the thorax,  bowels,  or
limbs, produce a hard  and full pulse,  it is reasonable  to
suppose that the same symptom will be produced by the
effusion of serum in the brain.  But the dissections col-
lected by  Lieutaud* place this opinion beyond all con-
troversy.   They prove that the symptoms of great and
feeble  morbid action, as they appear in the pulse,  follow
alike the effusion of serum and blood in the brain.  This
fact will admit of an  important application to the disease,
which  is to be the subject of the next inquiry.
             * Historia Anatomico Medica, vol. II.
vol. n.
R. 
122                 ON DROPSIES.
  5. From the influence which has been  described,  of
the different states of action of the arterial  system,  upon
the lymphatic vessels,  in dropsies,  we  are  led to reject
the indiscriminate use of bark, mercury, and salt water,
in the scrophula.  When the action  of the arteries  is
weak, those remedies are  proper;  but when an opposite
state of the arterial system occurs, and, above all,  when
scrophulous tumours are attended with inflammatory ul-
cers, stimulating medicines of all kinds are hurtful.  By
alternating the above remedies with a milk and vegetable
diet, according to the tonic, or atonic states of the arterial
system, I have succeeded in  the cure of a case of  scro-
phula, attended  by large  ulcers in the inguinal  glands,
which had for several  years resisted the constant use  of
the three stimulating remedies which have  been  men-
tioned.
  6. Notwithstanding  I have supposed dropsies  to be     {
connected with a peculiar state of force in the blood-ves-
sels, yet 1 have not ventured to assert, that dropsies may
not exist from an exclusive affection of the exhaling and
absorbing vessels.  I conceive this to be as possible,  as
for a fever to exist from an exclusive affection of the ar-
teries, or a  hysteria from an exclusive affection of the
nervous system.  Nothing, however, can be said  upon
this subject,  until physiology  and  pathology have taught
us more of  the structure  and diseases of  the lymphatic
vessels. Nor have I ventured  further  to assert, that there
are not medicines  which  may act specifically upon the
lymphatics, independently  of  the arteries.   This I con-
ceive to be as possible as  for asafaetida to act chiefly upon
the nerves,  or ipecacuanha and jalap upon  the alimentary
canal, without affecting other parts of the system.  Until
such medicines  are discovered, it  becomes us  to  avail
ourselves  of  the access to the lymphatics,  which is fur-
nished through the medium of the  arteries, by means of
most of the remedies which have been mentioned.
   7.  If it should appear hereafter,  that we  have  lessened
the mortality of certain dropsies by the theory and prac-
tice which, have been proposed, yet many cases of dropsy
must still occur in which  they will afford us no aid. The
cases I allude to are dropsies from enclosing cysts, from 
ON  DROPSIES.                 123
the ossification of certain arteries, from schirri of certain
viscera from large ruptures of exhaling or lymphatic ves-
sels, from a peculiar and corrosive acrimony of the fluids,
and, lastly, from an exhausted state of the whole system.
The records of medicine furnish us with instances of death
from each of the above causes.  But let  us not despair.
It becomes a physician to believe, that there is no disease
necessarily incurable;  and that there exist in the womb
of time, certain remedies for  all  those morbid affections,
which elude the present limits of the healing art. 
 
          AN INQUIRY






              INTO







       THE CAUSES AND CURE







             OF THE







INTERNAL DROPSY OF THE BRAIN. 
 
AN INQUIRY, &c.
     HAVING, for many years, been unsuccessful in all
 the cases,  except two, of internal dropsy of the brain,
 which came under^my care, I began to entertain doubts
 of the common theory of this disease,  and to suspect that
 effusion of water should be considered only as the effect
 of a primary disease in the brain.
   I mentioned this opinion to my colleague, Dr. Wistar,
 in the month of June,  1788,  and delivered  it  the  winter
 following  in my lectures.  The year afterwards  I  was
 confirmed  in it, by hearing that the same idea had  occur-
 red to Dr. Quin.   I have since read Dr.  Quin's treatise
 on the dropsy of the brain with great  pleasure, and con-
 sider it as the  first dawn  of light which  has  been shed
 upon it. In pursuing this subject, therefore, I shall avail
 myself of Dr. Quin's discoveries, and endeavour  to ar-
 range the facts and observations I have collected in such
 a manner,  as to form a connected theory from  them,
 which I hope will lead to a new and more  successful
 mode of treating this disease.
   I  shall  begin this inquiry by delivering a few general
 propositions.
   1.  The internal dropsy of the brain  is a disease con-
 fined chiefly to  children.
   2. In children the brain is larger in proportion to other
 parts of the body,  than it is in adults; and of course  a
 greater proportion of blood is sent to it in childhood, than
 in the subsequent periods of life.  The effects of this de-
 termination of blood to the brain appear in the mucous dis-
 charge from the nose, and in the sores on the head and
behind the  ears, which are so common in childhood.
  3. In all febrile diseases, there is a preternatural deter-
mination of blood to the brain.   This occurs in  a  more 
128              ON THE  INTERNAL
especial manner in children;  hence the  reason why they
are so apt to be affected  by convulsions in the  eruptive
fever of the small-pox, in dentition, in the diseases from
worms, and in the first paroxysms of intermitting fevers.
   4. In fevers of every kind, and in every stage of  life,
there is a disposition to effusion in that part to which there
is the  greatest determination   Thus,  in  inflammatory
fever, effusions take place in the lungs and in the joints.
In the  bilious  fever they occur in  the liver,  and in the
gout in every part of the body.  The matter effused is
always influenced by the  structure of the part  in which
it takes place.
   These propositions being premised, I should have pro-
ceeded  to  mention  the  remote causes  of this  disease;
but as  this inquiry may  possibly fall  into the  hands of
some gentlemen who may not have access to the descrip-
tion of it as given by Dr.  Whytt, Dr. Fothergill, and Dr.
Quin,  I shall introduce a history of its  symptoms taken
from the last of those authors.   I prefer it  to the histo-
ries by Dr. Whytt and Dr. Fothergill, as it accords most
with the ordinary phenomena of this disease in the United
States.
   " In general, the patient is at first languid and inactive,
" often drowsy and peevish, but at intervals cheerful and
" apparently free from  complaint.  The appetite is weak,
" a nausea, and, in  many cases, a vomiting,  occurs once
" or twice in a day,  and the skin is observed to be hot and
" dry towards the evenings;  soon after  these symptoms
" have appeared, the patient is affected with a sharp head-
" ache, chiefly in the fore-part, or, if not there,  generally
" in the crown of the  head: it is sometimes,  however,
" confined to one side of  the head, and, in that case, when
" the posture of the body is erect, the head often inclines
" to the side affected.  We frequently find, also, that the
" head-ach alternates with the affection of the stomach;
" the vomiting being less troublesome when  the pain  is
" most violent, and vice versa, other parts of  the body
" are likewise subject to  temporary attacks of pain,  viz.
u the extremities, or the  bowels, but more constantly the
" back of the neck, and between the scapulae; in all such
" cases the head is  more free from uneasiness." 
              DROPSY  OP THE  BRAIN.            129

  " The patient dislikes the light at this period; cries
" much, sleeps little, and when he does sleep, he grinds
" his  teeth, picks  his nose, appears to be uneasy, and
" starts often, screaming as if he  were terrified ;  the
" bow els are in the majority of cases very much confined,
" though it sometimes happens that they  are in an oppo-
" site state: the pulse in this early stage  of the disorder,
" does not usually indicate any material derangement.
  " When the symptoms above-mentioned  have  con-
" tinued for a few days,  subject as they always are in
" this disease to great fluctuation, the axis of one eye is
" generally found to be turned  in towards the nose ; the
" pupil on this side is  rather more dilated than  on the
" other; and when both have the axes directed inwards
" (which sometimes happens) both pupils are larger than
" they are observed to be in the eyes of healthy persons :
" the vomiting becomes more constant, and the head-ach
" more excruciating ; every symptom of fever then makes
" its appearance, the pulse is frequent,  and the breathing
" quick;  exacerbations of the fever take place  towards
" the evening, and the face is occasionally flushed ; usual-
" ly one cheek is much  more  affected  than the other;
" temporary perspirations likewise break  forth, which are
" not followed by any alleviation of distress ;  a discharge
" of blood from the nose,  which sometimes appears about
" this period, is equally inefficacious.
  " Delirium, and that of the most violent kind, particu-
" larly if  the patient has arrived at the age  of puberty,
" now takes place,  and with all the preceding symptoms
" of  fever, continues for a while to increase,  until about
" fourteen days, often a much shorter space of time, shall
" have  elapsed  since the apper ranee  of the  symptoms,
" which were first mentioned in the above detail.
   •' The disease then undergoes that remarkable change,
" which sometimes  suddenly points out the  commence-
" ment of what has been called its second stage: the pulse
" becomes slow but unequal, both as  to its strength, and
" the intervals between the pulsations;  the  pain of the
" head, or of whatever  part had previously been affected,
" seems to abate, or at least the patient becomes apparent-
" ly  less sensible of it; the interrupted slumbers, or ner-
   vol.  u.                 R 
130             ON THE INTERNAL
" petual  restlessness which prevailed during the earlier
" periods of the disorder,  are now succeeded by an al-
" most lethargic torpor, the strabismus, and dilatation of
" the pupil increase, the patient lies with one,  or both
" eyes half closed, which,  when minutely examined,  are
".often found to be  completely insensible to light;  the
" vomiting ceases;  whatever food or medicine is offered
" is usually swallowen with apparent voracity ; the bowels
" at this  period generally remain obstinately costive-
  " If every effort made by art fails to excite  the sinking
" powers of life, the symptoms of what has  been called
" the second stage are soon succeeded by others, which
" more certainly annouunce the approach of death.  The
" pulse again  becomes equal, but so weak  and quick,
" diat it  is almost impossible to count it; a difficulty of
" breathing, nearly  resembling  the stertor apoplecticus,
" is often observed ; sometimes the eyes are suffused with
*' with blood,  the flushing of the face is more frequent
" than before, but of shorter duration, and followed by a
" deadly  paleness ; red spots, or blotches, sometimes ap-
" pear on the body  and limbs;  deglutition becomes dif-
" ficult, and convulsions generally close the  scene.   In
" one case, I may observe,  the jaws of a child of four
" years of age  were so  firmly locked for more than a day
*' before death, that  it was impossible to introduce either
" food or medicine into his mouth ; and, in another case,
" a haemiplegia, attended with some remarkable  circum-
" stances, occurred during the two days preceding dis-
" solution.
  " Having thus given as exact a history of apoplexia
" hydrocephalica as  I  could compile from the  writings
" of others, and from my own observations, I should
" think myself guilty of imposition on my readers, if I
" did not caution them that it must be considered merely
" as  a general  outline :  the human brain seems  to be so
" extremely capricious (if the expression may be allowed)
" in  the  signals it gives to other parts of the system, of
" the injury it suffers throughout the course  of this dis-
" ease, that although every symptom  above-mentioned
" does occasionally occur, and indeed few cases of the
" disease are to be met with, which do not exhibit many 
               DROPSY OP THE BRAIN.            131

" of them;  yet it does not appear to me, that any one of
" them is constantly and inseparably connected with it."
  To this history I shall add a few facts, which  are  the
result  of observations made by himself, or  communi-
cated to me by my medical brethren.   These facts will
serve to shew that there are  many deviations from  the
history  of the disease which has been given, and  that it
is indeed, as Dr. Quin has happily expressed it,  of  " a
truly proteiform" nature.
  I have not found the dilated and insensible pupil,  the
puking, the dilirium,  or the strabismus, to attend uni-
versally in this disease.
  I saw one case in which the  appetite was unimpaired
from the first to the last stage of the disease..
  I  have met with one case  in  which the disease was
attended by blindness, and another by double vision.
  I  have observed an  uncommon acuteness in  hearing
to attend two cases of this disease.  In one of them the
noise of the sparks which were discharged from a hiccory
fire, produced great pain and  startings which threatened
convulsions.
  I  have seen three cases in which the disease termi-
nated in hemiplegia    In two  of them it  proved fatal in
a few  days;  in a third it continued for nearly eighteen
months.
   I have met with  one case  in which no preternatural
slowness or intermission was ever perceived in the pulse.
   I have seen the disease in children of nearly all ages.
I once saw it in a child of  six weeks old.   It  was
preceded by the cholera infantum.   The sudden deaths
which we sometimes observe  in  infancy,  I believe, are
often produced by  this disease.  Dr. Stoll is of the same
opinion.   He calls it,  when  it appears in this form,
" apoplexia infantalis."*
   In the month of March, 1771,  I obtained  a gill of
water from the ventricles of  the brain of a  nergro  girl
of  nine years of age, who died of this disease, who com-
plained in no stage of it of a pain in her head or limbs,
nor of a  sick  stomach.   The disease  in this case  was
* Prsdectiones, vol. I. p. 254. 
132
ON  THE  INTERNAL
introduced suddenly by a pain in the breast, a fever, and
the usual symptoms of a catarrh.
   Dr. Wi'star informed  me,  that he  had likewise met
with  a case of internal  dropsy of the brain,  in  which
there was a total absence  of pain  in the head.
   Dr. Carson informed me, that he had attended a child
in this disease that discovered, for some  days before it
died, the symptom of hydrophobia.
   Dr. Currie obtained,  by dissection, seven ounces of
wather  from the  brain  of a  child  which died of this
disease; in  whom, he assured me, no dilatation  of the
pupil, strabismus,  sickness, or  loss of appetite had at-
tended, and but very little head-ach.
   The  causes which induce  this disease,  act  either
directly on the brain,  or  indirectly upon it, through the
mi dium of the whole system.
   The causes which act  directly on the brain are falls or
bruises upon the head, certain  positions of the body, and
childish plays,  which  bring on congestion or  inflamma-
tion,  and afterwards an effusion of water in the brain.   I
have  known it brought  on in  a  child by falling into a
cellar upon its feet.
   The indirect causes of this disease are more numerous,
and  more frequent, though less  suspected, than  those
which have been mentioned.  The following diseases of
the whole system appear  to act indirectly in producing an
internal dropsy of the br,.'in.
   1.  Intermitting,  remitting,  and continual fevers.  Of
the effects of these fevers in inducing  this disease, many
cases are recorded by Lieutaud.*
   My former pupil, Dr.  W'oodhouse, has furnished me
with  a  dissection, in  which  the  disease was evidently
the effect of the remitting fever.   That state of continual
fever which  has  been  distinguished  by  the  name  of
typhus, is often the remote cause of this disease.   The
languor and weakness in all  the muscles of  voluntary
motion, the  head-ach, the  inclination  to rest c..d sleep,
and  the disposition to  be disturbed, or  terrified by
dreams, which are  said to be the precursors of water in
the brain, I  believe are frequently symptoms of a typhus
             * Historia Antomica-Medica, vol. II. 
DROPSY OF  THE BRAIN.
133
fever, which terminates in an inflammation,  or effusion
of water in the brain.   The history which is given of the
typhus state of fever in children by Dr.. Butter,* seems
to favour this opinion.
  2. The rheumatism.   Of this I  have known two in-
stances.  Dr. Lettsom has  recorded a  case  from  the
same  cause.f  The pains in the limbs,  which are sup-
posed to be the effect, I suspect are frequently the  cause
of the disease.
   3. The pulmonary consumption.   Of the connection of
this disease  with an  internal dropsy of the  brain, Dr.
Percival  has furnished us with the following communica-
tion :% " Mr. C-------'s daughter, aged nine years, after
" labouring under  the phthisis pulmonalis  four months,
" was  affected with unusual pains in her head.  These
" rapidly increased, so as to occasion frequent screamings.
" The cough,  which had  before been extremely violent,
" and  was  attended  with stiches  in  the breast,  now
" abated, and in a few days ceased  almost entirely.  The
" pupils of the eyes became dilated, a strabismus ensued,
" and  in about a week death put an end to her agonies.
" Whether  this  affection  of the  head arose  from  the
" effusion of water or  of blood,  is uncertain, but its
" influence on the state of the lungs is worthy of notice."
Dr. Quin likewise  mentions a case from Dr. Cullen's
private practice,  in which an internal dropsy of the brain
followed a pulmonary consumption.  Lieutaud mentions
three cases of the same kind,§ and two, in  which it suc-
ceeded a catarrh. ||
   4. Eruptive fevers.   Dr. Odier informs us,T[ that he
had seen four  cases in which it had followed the small-
pox, measles,  and scarlatina.  Dr. Lettsom  mentions a
case in  which it followed the small-pox,**  and I  have
seen one in which it was obviously the  effects of debility
induced upon the system by the measles.
   5.  Worms.  Notwithstanding the discharge of worms
   * Treatise on the Infantile Remitting Fever.
   f Medical Memoirs, vol. I. p. 174.
   % Essays, Medical,  Philosophical, and Experimental, vol. II. p. 339,
  340.
   § Historia Anatomica-Medica, vol. II lib. tertius, obs. 380, 394, 1121.
   j| Obs. 383, 431.   1 Medical Journal.
   ** Medical Memoirs, vol. I. p. 171. 
134              ON THE INTERNAL
gives no relief in this disease, yet there is good reason to
believe, that it has, in some instances, been produced by
them.   The morbid action continues in the brain, as in
other cases of disease, after the cause Which  induced  it,
has ceased to act upon the body.
   6. From the dissections of Lieutaud, Quin, and others,
it  appears further, that the internal  dropsy of the  brain
has been observed to succeed each of the following dis-
eases, viz. the colic, palsy, melancholy, dysentery, denti-
tion, insolation,  and scrofula,  also the sudden healing of
old sores.   I have seen  two cases of it from  the last
cause, and one in which it was produced by the action of
the vernal sun alone upon the system.
   From  the  facts which have  been  enumerated,  and
from  dissections to  be mentioned  hereafter, it  appears,
that the disease in its  first stage is  the effect of causes
which produce a less degree of that morbid action in the
brain  which  constitutes  phrenites, and that its  second
stage  is the effect of a less degree of that effusion, which
produces  serous apoplexy in adults.  The former par-
takes  of the  nature of the chronic inflammation of Dr.
Cullen, and of the asthenic inflammation of Dr. Brown.
I  have  taken the liberty to call it phrenicula,  from its
being a diminutive species or state of phrenitis.  It bears
the same relation to  phrenites,  when it arises from in-
direct causes, which  pneumonicula does to pneumony ;
and it is produced nearly in the same manner as  the pul-
monary  consumption, by debilitating causes which act
primarily on the whole system.  The peculiar size and
texture of the brain seem to invite the inflammation and
effusions which  follow debility, to that  organ in child-
hood, just as the peculiar structure and  situation of the
lungs invite the  same morbid phasnomena to them, after
the body has acquired its growth,  in youth and  middle
life.   In the latter stage which has been mentioned the
internal  dropsy of the brain partakes of some of  the* pro-
perties of apoplexy.  It differs from it in  being the effect
of a slow, instead of  a sudden effusion of water or blood
and in being the effect of causes which are of an acute
instead of a chronic nature.  In persons advanced beyond
middle life, who are affected by this disease, it approaches 
               BR0PSY OF THE BRAIN.           135

to the nature of the common apoplexy,  by a speedy ter>-
mination in life or death.  Dr.  Cullen has called it sim-
ply by the name of " apoplexia hydrocephalica." I have
preferred for its last  stage the term of chronic apoplexy ;
for 1 believe with  Dr. Quin, that it has no  connection
with a hydropic diathesis of the whole system.  I am
forced to adopt this opinion,  from my having rarely seen
it accompanied by dropsical effusions in other  parts of
the body, nor a general dropsy  accompanied by an inter*.
nal dropsy of the brain.  No more occurs in this disease
than takes place when hydrothorax follows an inflamma-
tion of the lungs,  or when serous effusions follow an in-
flammation of the joints.  I do  not suppose that both in-
flammation and effusion always attend  in this  disease;
on  the contrary, dissections  have shown  some  cases of
inflammation, with little or no effusion,  and some of ef-
fusion without inflammation.  Perhaps this variety may
have been produced by the different stages of the disease
in which death and the inspection of the brain took place.
Neither do I suppose, that the two stages which have been
mentioned, always succeed  each other in the  common
order of inflammation and effusion.  In  every case where
the full, tense, slow and intermitting pulse occurs,  I be-
lieve there is inflammation; and as this state of the pulse
occurs in  most cases in the beginning of the disease,  I
suppose the inflammation,  in most cases, to precede the
effusion of water.  I have met with only one case in which
the slow and tense pulse was absent; and out of six dis-
sections of patients whom I have lost by this disease, the
brains of four of them exhibited marks of inflammation.
   Mr. Davis discovered signs of inflammation, after death
from this disease,  to be universal.  In eighteen or twenty
dissections, he tells  us,  he  found the pia mater always
distended  with blood.*  Where  signs of inflammation
have not occurred, the blood-vessels had probably reliev-
ed themselves by  the effusion of serum,  or the  morbid
action of the blood-vessels had exceeded that grade of ex-
citement,  in which only inflammation can take place.   I
have seen one case of death  from this disease,  in which
there was not more than a  tea-spoonful of water in the
                 * Medical Journal, vol VIII. 
136              ON THE  INTERNAL
 ventricles of the brain.   Dr. Quin mentions  a similar
 case.  Here death was induced by simple excess of ex-
 citement.  The water which is found in the ventricles of
 the brain refuses to coagulate by heat, and is always pale
 in those  diseases, in which the  serum-of the  blood, in
 every other part of the body, is of a yellow colour.
   In addition to these facts,  in support of the internal
•dropsy of the brain being the  effect  of inflammation, I
 shall mention one more communicated to me in a letter,
 dated July 17th,  1795,  by my  former pupil, Dr.  Coxe,
 while he was prosecuting his studies in London.  " It so
 happened (says my ingenious corrsespondent), that at the
 time of my receiving your letter, Dr. Clark was  at the
 hospital.  I read to him that part which relates to your
 success in the treatment of hydrocephalus internus.  He
 was much pleased with it, and  mentioned to me  a fact
 which strongly corroborates your idea of its being a pri-
 mary inflammation of the brain.  This fact was,  that upon
 opening, not long since, the head of a child that had died
 of this disease,  he found between three and four ounces
 of water in the  ventricles of the brain ; also an inflamma-
 tory crust on the optic  nerves,  as  thick as he  had ever
 observed it on the intestines  in  a state of inflammation.
 The child lost  its sight before  it died.   The  crust ac-
 counted  in a satisfactory manner for its blindness.   Per-
 haps something similar may always be noticed in the dis-
 sections  of such as die in  this disease, in whom the eyes
 are much affected."
   Having adopted the theory of this disease, which I have
 delivered, I  resolved upon such a change  in my practice
 as should accord with it.   The  first remedy indicated by
 it was
   I. Blood letting.  I shall briefly mention  the effects of
 this remedy in  a few of the first cases in which  I pre-
 scribed it.

                      CASE  I.

   On the 15th of November, 1790, I was called to visit
 the daughter of  William Webb, aged four years, who
 was indisposed with a cough, a pain in  her bowels, a coma 
              DROPSY OF  THE BRAIN.            137

great sensibility of her eyes to light, costiveness, and a sup-
pression of urine,  a slow and irregular, but tense pn'se,
dilated pupils, but no head-ach. I found, upon inquiry, that
she had received a  hurt on her head by a fall, about seven
weeks before I saw her.  From this information,  as well
as from her symptoms, I  had no doubt  of the disease be-
ing the internal dropsy of the brain.  I advised the loss of
five ounces of blood, which gave her  some relief.  The
blood was sizy. The next day she took a dose of jalap and
calomel, which operated  twelve times.   On the 18th she
lost four ounces more of blood,  which was more  sizy
than that drawn on the 15th.  From this time she mended
rapidly.  Her coma left  her on the 20th,  and her appe-
tite returned; on the 21st she made a large quantity of
turbid dark coloured urine.   On  the 22d  her pulse be-
came again a little tense,  for which she took a gentle
puke.  On the 23d she had a natural stool.  On die 24th
her pupils appeared to be contracted to their natural size,
and on the 30th I  had the  pleasure of seeing  her seated
at a tea-table in good health.  Her pulse notwithstanding,
was a little more active and tense than  natural.

                     CASE II.

   On the 24th of the same month, I was called to visit
the son of John Cypher,  in South-street, aged four years,
who  had been hurt about a  month before,  by a wound
on his forehead with a brick-bat, the mark of which still
appeared. He had been ill for near two weeks with coma,
head-ach, colic, vomiting, and frequently startings in his
sleep. His evacuations by stool and urine were suppress-
ed ; he had discharged  three worms,  and  had  had two
convulsion fits just before I saw* him.   The pupil of the
right eye was larger than that of the left.  His pulse was
full, tense, and slow, and intermitted every fourth stroke.
The  symptoms plainly indicated  an internal dropsy of the
brain. I ordered him to lose four or five ounces of blood.
But three ounces of blood were drawn, which produced
a small change in  his pulse.  It rendered the intermission
of a  pulsation perceptible  only after every tenth stroke.
On the 25th he lost five  ounces of blood, and took a
   vol. n.                   s 
138              ON THE INTERNAL
purge of calomel and jalap.  On the 26th he was better.
On the 27ih the vomiting was troublesome, and his pulse
was still full and tense, but regular.   I ordered  him  to
lose four ounces ol blood.   On the 28th his puking and
head-ach continued; his pulse was a little tense, but re-
gular ;  and his right pupil  less  dilated.  On the 29th his
head-ach and  puking ceased,  and he p.ayed  about the
room    On the 4th of December he  grew worse; his
head-ach and  puking returned,  with a hard  pulse, for
which 1 ordered him to lose five  ounces  of blood.   On
the 5th he was better, but on  the 6th  his head-ach and
puking returned   On the 7th  I ordered his  forehead to
be bathed frequently with  vinegar, in which ice had been
dissolved.  On the 8th he was much better.  On the 9th
his pulse became  soft,  and he complained but  little of
head ach.  After appearing to be well for near three weeks,
except that he complained of a  little head-ach, on the 29th
his pulse became  again full and tense, for which I order-
ed h.m to lose six ounces of  blood,  which for the first
time discovered a buffy coat.   After this last bleeding,
he discharged  a large quantity  of water.  From this time
he recovered slowly, but his pulse was a  little  fuller than
natural on the 19th of January following.  He  afterwards
enjoyed good health.

               CASES III. AND IV.

   In the month of March, 1792,  I attended two children
of three years of age, the one the daughter of William King,
the other the da lighter of William Blake: each of whom had
most of the symptoms of the inflammatory stage of the inter-
nal dropsy of the brain.  I prescribed the loss of four ounces
of blood, and  a smart purge  in  both  cases,  and in  the
course of a few days had the pleasure of observing all the
the symptoms of the disease perfectly subdued in each of
them.


                      CASE V.

   In the months of July and August,  1792, I attended a
 female  slave of Mrs. Oneal,  of St.  Croix,  who had an 
               DROPSY OF THE BRAIN.            139

obstinate head-ach, coma, vomiting, and a, tense, full and
slow pulse.  I believed it to be the phrenicula, or internal
dropsy of the brain, in its inflammatory stage. I bled her
five  times  in the course of two months, and each time
with obvious relief of all the  symptoms of the disease.
Finding that her  head-ach, and a disposition to vomit,
continued after  the tension of her pulse was nearly reduced,
I gave her as much calomel as excited a gentle salivation,
which in a few  weeks completed her cure.

                      CASE  VI.
   The  daughter of  Robert Moffat,  aged eight years, in
consequence of the  suppression of a habitual discharge
from sores on her head, in the month of April, 1793, was
affected by violent  head ach,  puking,  great pains and
weakness in her limbs, and a full, tense, and slow pulse.
I believed these symptoms to be produced by an inflam-
mation of the  brain   I ordered her to lose six or seven
ounces of blood,  and gave her two purges of jalap and
calomel, which operated very plentifully.   I afterwards
applied a blister to her neck.  In one week from the time
of my  first visit  to her  she  appeared  to be in perfect
health.

                      CASE  VII.
   A. young woman  of eighteen years of age, a  hired ser-
 vant in the family of Mrs Elizabeth Smith,  hud been
 subject to a head-ach  every spring for several years. The
 unusual warm days which occurred in  the beginning of
 April,  1793,  produced a return of this periodical pain.
 On the eighth of the month, it was so severe as to confine
 her to her bed. I was called to visit her on the ninth.   I
 found her comatose,  and,  when awake, delirious.  Her
 pupils  were unusually dilated, and insensible to the light.
 She was constantly sick at her stomach, and vomited fre-
 quently.   Her bowels were obstinately costive, and her
 pulse  was full, tense,  and so slow as seldom to  exceed,
 for  several days,  from  56 to 60 strokes in a minute.   I
 ordered her to lose  ten  ounces of blood every day, for
 three days successively,  and  gave her,  on each of those
 days, strong doses of jalap and aloes. The last blood which 
140               ON THE INTERNAL
was drawn from her was sizy.  The purges procured from
three to ten discharges every day from her bowels.   On
the 12th, she appeared to be much better. Her pulse was
less tense, and beat 80 strokes in a minute. On the 14th,
she h.d a fainting fit. On the  15th, she sat up, and called
for food.   The  pupils of her eyes now  recovered their
sensibility to light, as well as their natural  size. Her head-
ach left her, and, on the 17th,  she appeared to be in good
health.  Her pulse, however,  continued  to beat between
50 and  60  strokes in a minute, and retained a small por-
tion of irregular action for  several days after she reco-
vered.
   I am  the  more disposed to pronounce  the cases which
have been described to  have been internal dropsy of  the
brain, from my having never been deceived  in  a single
case in  which  I have  examined the  brains  of  patients
whom I have suspected to have died of it.
   I could add many other cases to those which have been
related,  but enough, I hope,  have been  mentioned to
establish the safety and efficacy of the remedies that have
been recommended.
   I believe, with Dr. Quin, that this disease is much more
frequent than is commonly supposed.  I can recollect
many cases  of anomalous fever and head-ach in children,
which have  excited the most distressing apprehensions of
an approaching internal dropsy of the brain, but which have
yielded in a few days to bleeding, or to purges and  blisters.
I think it probable, that some, or perhaps most of these
cases, might have terminated in an effusion of water in the
brain, had they been left to themselves, or not been treated
with the above remedies. 1 believe further, that it is often
prevented by all those physicians  who treat the first stage
of febrile diseases in children with evacuations, just as the
pulmonary consumption is prevented  by bleeding,  and
low diet, in  an inflammatory catarrh.
   Where blood-letting  has failed of curing this disease  I
am disposed to ascribe it to its being used less copiously
than the disease  required. If its relation to pneumonicula
be the same in  its cure, that I have supposed it to be in
its cause, then 1 am persuaded,  that  the same excess in
blood-letting is indicated in it, above what is necessary in 
               DROPSY OF THE BRAIN.            141

phrenitis, that has been practised in pneumonicula, above
what is necessary in the cure of an acute inflammation of
the lungs.  The continuance, and, in some instances, the
increase of the appetite in the internal dropsy of the brain,
would seem to favour this opinion no less in this disease,
than in the inflammatory state of pulmonary consumption.
The extreme danger  from the effusion of water into the
ventricles of the brain, and the certainty of death from its
confinement tnere,  is a reason  likewise why more blood
should be drawn in this disease, than in  diseases of the
same force in other parts of the body, where the products of
inflammation have  a  prompt,  or certain outlet from the
body.   Where the internal dropsy is obviously the effect
of a fall, or of any other  cause  which acts directly on the
brain,  there can be  no doubt of the safety of very plentiful
bleeding;  all practical writers upon surgery  concur in
advising it.  The late Dr. Pennington favoured me with
an extract from Mr. Cline's  manuscript lectures upon
anatomy,  delivered in  London in the winter of  1792,
which places the advantage of blood-letting, in that species
of inflammation which follows a local injury of the brain,
in a very strong point of light.   " I know (says he) that
" several  practitioners object  to  the use  of evacuations
" as remedies for concussions  of  the  brain, because
" of the weakness of the pulse; but in these cases the
" pulse is depressed. Besides,  experience  shows, that
" evacuations are frequently attended with very great ad-
" vantages.  I remember a  remarkable case of a man in
" this [St. Thomas's] hospital, who was under the care
 " of Mr. Baker.   He lay in a comatose  state for  three
" weeks after an injury of the head.  During that time
 " he was bled twenty times, that is to say,  he was bled
 " once every day upon an average.  He was bled twice a
 " day plentifully, but towards the conclusion he was bled
 " more sparingly,  and only every other day;  but at each
 " bleeding, there were taken, upon an average, about six-
 " teen ounces of  blood.  In consequence of this treat-
 " ment, the man perfectly recovered his health and reason."
   Local bleeding by  cups, leaches, sacrifications, or arte-
riotomy,  should be  combined with venesection, or pre-
ferred to it, where the arterial system does not sympathize
 with the disease in the brain. 
142              OK THE INTERNAL
   II. A second remedy to  be used in the second stage
of this disease is purges.  I have constantly observed all
the patients whose cases have been related, to be relieved
by plentiful and repeated evacuations from the bowels. I
was led  to  the use of frequent purges, by having long
observed their good effects in  palsies, and other cases of
congestion in the brain, where blood letting was unsafe,
and where it had been used without benefit. In the Leipsic
Commentaries,* there is an  account of a case of internal
dropsy of the brain, which  followed the measles, being
cured by no other medicines  than purges and  diuretics.
I can say nothing in favour of the latter remedy,  in this
disease, from my own experience. The foxglove has been
used in this city by several respectable practitioners, but,
I believe, in no instance with any advantage.
   III.  lilisters have been uniformly  recommended by all
practical writers upon this disease.   1 have applied them
to the head, neck, and temples, and generally with obvious
relief to the pain in the head.   They should  be omitted
in no stage of the disease;  for even in its inflammatory
stage, the discharge they occasion from the vessels of the
head, greatly overbalances their stimulating effects upon
the whole system.
   IV. Mercury was long considered as the only remedy,
which gave the least chance of a recovery from a  dropsy
of the brain. Out of all the  cases in which I  gave it, be-
fore the year 1790, I succeeded in but two: one of them
was a child of three years old, the other was a  young
woman of twenty-six years of age.   I am the more con-
vinced that the latter case was  internal dropsy of the brain,
from my patient having relapsed, and died between two or
three years afterwards, of the same  disease.  Since I have
adopted  the depleting  remedies which have been men-
tioned,  I have declined  giving mercury altogether, ex-
cept when combined with some purging medicine, and
1 have given  it in this form chiefly with a view  of dis-
lodging  worms.   My reasons  for not  giving it as a sia-
lagogue  are the uncertainty of its operation^ its frequent
inefficacy when it exciies a salivation, and, above all, its
disposition  to  produce gangrene in the tender jaws of
                    • Vol. xxix. p. 139. 
DROPSY OF THE BRAIN.            143
children. Seven instances of its inducing death from that
cause, in children between three and eight years of age,
and with circumstances of uncommon distress, have oc-
curred in Philadelphia since the year 1795.
   V. Linen cloths,  wetted with cold vinegar,  or water,
and applied to the forehead,  contribute very much  to re-
lieve the pain in the head   In the case of Mr  Cypher's
son,* the solution of ice in the vinegar appeared  to af-
ford the most obvious relief of this distressing symptom.
   A puncture in the brain has been  proposed by some
writers to discharge the water from  its ventricles.  If the
theory I have delivered be true, the operation promises
nothing, even though it could always be performed with
perfect safety. In cases of local injuries, or of inflamma-
tion from any cause, it must necessarily increase the dis-
ease ; and in cases of effusion only, the debilitated state
of the whole system forbids us to hope for any relief from
such a local remedy.
   Bark, wine, and opium  promise  much more success
in the last  stage of the disease.   I can say  nothing in
their favour from my own experience ;  but from the aid
 they  afford to mercury in other diseases, I conceive they
 might be made to accompany it with advantage.
   Considering the  nature of the indirect causes  which
 induce the disease, and the case of a relapse, which has
 been mentioned,  after an interval of near three years as
 well  as the symptoms of slow convalescence,  manifested
 by the  pulse, which occurred in the first and seventh
 cases,  I submit  it to  the  consideration  of  physicians,
 whether the use of moderate exercise, and the cold bath
 should not  be recommended  to prevent a return of the
 disease  in every case,  where it has  yielded to the  power
 of medicine.
   I have great pleasure in adding, that the theory of this
 disease, which  I  have delivered,  has  been adopted by
 many respectable physicians in Philadelphia, and in other
 parts of the United States, and ,that it  has  led  to the
 practice that has  been recommended,  particularly  to
 copious blood-letting; in consequence of which,  death
 from a dropsy of the brain  is not a more frequent  occur-
 rence, than from any other of the acute febrile diseases of
 our country.
                         Case II- 
 
    OBSERVATIONS






         UPON







THE CAUSE AND CURE






          OF







     THE GOUT.
VOL. II. 
 
OBSERVATIONS, &c.
     IN treating upon the gout, I shall deliver a few pre-
liminary propositions.
  1. The gout is a disease of the whole system.  It af-
fects the ligaments, blood-vessels, stomach, bowels, brain,
liver, lymphatics, nerves, muscles, cartilages, bones,  and
skin.
  2. The gout  is a primary disease, only of the solids.
Chalk-stones, abscesses,  dropsical effusions into cavities,
and cellular membrane, and eruptions on the skin, are all
the effects of a morbid action in the blood-vessels.  The
truth of this proposition has been ably proved  by  Dr.
Cullen in his First Lines.
  3. It affects most frequently persons of a sanguineous
temperament; but  sometimes it affects persons of  ner-
vous and phlegmatic temperaments.  The idle and lux-
urious  are more subject to it,  than the labouring  and
temperate part of mankind.  Women are said to be less
subject to it than men.   I once believed, and taught this
opinion, but I now retract it.  From the peculiar delicacy
of the  female constitution, and  from the thin covering
they wear on  their feet and limbs, the gout is less apt
to fall upon those parts than in men,  but  they exhibit all
its other symptoms, perhaps more frequently than men,
in other parts of the body.  The remote causes  of gout
moreover to be mentioned presently, act with equal force
upon both  sexes,  and more of them I believe upon
women, than upon men.
  It generally attacks in those  periods  of life, and in
those countries, and seasons of the year, in which inflam-
matory diseases are most  common.   It seldom affects
persons before puberty, or in old age,  and yet I  have
heard  of  its appearing with  all its most  characteristic
symptoms in this city in a  child of 6, and  in a  man 
148              OBSERVATIONS ON
above 80 vcars of age.  Men of active minds are said to
be most subject to it', but 1 think I have seen it as frequent-
ly in  persons of slender and torpid intellects,  as in persons
of an opposite character.   I have heard of a case of gout
in an Indian at Pittsburg,  and I have cured a fit of it in
an Indian in this city.   They had both been  intemperate
in the use of wine and fermented liquors.
   4.  It is in one  respect a hereditary disease, depending
upon the propagation of a similar temperament from fa-
ther to son. When a predisposition to the gout has been
derived from ancestors, less force in exciting causes will
induce it than in  those habits where this has not been the
case.  This predisposition sometimes passes by children,
and appears in grand-children.  There are instances like-
wise in which it has  passed  by the  males, and appeared
only in the females of a family.   It  even  appears in the
descendants of families who have been reduced to poverty,
but not often where they have been obliged  to labour for
a subsistence.  It generally passes by those children who
are born  before the gout makes its appearance in a father.
It is curious to observe how extensively the predisposi-
tion pervades some families.  An English gentleman, who
had been afflicted with the gout, married a young woman
in Philadelphia many years ago, by whom  he had one
daughter.  His wife dying three weeks after the birth of
this child,  he  returned to England,  where he married a
second wife, by whom he had six children, all of whom
except one died with the gout before they attained to the
usual age of matrimony in Great Britain.   One of them
died in her 16th year.  Finally the father and grandfather
died  with the  same  disease.   The  daughter whom this
afflicted gentleman left in this city, passed her life subject
to the gout, and finally died under  my care  in the year
1789, in the 68th year of her age.   She left a family of
children, two of  whom had the gout.   One of them, a
lady,  has suffered exquisitely from it.
  5.  The gout is always induced by general predisposing
debility.
  6.  The remote causes  of the gout which induce this
debility,  are, indolence,  great bodily labour,  long  pro-
tracted bodily exercise,  intemperance in eating  and in 
THE GOUT.                  149
venery, acid aliments and drinks,  strong tea and coffee,
public and domestic vexation, the violent,  or long con-
tinued exercise  of the  understanding, imagination,  and
passions in study, business,  or pleasure, and lastly, the
use of ardent and fermented liquors.  The last are absolute-
ly necessary to produce that form of gout which appears
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 never saw a case of gout
in the limbs in any person who had not used spirits or
wine  in a greater 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 resolved 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 fever,  or intermitting fever, while spirits resem-
ble that violent action induced by miasmata which passes
by the blood-vessels," ligaments, and muscles, and invades at
once the liver, bowels, and brain. There is one system of the
gout  in the extremities  which seems to be  produced ex-
clusively 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 my pa-
tients of intemperance in the  use of spirits, when no other
mark of their having taken them in excess, appeared in the
system.
   While I thus ascribe the gout to the use of fermented
and  distilled  liquors, let  me repeat that they are not its
exclusive causes.  Dr.  Harle of New-Castle died  of the
gout, and yet he never tasted wine nor spirits in the whole
course of his  life.  He could not  even bear the taste of
either of them in a piece  of  sweet  cake.   The Bramins
who neither drink wine nor spirits, nor eat  animal food,
are not exempted from this disease ;  and Sir James Jay
has assured me that he has seen instances of it in persons
who lived wholly upon vegetables.
   I have enumerated among the remote causes of the 
150              OBSERVATIONS ON
gout, the use  of strong  tea.  I infer its predisposing
quality to that disease, from its frequency at Japan, where
tea is used  in lage quantities, and from the gout being
more common  among that sex in our country who drink
the most, and the strongest tea.
   7. The exciting causes of the gout are frequently a
greater degree,  or a sudden application of its remote and
predisposing causes.  They  act  upon  the accumulated
excitability of the system, and by destroying its  equili-
brium of excitement,  and regular order of actions,  pro-
duce 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 sudden 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,  vomiting,
fasting,  cold, a sudden  stoppage of moisture 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 they  are aided  by the additional  de-
bility 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 of 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 else-
where delivered,  that disease is  the  effect of stimulus.
The abstraction of a natural  and habitual impression 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 dis-
proportioned stimulus, as if they were induced by causes
that are externally and evidently stimulating.   It  is thus 
THE GOUT.                 151
in many other of the operations of nature, opposite causes
produce the same effects.
  8. The gout consists simply in morbid excitement, ac-
companied with irregular action,  or the absence of all
action from the force of stimulus.  There is nothing spe-
cific in the morbid excitement and  actions 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  pathology. The rejection of a specific ac-
rimony as the cause of each disease, has unfortunately been
followed by a  belief in as many specific actions as there
are different forms and  grades  of disease, and thus per-
petuated 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 alimentary canal, the lym-
phatics, the skin, and the bones of the  human body,  and
here we shall find that it is an epitome  of all diseases.
   1. The ligaments which connect the  bones are the seats
of what is called a legitimate or true  gout.  They are af-
fected  with pain, swelling, and inflammation.   The pain
is sometimes so acute as to be compared to the knawing
of  a dog.  We perceive here the  sameness of the gout
with the rheumatism.   Many  pages,  and  indeed  whole
essays, have  been composed by  writers to  distinguish
them,  but they are  exactly the same  disease while the
morbid  actions are confined to this  part of the  body.
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, whether it be inflamed
by a candle, or by a spark  of electricity.  The morbid
actions which are  induced  by the  usual causes of rheu-
matism affect, though less frequently,  the lungs, the tra-
chea, the head, the bowels,  and even the heart as well as
the gout.  Those actions, moreover, are the means of a
fluid being secreted which is changed into  calcareous 
152              OBSERVATIONS ON
matter in the joints and other parts of the body, exactly
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 hereafter.  The only  differ-
ence between what are called gouty,  and rheumatic ac-
tions, consists in their seats and  in the degrees of their
force.   The debility which predisposes to the gout, be-
ing greater, and more extensively diffused  through the
body than  the debility which precedes rheumatism, the
morbid 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 sys-
tem by  marsh miasmata, made use of upon a former oc-
casion, will serve me again to illustrate this part of our
subject.   A mild remittent, and a yellow fever, are dif-
ferent grades of the same disease.   The former, like the
rheumatism, 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 fever. 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 different grades of fever, from the ma-
lignity of the plague, to the mildness of a common in-
termittent.  It has moreover its regular exacerbations and
remissions  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 persons 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 instances of this disease appear-
ing in the form of a  genuine hectic, and one in which  it
appeared to yield to lunar influence,  in the manner de- 
THE GOUT.                  153
 scribed by Dr. Balfour. In the highly inflammatory state
 of the gout, the  sensibility of the blood-vessels  far ex-
 ceeds 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 weather would  have  made  a  large  fire
 agreeable to him.   I once attended a ladv in this disease
 in  whom the walking  of  her  attendants  across the floor
 of her .chamber, and even the touch of a hand upon  any
 part of her body in moving her in bed, excited consider-
 able pain.   It is from  the  extreme sensibility which the
 gout imparts to the 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 me-
 dicine, while his arterial system was in this state of mor-
 bid excitability, from a fit of the gout.   It is  remarkable
 that the gout is most  disposed to  assume a malignant
 character, during the prevalence of an inflammatory con-
 stitution of the atmosphere.   This has  been long ago re-
 marked by Dr. Huxham.   Several instances of it have
 occurred in this city since  the year 1793.
   III. The gout affects most of the viscera. In  the brain
 it produces head-ach, vertigo, coma, apoplexy, and palsy.
 In the lungs it produces pneumonia vera, notha, asthma,
 haemoptysis, pulmonary consumption, and a short necking
 cough, first described by Dr. Sydenham.  In the throat
 it produces inflammatory angina.  In the uterus it pro-
 duces hasmorrhagia uterina.  It affects  the  kidneys with
 inflammation, strangury, diabetes, and calculi.   The po-
 sition of the body for weeks or months on the back,  by
favouring the compression of the kidneys 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 Literary Essays of Edinburgh,
by Dr. David Clark.   I have seen one  instance  of death
  VOL. II.                 u 
154
OBSERVATIONS ON"
in an old man from this cause.  The catheter brought no
water from his bladder.  The late Mr.  John Penn, for-
merly governor of Pennsylvania,  I  have been  informed
by one of his physicians, died from a similar affection in
his kidneys 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 becomes the seat of
the gout. It discovers itself by spasm, and a suppression
of urine in some  cases, and occasionally by an habitual
discharge of mucus through the urethra    This disease
has been called, by Lieutaud,  " a catarrh of the bladder."
Dr. 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 inflammation, suppura-
tion, melena, schirrus, gall-stones,  jaundice, and an ha-
bitual increased secretion and  excretion of bile.   These
affections of the liver appear 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  specifically upon
the liver,  probably  for the wise purpose of discharging
such parts of the  blood from the body, as are vitiated by
the rapidity of its circulation.   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 fermented
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
madness and the malignant sore-throat, also in contusions
of the brain, and  in the excited state of the blood-vessels
w*hich is produced by  anger and exercise.   I have found
an attention to these facts  useful in prescribing  for dis-
eases of the liver, inasmuch as they have  led me from
 considering them as idiopathic affections,  but  as the ef-
 fec»s only of morbid actions excited in other parts of the
 bod/.
                       * Vol. IV. 
                     THE GOUT.                  155

  IV. The gout sometimes affects the arterial  and ner-
vous systems jointly, producing in the brain, coma, ver-
tigo, apoplexy, palsy, loss of memory, and madness,  and
in the nerves,  hysteria, hypochondriasis and syncope.   It
is common to say the gout counterfeits all these diseases.
But this is an inaccurate mode of speaking.   All those
diseases have  but one cause, and  they  are exactly the
same, however different the stimulus  may be, from which
they are derived.  Sometimes the gout affects the brain
and nerves exclusively, without producing the least mor-
bid action in the blood-vessels.  I once attended  a gen-
tleman 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, in his hands or feet.
  The muscles  are sometimes affected by the gout with
spasm,  with general and partial convulsions, and lastly
with great pain.   Dr. Stoll describes a case of opisthoto-
nos from it.   The angina pectoris, or a  sudden inability
to breath 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  arthritica."   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 swell-
ings.  But further;  the  gout in some cases seizes upon
the tendons, and twists them in such a manner as to dis-
locate 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 alimentary 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 
156              OBSERVATIONS ON
  dyspepsia, with all its train of distressing evils, are fre-
  quently the effects of gout concentrated in the stomach.
  I have seen a case in which the gout, by retreating to this
  viscus, produced  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 colletor of the
  port of Philadelphia, under the  British grovernment.  I
  was  not surprised at these two uncommon symptoms in
  the gout, for I had long been familiar with its disposition
 to affeGt  the biliary 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
 " downward 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 gentleman in this city,  and I have
 heard from a southern gentleman, who had been afflicted
 with  gouty symptoms,  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,  1 am led to take notice of a troublesome itching in
 the anus which has been described by Dr. Lettsom, and
justly attributed by him to this disease.*   I have known
 several cases of it. They always occurred in gouty habits.
 A  distressing collection  of air  in  the  rectum,  which
 renders frequent  retirement from company necessary to
 discharge  it, is likewise a symptom of gout. It is accom-
panied 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 symptom of  gout.  Out of  more than
500 persons who were the  patients of the Liverpool  in-
firmary and dispensary,  in  one  year,  Dr. Currie informs
us, "a great majority were  females."f
  * Medical Memoirs, vo.. 111.
  t Medical Reports on the Effects of Hot and Cold Water, p. 215. 
THE GOUT.                   157
  VI. The gout affects  the glands and lymphatics.   It
produced a salivation of a profuse nature in major Pearce
Butler, which continued for two days. It produced a bubo
in the groin in a citizen of Philadelphia.   He had never
been infected with the venereal disease, of course no sus-
picion was  entertained  by me  of its being  derived from
that cause.  I knew a lady who had periodical swellings in
her breasts, at the same season of the  year in which she
had before  been accustomed to have a  regular fit of the
gout.  The scrofula and all the forms of dropsy are the
effects in many  cases of the disposition  of the  gout to
attack the lymphatic system.  There is  a large hard swel-
ling  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 colonel
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 indolent 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 after-
wards 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 rea-
son to suspect it 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 these facts as an additional proof of the same-
ness of the gout  and rheumatism, 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 time
the sensation of pain.
   Under this head I  shall include an  account of the
mucous discharge  from the urethra,  which  sometimes 
158             OBSERVATIONS ON

takes places in an attack of the gout, and which has ignor-
antly been ascribed to a venereal gonorrhaea.  There is a
description of this symptom 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 work entitled
Pathologia  Methodica, and afterwards by Dr. Whytt.
Dr. Plaigne saw an instance of  this symptom alternating
with a  pain in the great toe, and which  was removed by a
blister  to that part of the body.  It occurs most frequently
in old people.   I  have known three instances 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
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 females,  apparently
of the most robust habits.  In such persons,  more especi-
ally if  they have  been descended from gouty ancestors,
and have led indolent 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.   It is known
by being accompanied with pains in the limbs, and by
being worst when in bed.   An itching  similar to that  I
formerly mentioned in the  anus, sometimes occurs in the
vagina  of women.  Dr. Lettsom has described it.  In all
the cases I have known of it, 1 believe it was derived from
the usu.J causes of the gout.
  VII. There .re many records in the annals of medicine
of the gout affecting the skin.  The erysipelas, gangrene 
THE GOUT*.                  159
and petechia; 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. Hutchin-
son,  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 Baltimore, about two years ago.
In the disposition of the gout to attack  exernal  parts, it
sometimes affects  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 the ligaments  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 effu-
sion  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 dis-
lodging  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 accurately 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 fever. Who can
 compare the symptoms and seats of both  diseases, and
 not  admit the unity of the remote and immediate causes
 of fever ?
   Thus I have 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 con-
 genial or acquired predispositions, 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 
160              OBSERVATIONS ON
seated in the  ligaments,  the blood-vessels, and viscera,
and left to themselves, produce  effects different in  their
nature, according to the parts in which they take place.
In the viscera they produce congestions composed of all
the component parts of the blood.   From the blood-ves-
sels  which terminate in hollow cavities and  in cellular
membrane, they produce those effusions of serum which
compose dropsies.  From the same vessels proceed those
effusions which produce on the skin erysipelas, tetters,
and all the different kinds of eruptions.  In the ligaments
they  produce an effusion of coagulable lymph, which by
stagnation is changed into what are called chalk-stones.
In the urinary organs they produce an effusion of parti-
cles of coagulable lymph or red blood, which,  under cer-
tain circumstances, are  changed into sand, gravel, and
stone.   All these observations are  liable to some excep-
tions.  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 un-
der 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 debilitated by the  usual remote causes of
that disease.   A bilious  constitution  of  the air so often
excites the peculiar symptoms of gout in persons predis-
posed 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.  It is because gouty people have
some parts  of their bodies  previously debilitated,  that
they often escape epidemic diseases.   Those weak  parts
invite, and fix disease to one or two places, and thus pre-
vent its being diffused throughout  the whole system.  Of
this Sir  John Pringle relates a striking instance.  While 
THE GOUT.                  161
the British army was in the north of Scotland, in the year
1746, the weather became suddenly very cold, in conse-
quence of which catarrhs became general among the sol-
diers, while many of the officers were affected only with
gout.  Here the obstructed perspiration which  fell upon
the breast in the soldiers, was translated to parts previous-
ly debilitated in the officers, and there excited the symp-
toms of what is called another disease.
   From a  review of the symptoms of the gout, the im-
propriety 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 yellow fe-
ver." In short, the  gout may be compared to a monarch
whose empire is  unlimited.  The whole  body crouches
before it.
   It has been said as a reflection  upon  our profession,
that physicians are  always  changing  their opinions re-
specting chronic diseases.  For a long  while they were
all classed  under the heads of nervous, or bilious. These
names  for many years afforded a sanctuary for the pro-
tection of fraud and error in medicine.  They have hap-
pily yielded 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 ex-
citement, invited by debility, and disposed to invade every
part of the body,  we conform our ideas to facts, and thus
simplify theory and practice in chronic diseases.
   I proceed now  to treat of the method of curei
   Let not the reader startle when I  mention curing the
gout.  It is not a sacred disease.   There will be no pro-
fanity 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 intermitting 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
   VOL. II.                 x 
16&              OBSERVATIONS ON
curing it. The venereal disease is more  egregiously 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 opin-
ion of the  gout being a curable' disease, is as humane
as it is just   It is calculated to prompt to early applica-
tion for medical aid, and to prevent that despair of  re-
lief which has contributed so  much to its duration, and
mortality.
   But does not the gout prevent  other diseases, and is it
not improper upon  this account to cure it?  I answer,
that it prevents other diseases,  as  the daily use  of drams
prevents the intermitting fever.  In doing this, it brings
on a  hundred  more incurable morbid  affections.  The
yellow fever carried off many chronic diseases in the year
1793, and yet who  would wish for, or admit such  a  re-
medy for a similar purpose ? The practice of encouraging,
and inviting what has been called a " friendly fit" of the
gout as a cure  for other diseases, resembles the practice
of school boys who swallow the stones of cherries to assist
their stomachs in digesting that delicate  fruit.   It is no
more necessary to  produce the gout in the  feet, in order
to it,  than it is to wait for, or encourage  abscesses or  na-
tural  haemorrhages, to cure a  fever.  The practice origi-
nated at a time when morbific matter was supposed to be
the cause of the gout, but it has  unfortunately'  continued
under the influence  of theories  which have placed the seat
of the disease in the solids.
   The  remedies for the gout naturally divide themselves
into the following heads.
   I. Such as  are proper in its approaching,  or form-
ing 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 symp-
toms  which are not accompanied  by general morbid  ac-
tion.   And
   V. Such as are proper to prevent its recurrence, or, in
other words, to eradicate it from the  system.
   1. The symptoms of an approaching fit of the gout are 
THE C0UT.                   163
great languor and dulness of body and mind, doziness,
giddiness, wakefulness, or sleep disturbed by vivid dreams,
a dryness, and sometimes a coldness, numbness, and prick-
ling, 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 appe-
tite.   The chemists have discovered another symptom of
an approaching fit of the gout, and that is, the presence
of the phosphoric acid in the urine.  The very sweats they
say of gouty patients tinge the syrup of violets of a red
colour from the predominance of this acid in  them.  The
symptoms which have been mentioned 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 and mias-
mata, and assent, from  this proof in addition 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 symptoms,
is  in a state  of morbid depression.   The disease is as yet
unformed, and may  easily be prevented by the loss of a
few ounces of blood, or,  if this remedy be objected to,
by a gentle dose of physic, and afterwards by bathing the
feet in warm water, by a few drops of the spirits of harts-
horn in a little sage or camomile tea, by a draught of wine
whey, or a  common dose of liquid laudanum, and, ac-
cording to a late Portuguese  physician, by taking a few
doses of  bark.
   It is worthy  of notice, that if these remedies are omit-
ted,  all the premonitory symptoms that have  been men-
tioned 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 viscera.
   I shall begin this head by repudiating the  notion of a
specific cure for the gout existing in  any single 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 «t- 
164              OBSERVATIONS ON
tempts to cure  the whooping cough by spells,  or tricks
of legerdemain.
   The first remedy that I shall mention  for  reducing
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,
near forty 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 medi-
cine 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 preternatural 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 favour of
bleeding  in a pleurisy applies in the present instance, for
they both depend  upon the same kind of morbid action
in the  blood-vessels.   Bleeding 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 objection to the lancet
has been  urged by Dr. Sydenham, who was misled in his
opinion of it, by his theory of the disease  being the off-
spring of morbific matter.  The assertion  is unfounded,
for bleeding in a fit of the gout has no such effect, pro-
vided the remedies to be mentioned hereafter are used to
prevent it.  But a fit of the gout is not singular in its dis-
position to recur after being once cured.   The rheuma-
tism, the pleurisy, and the intermitting fever  are all equally
disposed  to return when persons  are exposed to their
remote and exciting causes, and yet we do  not upon this
account consider 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 
THE GOUT.                  165
being the case.  It frequently makes its first attack upon
the head, lungs, kidneys, stomach, 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 cor-
dials 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 the 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 bowels, in the winter of *795, and major
Butler derived the same benefit from  the loss  of near 30
ounces,  in an attack of the 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 striking 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.   During
his old  age, he was bled every three months.
   I have said, in the history of the symptoms of the gout,
that it sometimes appeared in the form of a hectic fever.
I have prescribed occasional bleedings in a case of this
kind accompanied with 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 the pulse, as described in another place,*
should govern the use of the lancet in this disease. Bleed-
ing is required as much in its depressed, as in its full and
chorded state.  Colonel Miles's pulse, at the time he suf-
fered from the gout in his bowels, was scarcely percepti-
ble.  It did not rise till after a  second or third bleeding.
   Some advantage may be derived from examining the
blood.  I have once known it to be dissolved;  but for the
* Defence of Blood-letting, vol. IV. 
166              observations on
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 bleeding in
the diseases of old people in a former volume, apply with
equal force to its use in the gout. 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 inflammatory 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, cupping 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 appears in a  feeble
state in the rest of the arterial system.
  The advantages of bleeding in  the gout, when perform-
ed 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 effusion of lymph or blood from previous
morbid action in the kidneys.   If this disease were nar-
rowly 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 Philadelphia 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 similar 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 pre-
disposition to frequent returns of the disease.
  4. It shortens the duration of a fit of gout, by throwing 
THE GOUT.  '                167
it, not into the feet, but out of the system, and thus pre-
vents a patient's lying  upon his back for two or three
months with a writhing face, scolding a wife and family
of children, and sometimes  cursing  every servant  that
comes near enough to endanger the touch of an inflamed
limb.  Besides preventing ull this  parade of pain  and
peevishness,  it frequently, when assisted with other re-
medies to be  mentioned presently, restores a  man to his
business and  society in  two or three days : a circumstance
this of great importance in the  public as wtll as private
pursuits of men; for who has not read of the most interest-
ing affairs of nations being neglected 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 pre-
ferred for this purpose,  but castor oil,  cream of tartar,
sena, jalap, rhubarb, and calomel, may all be used  with
equal safety and advantage.  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 the gout in Dr.
 Brown.
   3. Vomits may be given in all those cases where bleed-
 ing is objected to, or where the pulse is only  moderately
 active.   Mr. Small, in an excellent paper upon the gout,
 in the  6th volume of  the Medical Observations and In-
 quiries, p. 205,  containing  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  indi-
 cated a morbid state of the liver, for it was always a dark
 greenish bile, which was  insoluble in water.   A British
 lieutenant, whose misfortunes reduced him to the neces-
 sity of accepting a bed in the poor-house of this city, in-
 formed  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 eme-
 tic.   Dr. Pye adds his  testimony to  those  which have
  been given in iavour of vomits, and  says further, that 
168
OBSERVATIONS ON
they do most service when they discharge an acid humour
from the stomach.  They appear to act in part by equal-
izing the divided excitement of the system, and  in part
by discharging the contents of the gall-bladder and sto-
mach,  vitiated by the previous debility of those organs.
Care should be  taken not to exhibit  this remedy where
the gout attacks the stomach with symptoms  of  inflam-
mation, or where it has a tendency to fix itself upon the
brain.
   4. Nitre may be given with advantage in cases of in-
flammatory action, where the stomach is not affected.
   5. A fifth remedy is  eool or cold air.  This is as safe
and as  useful in the gout as  in any other inflammatory
state of fever.   The affected limbs 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 removed 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.
Dr. Kinlake has lately published a treatise in favour of the
the application of cold water to the limbs of gouty patients.
To be effectual, he  says it should be applied by means of
wet cloths for eight and forty hours,  and  that frictions
should  be used afterwards  to the parts affected.   This
practice has had its advocates and its opponents.   Where
no internal predisposition exists from debility, it is I be-
lieve as safe as in a common rheumatism,  but I would
by no means advise it to persons who had been previous-
ly affected  with gout in the stomach, bowels, breast or
brain.   Perhaps it would be best in most cases to prefer
cool, or cold air, to cold water.   The safety and advan-
tages of both the modes of applying cold to the affected
limbs which have been mentioned, show the improprie-

       * Medical Observations and Inquiries, vol. VI. p. 201. 
THE GOUT.                   169
ty of the common 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 perspiration.
   7. Abstinence from wine, spirits, and malt liquors,  also
from such aliments as afford much nourishment or stim-
ulus, should be carefully enjoined.  Sago, panada, tapioca,
diluted  milk with bread,  and the  pulp of apples, sum-
mer fruits, tea, coffee, weak chocolate, and bread soaked
in chicken water  or beef tea,  should constitute the prin-
cipal diet of patients in this state of the gout.
   8. Blisters are  an  invaluable remedy in this disease,
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 wrists in
general gout, and to the neck and sides, when it attacks
the head or breast.  A strangury from the gout is no ob-
jection  to their use. So far from increasing this complaint,
Dr. Clark and Dr. Whytt inform us, that they remove
it.*  But the  principal advantage of blisters is  derived
from their collecting and concentrating scattered and pain-
ful 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 his feet, was suddenly cured
by hearing the cry of fire  on board his ship.   This  fact
was communicated  to me  by a gentleman  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,  era-
dicated the disease from  the  system so completely, as
ever afterwards to prevent its return.
   Thus  have I enumerated the remedies which are pro-
per in  the gout when it affects the  blood-vessels and vis-
 cera 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 whe-
          * Physical and Literary Essays, vol. III. p. 469.
    VOL. II.                 Y 
170              OBSERVATIONS ON
 ther they produce local pain, or general convulsion, pro-
 vided they are of a violent nature.
   There are some remedies under this head  of a doubt-
 ful nature, on which I shall make a few observations.
   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 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
 medicine to be trusted in this state of the  disease is the
 Seneka snake-root.  It promotes all the secretions and
 excretions,  and exerts but a feeble stimulus upon the ar-
 terial system.
   Many different preparations of opium have been advis-
 ed in this state of the gout. They are all hurtful 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 suc-
 cess.   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 blister, and generally removed it  by that
 means in two or three days.  I have imitated this prac-
 tice in several 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 ap-
 plied  to  gouty limbs with advantage.   The moxa de-
 scribed and used  by  Sir William Temple,  which is
 nothing but culinary fire, has often not 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 fall-
 ing upon the head produces coma, or symptoms of apo-
 plexy.  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.  Blisters and cata-
 plsams of mustard, had  been previously used to different
parts of his body, but without the least effect.  In  cases
                 * Defence of Blood-letting. 
                     THE GOUT.                  171

of moderate pain, where a blister has been objected to,
I have seen a cabbage leaf afford considerable relief.  It
produces 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 liniments 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 the patient exercises his lower limbs by
walking after a fit of the gout, the better.   " I made it a
constant rule  (says Mr. Small)  to walk abroad  as  soon
as the inflammatory state of the gout was past, and though
by so doing,  I often suffered great pain, I am well con-
vinced  that the free use I now enjoy of my limbs is chief-
ly 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 indolence and
fear of  pain,  than to the genuine effects of the  gout."*
Sir William Temple confirms the propriety of Mr. Small's
opinion and practice,  by an account of an old man who
obviated a fit of the gout as often as he  felt it coming in
his feet, by walking in the  open air,  and afterwards 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 recommended 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  concludes the
history of his own case in the following words: " I fa-
voured  it [viz. the swelling  in my feet]  all this while
more than I needed, upon the common opinion, that walk-
ing 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 da/
the pain left me,  the swelling might have left me too in a
much less time."f

  * Medical Observations and Inquiries,  vol. vi. p. 220.
  f Kssav upon the Cure of the Gout by moxa, vol. i. folio  edition, p.
141 and 143. 
172              OBSERVATIONS ON

  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 the 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 adop-
tion 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  climate,  the season
of the year, the constitution of the atmosphere, and the
nature of the prevailing epidemic, should be carefully at-
tended to by a physician.  But his principal dependence
should be placed upon the state  of the pulse.  If it do
not discover the marks which  indicate bleeding formerly
referred  to, but is weak, quick, and soft,  the remedies
should be such as are calculated  to  produce a more vi-
gorous and equable action in the blood-vessels 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 hav-
ing 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 check-
ed a vomiting,  from the gout, which seemed  to be the
last symptom of his departing life.   If porter fail of liv-
ing relief,                                        6
  4.  Ardent spirits should be given, either alone,  or in
the form of grog or toddy. Cases have occurred in which
a pint of brandy has been taken in the course of an hour
with advantage. Great benefit has sometimes been found 
THE GOUT.                   173
from Dr. Warner's tincture, in this state of the gout. As
these observations 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 brandy to the in-
gredients, 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 in-
tended effects, in two or  three hours.   If all the different
forms of ardent  spirits which have been mentioned fail of
giving relief,
  5. From 30 drops to a tea spoon full of ether 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, Vir-
ginia snake-root, cloves,  and mace in the form of teas have
all been useful in this state of the gout.   Dr. Heberden
prefers  them to wine and spirits,  from their being  more
permanent in their effects.
  All  these remedies are indicated in  a more especial
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 clyster.  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
clysters injected daily for two or three weeks.
   8. Where the gout produces spasmodic or convulsive
motions, the oil of amber may be given with  advantage.
1 once saw it remove for a while a convulsive cough from
the gout. 
174
OBSERVATIONS ON
   9. In  cases where  the stomach  will bear the bark,  it
should be given in large and frequent doses.  It does the
same service in this state of gout, that it does in the slow,
or low states of fever from any other cause.  Where the
gout appears in the form of an intermittent, the bark af-
fords the same relief that it does in the same disease from
autumnal exhalations.  Mr.  Small  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 stomach, and subsequent heat.
In this the gout bears a  resemblance to an irregular in-
termittent, 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 exciting
a regular and healthy  action in the sanguiferous 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 dipped in  warm water.  In case
of a failure of all the above remedies,
   11. A salivation should be excited as speedily as pos-
sible, b\T means of mercury.   Dr. Cheyne 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 dif-
fuses it equally through every part of the body.
   12. Besides  these  internal  remedies,  frictions with
brandy, and volatile liniment,  should be used to the sto-
mach and bowels.   Blisters should be applied to parts in
which congestion or pain is seated, and stimulating cata-
plasms should be applied 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  nervous  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.
* Medical Observations and Inquiries, vol. vi. p. 220. 
THE GOUT.                  175
  It is agreeable in medical  researches to be under the
direction of  principles.   They render unnecessary,  in
many instances, the slow and expensive operations of ex-
perience, and thus multiply knowledge, by lessening la-
bour.  The science of navigation has rested  upon this
basis, since the discovery of the loadstone.  A mariner
who has navigated 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 same means cure
all the diseases of the human  body, for their causes are
the same.  Judgment  is required, only in  accommo-
dating 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 mode-
rate talents.
  IV. Were I to enumerate all the local symptoms  of
gout which occur without fever,  and the remedies that
are  proper to relieve them, I should be led into a tedious
digression.  The reader must consult 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 delivered, will
enable us to understand the reason why a disease which
properly  belongs to the whole system 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 sound parts are propagated to such
as are weak,  where  they excite those morbid actions we
call disease.
  The head-ach is a distressing symptom of  the gout.
It yields to depleting or tonic  remedies, according to the
degree of morbid action which accompanies it.  I  have
heard an instance of an old man, who was cured of an ob-
stinate 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  cars, are all proper remedies, 
176              OBSERVATIONS ON
and  should be used together,  or in  succession, as the
nature of the disease may require.  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, particular-
ly 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 many other  tonic
remedies, had been taken to no purpose.
   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 many abstract the gouty
action from the eye.
   Dull but constant pains in the limbs yield to frictions,
volatile liniments,  muslin and woollen worn next  to the
skin, electricity, a salivation, and the warm and cold bath.
A gentleman who was  afflicted 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. A cerecloth or taffety by touching
the flesh at more,  or at all points  has been found to give
great relief.  Rubbing the limbs with castor oil, and wrap-
ping them up in hot sand have  likewise been useful.  In
obstinate  sciatic pains, with fever or inflammation, Dr.
Pitcairn's remedy, published by Dr. Cheyne, has perform-
ed 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 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 
THE GOUT.                  177
heard  of its being checked,  after continuing  for  many
years, by the patient eating 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 fulness and tension
in the pulse.  After these are  reduced 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 constant 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 disease.   It is preferable to spiced wine and
spirits, inasmuch as it acts quicker, and leaves no dispo-
sition to contract a love for it when it is not required  to
ease pain.
   The pain in  the rectum, which has been described,
yields to the common remedies for the piles. Cold water
applied to the part, generally gives immediate relief.
   For a preternatural secretion and excretion of bile gen-
tle 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 ap-
plied to the  part affected.   Dr. Lettsom recommends fo-
menting the  part with a  decoction of poppy heads and
hemlock, and advises lenient purges and a vegetable diet
as a radical cure for the disease.*
   For the itching  in the vagina I  have found a solution
of the sugar of led in water to be an excellent  palliative
application.   Dr.  Lettsom recommends as a cure for it,
the use of bark indelicate habits, and occasional bleeding,
with a light  and moderate diet if  it occur about the time
of the cessation  of the menses.
   Obstinate cutaneous eruptions,  which are the effects  of
gout, have been cured by gentle physic, a  suitable diet,
issues, and applications of the unguentum citrinum to the
parts affected.
                 * Medical Memoirs, vol. Ill
   VOL. II.                 Z 
178'              OBSERVATIONS ON
   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 consequence to in-
quire, before we attempt to cure them, whether they have
not succeeded general gout, and thereby relieved the sys-
tem 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 ex-
changed for a general one, should be obviated by reme-
dies 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 considera-
tion.  Before I  enter upon this head, I  shall  premise,
that I do not admit of the seeds of the gout remaining in
the body to be eliminated by art after a complete termi-
nation 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
or bark.  A predisposition only remains in the system to
a return of the gout, from its usual remote 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
principles have  been discarded, from which they  were
derived.
   I have known several instances in which art, and I have
heard and read of others in which  accidental  suffering
from abstinence, pain, and terror  have  been the happy
means of overcoming a predisposition to the gout.  A
gentleman from one of the West-India islands,  who had
been  for many years afflicted 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, accidentally
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 in- 
THE GOUT.                  17$
timately, who was radically cured of a gout with which
he had been long afflicted, by the extreme bodily pain he
suffered innocently from torture in the canton of Berne.
He lived to be an old man,  and ever afterwards enjoyed
good health.* The following letter from my brother con-
tains the history of  a case in which terror suddenly eradi-
cated the gout from the system.

                           " Reading, July 27th, 1797.
il 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 Fetfaer, the person cured, is now alive, a house-
holder 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 swol-
len  and inflamed; the fits lasted long, and were excruci-
ating.  In particular, the last fit in 1785 was so severe,
as to induce an apprehension, that it would  inevitably
carry him off, when he was suddenly relieved by the fol-
lowing accident.
  44 As he lay in a small back room adjoining the yard,
it happened that one of his sons, in turning a wagon  and
horses, drove the tongue of the wagon with such force
against the window,  near which the old man lay  stretched
on a bed, as to beat in the sash of the  window,  and to
scatter the pieces of broken glass all about hinu  To such
a degree  was he alarmed  by the noise and  violence,  that
he instantly leaped out of bed, forgot that he had ever used
crutches, and eagerly inquired what was the matter.   His
wife, hearing the uproar,  ran into the room, where, to her
astonishment, she found her husband on his feet, bawling
against the author of the mischief, with the most passion-
ate  vehemence. From that moment, he has been entirely
exempt from the gout, has never had the slightest touch
             * Observat Chirurg. I. Cent. Obs. 79. 
180             OBSERVATIONS ON
of it, and now enjoys perfect health, has a good appetite,
and says he was never heartier in his life.   This is pro-
bably the more remarkable, when 1 add, that he has al-
ways been used to the hard work of a 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, occasionally
indulging in a glass of wine, after the manner of the Ger-
man farmers, but not to excess.
   44 To you, who have been  long accustomed to explore
diseases, I leave the  task of developing the principles, on
which this mysterious restoration from the lowest decre-
pitude and  bodily wretchedness,  to a state  of perfect
health, has been accomplished.  I well know that tooth-
achs, head-achs, hiccoughs, &c. are often removed by the
sudden impression of fear,  and that they return again.
But to see a debilitated gouty frame instantly restored to
vigour; to see the whole system in a moment, as it were,
undergo a perfect and entire change, and the most invet-
erate and incurable disease radically expelled, is surely a
different thing, and must be  acknowledged a very singu-
lar and marvellous event.  If an old man languishing under
disease and infirmity,  had died  of mere fright, nobody
would have been surprised at it; but that he should be
absolutely cured,  and his constitution renovated by it,  is
 a most extraordinary fact, which,  while 1 am compelled
 to believe by unexceptionable evidence, I am totally at a
 loss to  account for.
                         44 I am your sincerely
                             44 affectionate brother,
                            .   44 JACOB  RUSH."
    These facts, and  many similar  ones which might be
 mentioned, afford ample encouragement  to  proceed  in
 enumerating  the  means which  are proper to prevent the
 recurrence of the gout,  or, in other words,  to eradicate
 it from the system.   Besides these cases of radical cures,
 it has often been suspended, from two to thirty years by
 the power of medicine.
    V. I shall first mention the  means of preventing the
 return of that state of the disease which  is accompanied
 with violent  action, and afterwards take notice of the 
THE GOUT.
181
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 consists in avoiding all the
remote,  exciting, and  predisposing  causes of the  gout
which have been  mentioned.  I shall  say a  few words
upon 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 be regulated in its degrees
by the age, habits, and constitution of the patient. A diet
consisting wholly of milk, vegetables, and simple water,
has been found necessary to prevent the recurrence of the
gout in  some cases. It was cured in  lord Nelson by two
years' abstinence  from wine and animal food,  during
which time  he lived wholly upon milk  and  vegetables.
But,  in general, fish,  eggs, the white meats and weak
broths may be taken in  small quantities once 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 pre-
vents dyspepsia from a  diet consisting chiefly of vegeta-
bles.  The low and acid wines  should  be avoided, but
weak Madeira or  sherry wine and water, or small  beer,
may be drunken at meals.   The latter liquor was the fa-
vourite  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 contri-
buted 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 diminution of aliment, gentle pur-
ges 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 carried to its
utmost  extent, induced fits of the gout, and precipitated
death.  In such persons, the abstractions from their usual
diet should be small, and our dependence should be pla-
ced upon other means to prevent a return of the disease. 
182
OBSERVATIONS ON
  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 indo-
lence  and bodily activity meet in a point.   They  both
induce debility, which predisposes to a recurrence of a fit
of the gout.  Riding in a carriage, and on horseback, are
less proper  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 the 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 point of light, when we consider, how
much the operation of the remote and exciting causes of
the gout which act more or less upon persons in the hum-
blest 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 the  skin in
winter, and muslin in summer, in order to keep  up a
steady and  uniform perspiration.  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 gout in his stomach and
bowels which had nearly 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 understand- 
1J1.&  liUuTl
183
ings 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 system, than those which
are of a social and domestic nature; hence  generals and
statesmen are so often afflicted with the gout, and  that
too, as was hinted in another place, in moments the most
critical and important to the welfare of  a nation.  The
combination  of the exercises  of the understanding, and
the passion of avarice in gaming, have often produced an
attack of this disease.
   These facts show the necessity of gouty people subject-
ing their minds, with all their operations, to the govern-
ment of reason and religion.   The understanding should
be exercised  only upon light and pleasant subjects.   No
study should ever be pursued 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 efficacy
in all chronic diseases.
   5. The  venereal  appetite  should be  indulged  with
moderation.  And,
   6. Costiveness should be prevented by all persons 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,  4' Sulphur
is one of the best remedies in the intervals of the gout.
In the  whole extent of the materia medica, I know not a
more 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 wno had been accustom-
ed to have them once or twice a year.  Rhubarb in small
quantities chewed, or in the form of pills, may be taken to
obviate costiveness, 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
  * Essay on the Nature and True Method of Treating the Cout, p. 36. 
184              OBSERVATIONS ON
 weeks, lived in health, for four years after, without any
 symptom of it."*
   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 fe-
 brile 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 habi-
 tual visits to the system.  The late Dr.  Gregory had been
 accustomed to  an attack of the gout every spring.  Two
 seasons passed away 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 after-
 wards  he died suddenly  of  an apoplexy.  The loss of
 a  few ounces of blood at the usual time in which the
 gout affected him,  would probably have protracted his
 life for many years.   In the year 1796, in visiting a pa-
 tient, I was  accidentally introduced into a room where a
 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 with
 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 salu-
 tary nature of a fit of the gout, and therefore hugged his
 chains.   After explaining the reason of my prescriptions,
 he informed 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 fe-
ver, previously  to the time of the annual visit of his gout.
   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
                       * Page 20. 
THE COUT.                  185
\ few words.  A man who has had one fit of it, should con-
  * sider 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 will probably prevent, during his life, the re-ex-
   cite mVit of  the disease.
     Are  S^sues 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 unpleasant a remedy can seldom be
   necessary.   \
     Are  bitters \proper to prevent a return of this state of
   gout?  It will oe  a sufficient  answer to  this question to
   mention, that |he duke of Portland's powder,  which is
   composed of fitter ingredients,  excited  a  fatal gout in
   many people wfio 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 system, with-
   out the aid of more or  less of the remedies 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 repeated 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 cr  sherry wine, or
   weak 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  bowels.   Long intervals  between meals
   should  be carefully avoided.  The  stomach, when over-
   stretched or empty, is always alike predisposed to disease.
     vol. ii.                a a 
186              OBSERVATIONS ON
 There are cases  in which the evils of  inanition 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  different preparations of iron
 in large doses, in chronic diseases, and in that state of de-
 bility which disposes to them. A lady of a weak constitu-
 tion informed Dr. Cheyne, that she once asked Dr. Sy-
 denham how long she might safely take steel.  His answer
 was, that 44 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 pa-
 tients will have the benefit of country air.
   3.  The habitual use of the volatile tincture of gum guia-
 cum, and of other  cordial and gently stimulating 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 excite*
 ment into action. It moreover acts agreeably upon the
 nervous 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 mi^ht probably be: used with  advantage  for the
 same purpose. Aurelian speaks of certain remedies for
 the gout which he calls '4 annalia."f  The above medi-
cines belong  to this class.  To be effectual, they should
be persisted in, not for one year only, but for many years.
  4. Warmth, uniformly applied, by means  of suitable
 dresses, and sitting rooms, to every part of the body.
  5  The warm bath in winter, and the temperate or cold
bath in summer.
  6. Exercise.  This may be in a carriage, or on horse-
back.  The viscera being debilitated in  this state of pre-
 * Essay on the Nature and True Method of Treating the Gout p 69
  f Morborum Cbronicorum. Lib. v. Cap. 2.                'v'   ' 
THE COUT.
187
disposition to the gout,  are  strengthened in a peculiar
manner by the gentle motion of a horse.  Where this
or other modes of passive exercise cannot be had, fric-
tions to the limbs and body should be used every day.
   7. Costiveness should be avoided by taking occasion-
ally one or two table spoonsfull of Dr. Warner'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. If this medicine be
ineffectual for opening the bowels, rhubarb may be taken
in the manner formerly mentioned.
   8. The understanding and passions should be constant-
ly employed  in agreeable studies and pursuits.   Fatigue
of mind and  body should be carefully avoided.
   9. A warm climate often protracts life in persons sub-
ject 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 warmer sun, the pure air of the Me-
diterranean, and sir 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 native 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 ad-
ministered 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.   So-
lomon 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 na-
ture.  There is a time to eat meat, and there is a time
to abstain from it.   There is a time  to give tonic medi-
cines,  and a  time  to refrain from them.  In a word, the
cure of the goui depends wholly upon two things, viz,
proper remedies, in their proper times, and places. 
188
OBSERVATIONS ON
   I shall take leave of this disease, by comparing it to a
 deep and dreary cave in  a new country, in which  kro-
 cious beasts and venomous reptiles, with numerous ghosts
 and hobgoblins, are said  to reside. The neighbours point
 at the entrance of  this cave with  horror,  and tell of the
 many ravages that have been committed  upon  their do-
 mestic  animals, by the  cruel tenants which  inhabit it.
 At length a school-boy,  careless  of his  safety, ventures
 to enter 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 surface 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.
   The following is an epitome of the opinions  upon the
 cause and cure of the gout, which are contained in the
preceding observations, most of which are  opposed by
modern systems of medicine.
   1.  The gout does not  depend upon a specific action in
the blood-vessels,  any  more than  it Goes upon  a specific
morbid  matter
   2.  It is not seated exclusively in the joints,  nor in the
limbs.
   3.  It is not induced exclusively by ardent nor ferment-
ed liquors,  nor by intemperance in eating,  but by every
other cause that induces  chronic debility  trom  action or
abstraction; also by the causes that induce nearly all  other
diseases.
   4.  It is more common in  the female than in the  male
sex, and that in the ratio  of ten to one.
   5.  It differs from the rheumatism, only in its seats and
grades.
   6.  There  is no specific remedy for it.  The numerous
and pompous specifics that have been recommended for
its cure, are melancholy records of the imperfection and
obliquity of the human understanding.
   7.  It is, notwithstanding,  subject to the power of me-
dicine;  and  may be cured by the  application of the same 
THE COUT,                   189
principles and remedies to it, which cure other acute and
chronic diseases.
   8.  It is not necessary, in order to prevent or  cure the
gout, to translate or to fix it in the limbs.   It should be
chased out of the system.
   9.  It is not a healthy, nor a friendly disease.
   10.  It does not cure other diseases. It suspends weak
diseases only, when it attacks with great force. But while
it suspends weak diseases, it aggravates  all such as are of
a violent nature. 
/
• 
   OBSERVATIONS






        UPON






THE CAISE AND CURE






        OF THE






   HYIROPHOBJA. 
 
OBSERVATIONS,  &c.
   IN entering upon the consideration of this formidable
 disease, I feel  myself under an involuntary impression,
 somewhat like that which was produced by the order the
 king of Syria gave to his captains when he was conduct-
 ing them to battle:  44 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 horror ex-
 cited by it, both in patients and their friends, led me with
 great solicitude to investigate its nature. I have at length
 satisfied myself  with a theory 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 hydrophobia 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 contusion, by the teeth of the rabid animal,
 without the effusion of a single drop  of red blood, excited
 the disease.   Happily for mankind,  it cannot be commu-
 nicated by blood or saliva falling upon sound parts of the
 body.   In Maryland, the negroes eat with 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 incon-
 venience by a whole family, on the  very day in which she
 was affected by this disease, and which killed her in a few
                    * II. Chron. xviii. 30.       m
    VOL. II.                 B b 
194              OBSERVATIONS  ON
hours.  Dr. Baumgarten  confirms these facts by saying
that " the flesh and milk of rabid animals have been eaten
with perfect impunity."*
   In the  following  observations I shall confine myself
chiefly to  the treatment of the hydrophobia  which arises
from the bite of a rabid animal, but I shall add in this
place a short account of all its other causes.
   2. Cold night air.  Dr. Arthaud, late president of the
society of Philadelphians in St. Domingo,  has published
several cases  in which it was produced  in negroes by
sleeping all night in the open air.
   3. A wound in a tendinous part.
   4. Putrid and impure animal food.
   5. Worms.
   6. Eating beech nuts.
   7. Great thirst.
   8. Exposure to intense heat.
   9. Drinking cold water when the body was very much
heated.
   10. A fall.
   11. Fear.
   12. Hysteria.
   13. Epilepsy.
   14. Tetanus.
   15. Hydrocephalus.  Of the presence of hydrophobia
in the hydrocephalic state of fever, there have been several
instances in Philadelphia.
   16. An inflammation of the stomach.
   17. The dysentery.
   18. The typhus fever. Dr. Trotter mentions the hydro-
phobia as  a symptom  which frequently occurred in  the
typhus state of fever in the British navy.f
   19. It is taken notice of likewise in a putrid fever by
Dr. Coste; J and Dr. Griffitts observed it in a high degree
in a young lady who died of the yellow fever, in 1793.
   20. The bite of an angry, but not a diseased animal.
   21. An involuntary association of ideas.
   Cases of spontaneous hydrophobia from  all the above
  * Medical Commentaries, Philadelphia edition, vol. 7. p. 409
  t Medicina Nautica, p. 301,
  X Medical Commentaries, Dobson's edition, vol. II. p. 476. 
THE HYDROPHOBIA.
195
causes are to be met with in practical writers, and of most
of them in M. Audry's learned work, entitled, 44 Recher-
ches sur la Rage."
   The dread of water, from which this disease derives
its name, has five distinct grades. 1. It cannot be drunken.
2. It cannot be touched. 3.  The sound of it pouring
from one vessel to another, 4. the sight of it, and 5. even
the naming of it, cannot be borne, without exciting con-
vulsions.   But this symptom is not a universal one. Dr.
Mead  mentions three cases in  which there  was no dread
of water, in persons  who received the disease from the
bite of a rabid animal.  It is unfortunate for this disease,
as well as many others,  that a single symptom should
impose names upon them.  In the present instance  it has
done great harm, by fixing the attention of physicians so
exclusively upon the  dread of  water which occurs in it,
that they have in a great measure overlooked every other
circumstance which belongs to the disease.   The theory
of the hydrophobia, which an examination of its causes,
symptoms,  and accidental cures, with all the industry  I
was capable of,  has led me to adopt, is, that  it is a malig-
nant state of fever.  My reasons for this opinion are as
follow:
   1. The disease in all rabid animals is a fever.  This is
obvious in dogs who are  most subject to it.  It is induced
in them by the usual causes of fever, such  as scanty or
putrid aliment,* extreme cold, and the sudden  action of
heat upon their  bodies. Proofs of its being derived from
each of the above causes are to be met widi in most of
the authors who have written upon it.  The animal matters
which are  rendered morbid by the action of the above
causes upon them, are determined to the saliva,  in which
a change seems  to be induced, similar to that which takes
place in the perspirable matter of the human species from
the operations 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
  * " Animal food, in a state of putridity, is amongst the most frequent
causes of canine madness."
  " Canine madness rhiefly arises from the excessive number of ill-kept
and ill-fed dogs."
                         Young s Annals, vol. \\ II. p. 561. 
196
OBSERVATIONS ON
 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 occasion-
 ally among dogs at those times in which malignant fevers
 are epidemic.  This will not surprise those persons who
 have been accustomed to observe the prevalence of the
 influenza and bilious  fevers among other domestic ani-
 mals at a time when they are epidemic among the human
 species.
   3. Dogs, when they are  said to be mad, exhibit the
 usual syrmptoms of fever, such as a want of appetite, great
 heat,  a dull,  fierce, red, or watery  eye, indisposition to
 motion, sleepiness, delirium, and madness.   The symp-
 tom of madness is far from being universal,  and hence
 many dogs are diseased and die with this malignant fever,
 that are inoffensive, and instead of biting, continue to fawn
 upon their masters.  Nor is the disposition of the fever
 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 bit-
 ten 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 takes place in common malignant fe-
 vers.   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,
 Mean, Fothergill, Plummer, Arnold, 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 accompanied with
 a warm skin diffused all over the body, difficulty of breath
 ing,  sighing, restlessness, hiccup, giddiness,  head-ach
 delirium, coma, false vision, dilatation of the pupils, dul' 
THE HYDROPHOBIA.              197
ness of sight, blindness, glandular swellings, heat of urine,
priapism, palpitation 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 sup-
posed absence of fever is the effect of stimulus acting upon
the blood-vessels with so  much force as to suspend mor-
bid 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 cha-
racter to the hydrophobia; but the former  symptom, it
has been often seen, occurs in diseases from  other causes,
and the latter has been frequently observed in the yellow
fever.   It is no more extraordinary that a  fever excited
by  the bite a rabid animal should excite a dread of water,
than that fevers from other causes  should produce aver-
sion from certain aliments, from light, and  from sounds
of  all kinds;  nor is it any more  a departure  from the
known laws 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 spe-
cific manner.
  2. The hydrophobia partakes of the character of a ma-
lignant 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 itself   in intervals from eight to
twenty days, and  the  plague and  yellow  fever from  the
moment in which the  miasmata are inhaled, to nearly the
same distance 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 dis-
ease derived from another cause.   Such a person is pre-
disposed in common with other people to all the diseases 
198              OBSERVATIONS ON
of which the hydrophobia is a symptom.   The recollec-
tion 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 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 uncon-
nected 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 infec-
tions, 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 fe-
vers.   In Mr. Bellamy, the gentleman whose case is so
minutely related by Dr. Fothergill, the blood discovered
with " slight traces of size,  serum  remarkably yellowf*
It was  uncommonly 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 convulsions the  next day.  He had
been bitten by a mad dog on  one of his  temples, three
weeks  before  he  discovered  any signs of indisposition.
There  are several  other cases upon record,  of the blood
exhibiting, in this disease,  the same  appearances as in
common malignant and inflammatory fevers.
  6. The hydrophobia accords  exactly with malignant
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 malignant fevers.
  5. The body, after death from the  hydrophobia, pu-
trefies 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 hv- 
THE HYDROPHOBIA.
199
 drophobia, exhibit the  same  appearances which are ob-
 served on the bodies  of  persons who have perished of
 malignant fevers. These appearances, according to Mor-
 gagni 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
 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 aware that two cases of death
• from hydrophobia are related  by Dr. Vaughan, in which
 no appearance of disease was  discovered by dissection in
 any part of the body. Similar appearances have occasion-
 ally 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 inflammation, for it is  one of its pri-
 mary effects only, and hence, as was before remarked, it
 does  not take place in many instances in malignant fevers,
 until  the arteries are so far relaxed by two or three bleed-
 ings, 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 inflamma-
 tion.f  The existence of this grade of action in the arte-
 ries 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 prin-
 ciples 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.
    I.  The first remedy under  the first general head is,  ab-
   • Bibliotheque Choisie de Medecine, tome XV. p. 210.
   f In the 6th volume of the Medical Observations and Inquiries, there
 is an account of the dissection of a person who had been destroyed by tak-
 ing opium.  " No morbid appearance (says Mr. Whateley, the surgeon
 who opened the body) was found in any part of the body, except that the
 villious coat of the stomach was very slightly inflamed."  The stimulus
 of the opium in this case either 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. 
200
OBSERVATIONS ON
 stracting or destroying the virus, by cutting or burning
 out the wounded part, or by long and frequent effusions
 of water upon it, agreeably to the advice of Dr. Hay garth,
 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 poi-
 son has contaminated the blood.  The wound should be
 kept open and running for several months.  In this way
 a servant girl, who was bitten  by the  same cat that bit
 Mr. Bellamy, is supposed  by Dr. Fothergill to have es-
 caped the disease.  Dr. Weston of Jamaica believes that
'he prevented the disease by the same means, in two in-
 stances. Perhaps an advantage would arise from exciting
 a good deal of inflammation in  the wound.  We observe
 after inoculation, that the more  inflamed the puncture be-
 comes,  and  the  greater the discharge  from it, the less
 fever and eruption follow in the small-pox.  The inflam-
 mation in  both  cases prevents the absorption of the poi-
 son, by abstracting the usual excitement or capacity of
 action in the lymphatics, and concentrating it in the blood-
 vessels.
   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 stim-
 ulus 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 the remedies prescribed
 for him.
   Mercury has been used in order to prevent the disease.
 There are many well-attested cases upon record,  of per-
 sons who  have been salivated after being bitten bv mad
 animals,  in whom the disease  did not  show itself  but
 there an equal number of cases to be met with, in  which
 a salivation did 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 
                THE HYDROPHOBIA.              201

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 salivary 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, medicines
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 ac-
companying the bite of the animal.
  1. The animal may have been angry,  but not diseased
with a malignant fever, such as I have described.
  2. He may  have been  diseased,  but not to such a de-
gree as to have rendered  his saliva infectious.
  3. The  saliva,  when  infectious,  may have been so
washed off in passing through the patient's clothes, as
not to have entered the wound made in the flesh.  And
  4. There may have been no predisposition in the pa-
tient to receive the fever.  This is often observed in per-
sons exposed to the plague, yellow fever, small-pox, and
to the infection of the itch, and the venereal disease.
  II.  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 excep-
tions.  As soon as the disease discovers itself, whether
by pain or inflammation in the wounded part,  or by any
of the symptoms  formerly mentioned, the  first remedy
indicated is blood-letting.  All the facts which have been
mentioned, relative to its cause, symptoms,  and the ap-
pearances 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 additional argument in
favour of that remedy. To be effectual, it should be used
in  the  most liberal  manner.   The  loss of  100 to 200
ounces of blood will probably be  necessary 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 be
imposed upon by the absence oi frequency in it, in the
  vol. n.                c c 
202              OBSERVATIONS ON
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 following cases.
  Dr. Nugent cured a woman by two copious bleedings,
and afterwards by the use of sweating and cordial medi-
cines.
  Mr. Wrightson was  encouraged by Dr. Nugent's suc-
cess 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 hereafter, j*
  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, 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.  Hartley, by the loss of 120
ounces of blood.
  Dr. Tilton cured this disease in a  woman in the Dela-
ware  state by very copious bleeding.  The remedy was
suggested to the doctor by an account taken from a Lon-
don magazine of a dreadful hydrophobia being cured by
an accidental and profuse haemorrhage from the temporal
artery. §
  A  case is related  by Dr.  Innes,||  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 bleed-
ing was used in the most depressed,  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 morbid actions
were  exactly the same in both patients with those which
    *  Medical Transactions, vol. ii. n. 192.
    f  Ditto, p. 222.            l
    X  Bibliotheque Choisie de Medecine, tome xv. p  212
    §  Medical Essays of Edinburgh, vol. i  p. 226.
    II  Medical Commentaries, vol. iii. p. 496. 
THE HYDROPHOBIA.
203
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 consequence in the disease now under considera-
tion, 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 stimu-
lus. The inflammation of the stomach depends upon the'
same kind of morbid action, 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  conges-
tion of blood or water in the brain.  A dropsy from ob-
structions in the liver induced by strong  drink, does not
differ in its proximate cause from the dropsy brought on
by the obstructions in the same viscus which are left by
a neglected, or half cured bilious  fever.   These remarks
are of extensive application, and, if duly attended to, would
deliver us from a mass of error which has been accumu-
lating for ages in medicine: I mean  the  nomenclature of
diseases from  their remote  causes.  It is the most offen-
sive and injurious part of the rubbish of our science.
   I grant that bleeding has been used in some  instances
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 dis-
eases from the same causes.   I beg  it may not be  tried
in this disease, by any physician who has not renounced
our modern systems of nosology, and adopted,  in  their
utmost extent, the principles and  practice of Botallus and
Sydenham in the treatment of malignant  fevers.
   Before I quit the subject of blood-letting in hydropho-
bia,  I have to add, that it has been used  with success in
two  instances in dogs that had exhibited 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
support the theory and practice which I have endeavour-
ed to establish in this disease,  but because they will ren-
der it unnecessary to destroy the  life of a useful and af- 
204              OBSERVATIONS ON
 fectionate 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 him, and  thus lessen the  force  of the
 disease, by preventing the operation of fear upon the
 system.
   2. Purges and clysters 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 clysters given  five or six
 times every day.
   3. Sweating after bleeding  completed the cure  of the
boy whose case is mentioned by Mr. Wrightson.  Dr.
Baumgarten speaks highly of this mode of depleting, and
says further, that  it has never been cured 4< but by eva-
cuations of some kind."
   4.  All the advantages which attend a salivation in com-
mon 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 of these reme-
dies when the disease is attended with a moderate  or fee-
ble morbid action in the system, for I take it for granted, it
resembles malignant fevers from other causes in appear-
ing m different grades of force.  In its more violent and
common form, stimulants  of all kinds must do harm, un-
less they are of such a nature,  and exhibit in  such quan-
tities,  as to exceed in their force the stimulus  of the dis-
ease ;  but this is not to be expected, more  especially as
the stomach is for the  most part so irritable as sometimes
m7£es          aliments  as well  as the most  gentie

   After the morbid actions in the system have been weak-
 ened,  tome remedies would probably be  useful  in accel-
 erating the cure.
   Blisters and stimulating cataplasms, applied to the feet,
 might probably be used with  the same advantage  in the 
THE HYDROPHOBIA.
205
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 Water,
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 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 hydrophobia to depend upon
debility.   This debility I have since been led to consider
as partial, depending upon abstraction of excitement from
some, and a morbid accumulation of it in other parts of
the body. The preternatural excitement predominates so
far, in most cases of hydrophobia, over debility, that de-
pleting remedies promise  more speedily and  safely to
equalize, and render it natural, than medicines of an op-
posite character.
   In the treatment of those  cases of hydrophobia which
are not derived from  the bite of a rabid animal, regard
should always be had to its  remote and exciting causes,
so as to accommodate the remedies to them.
   The imperfection of the present nomenclature of me-
dicine has become the  subject of general complaint  The
mortality of the disease from the bite of a  rabid animal
has been increased by its name. The terms  hydrophobia
and canine madness convey ideas of the symptoms of the
disease only, and of such of them too as are  by no means
universal.   If the theory I have delivered, and theprac-
tice 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 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 
206              OBSERVATIONS ON
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.
  Since the  first edition of the foregoing observations,
I have seen a communication to the editors of the Medi-
cal  Repository,* by  Dr. Physick,  which  has thrown
new light upon this obscure disease, and which, I hope,
will aid the remedies that have been proposed, in render-
ing them more effectual for  its cure.   The doctor sup-
poses death  from  hydrophobia to  be  the  effect of a
sudden  and spasmodic constriction of the glottis, indu-
cing suffocation, and  that  it  might  be prevented by
creating an artificial passage for air into the lungs, where-
by  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 attended with
success.
  On the 13th 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 hydrophobia, 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  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  September
when he was seized  with a fever  which at first resem-
bled the remittent of  the  season.   Bleeding, purging
blisters, and  the warm bath were prescribed for him*
                      * Volume V. 
THE HYDROPHOBIA.             207
but without success.  The last named remedy appeared
to afford him some relief, which he manifested by pad-
dling and playing in the, water.   At the time I saw hini
he was much agitated, had frequent twitchings, laughed
often;  but, with this uncommon excitement in his mus-
cles  and nerves,  his  mind was unusually correct in all
operations.
   He discovered no  dread of water, except in one in-
stance,  when  he  turned  from it with horror.  He  swal-
lowed occasionally  about a spoon full  of it at  a  time,
holding the cup in  his own  hand, as  if to prevent  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 some-
times 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  difficulty.  This  was more remarkably the  case
when he  attempted to  pronounce  the words carriage,
water,  and  river.  After speaking he panted for breath
in the same manner that he did after drinking. He coughed
and  breathed as patients  do in the moderate grade of the
cyanche 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 pro-
posed  making an opening into his  windpipe.   To  this
his  parents  readily  consented; but while 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 retained his reason,  and
a playful  humour,  till the last minute of his life.   An
instance of the latter appeared in his throwing his hand-
kerchief at his father just before he  expired.  The pa-
rents consented  to our  united request to  examine his
 body.  Dr. Grffiitts being obliged  to go into the coun-
try, and Dr. Physick being indisposed, I undertook this
 business the next morning;  and, in the presence of Dr.
 John Dorsey (to whom  1 gave the dissecting knife,) and
 my pupil  Mr.  Murduck,  I discovered  the  following 
208              OBSERVATIONS ON
 appearances.  All  the  muscles of  the neck had a livid
 colour, such  as  we sometimes observe, after death, in
 persons who have died of the sore throat.   The muscles
 employed  in  deglutition  and  speech were suffused with
 blood.  The epiglottis 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 oesophagus  ex-
 hibited  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  described;
 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 disease, suffocation would be
 the  immediate and certain consequence.    The  same
 difficulty and  danger attend the swallowing saliva, and
hence the symptoms of spitting, which has been so often
 taken notice of in hydrophobia.  Solids are swallowed
more  easily than fluids, only because they  descend by
intervals, and because a less closure of the glottis is suf-
 ficient to favour their passage  into the stomach.   This
remark is confirmed by the frequent occurrence of death
 in the very act of swallowing, and that  too with  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 lunes in
a fever than m health, and much more so in a fever of a 
THE HYDROPHOBIA.            209
malignant character, such as the hydrophobia appears  to
be, than in fevers of a milder nature.   An aversion from
swallowing  liquids is not peculiar  to this  disease.  It
occurs occasionally in the yellow fever.   It occurs like-
wise in the disease which has prevailed among the cats,
both in  Europe and  America,  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 cause of death, being,
I hope, thus ascertained, the means of preventing death
come next  under our consideration.   Tonic remedies,
in all their forms, have been administered to no purpose.
The theory of the disease  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 the loss  of  blood in  the  most  liberal  quantity.   As
well might we expect  the  inflammation  and pain  of a
paronychia, or  what is called  a  fellon on the  finger, to
be removed by the same remedy.  Purging and sweat-
ing, though occasionally successful, have failed in many
instances; and even a  salivation, when excited (which
is rarely  the case,) has not cured it.   An  artificial aper-
ture into the  windpipe  alone bids fair to arrest its ten-
dency to death, by removing the symptom which gene-
rail)' induces it, and thereby giving time for other reme-
dies, 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
according to Fourcroy's advice, in diseases of the throat
which obstruct respiration, should be  preferred to trache-
   *  The  hoarse  barking, or  the  total inability of mad dogs 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.
   vol.  ii.                  n d 
210              OBSERVATIONS ON
 otomy, 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
 operations.  We cut through a large mass of flesh  into
 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 ope-
 ration, in order  to save life.  The operation  of laryngo-
 tomy is much  less painful and  dangerous than  any of
 them; and besides permitting the patient  to breathe  and
 to swallow, it is calculated 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 climates it is,  I  believe,  generally a
disease of feeble re-action,  and requires tonic remedies;
but in the middle and northern  states of America it is
more commonly attended with so much activity and ex-
citement of the blood-vessels, as to require copious blood-
letting and other depleting remedies.
  Should this new method of attacking this furious  dis-
ease be adopted, and  become generally  successful, the
discovery  will place the  ingenious gentleman who  sug-
gested it in the  first rank of the  medical benefactors of
mankind.
  I have only to add a fact upon this subject which may
tend to increase confidence in  a mode  of  preventing
the disease, which has  been recommended by Dr. Hay-
garth, and used  with  success in several 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,  washed it likewise with  soap and water.
He  happily escaped the disease,  and is now in good 
                 THE HYDROPHOBIA.              211

health.  That his wound was poisoned is highly proba-
ble, from its having been  made eight hours alter the last
of the above animals was bitten, in which time there can
be but little doubt of such  a fresh  secretion  of saliva
having 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 encouraged by
its happy  issue in this  case as  to  advise  it in prefer-
ence to cutting out the wounded part.   It should only
be resorted to where the fears of a patient,  or his  dis-
tance from a surgeon  render it  impossible to use  the
knife. 
( 
     AN INQUIRY





         INTO






  THE CAUSE AND CURE






         OF THE







CHOLERA INFANTUM. 
*
\r 
            AN INQUIRY

               INTO THE

      CAUSE AND CURE

               OF THE


CHOLERA  INFANTUM.
     BY this name I mean to designate a disease,  called
in Philadelphia, the  44 vomiting and purging of children."
From the regularity  of its  appearance  in the  summer
months,  it is likewise known by the name of 44 the dis-
ease of the season." It prevails in most of the large towns
of the United States.  It is distinguished in Charleston,
in South Carolina, by the name of 44 the April and May
disease,"  from  making its first appearance in those two
months.   It seldom appears in Philadelphia till the mid-
dle of June,  or the beginning of July, and generally con-
tinues till near the middle of September.  Its frequency
and  danger  are always in proportion to  the heat of the
weather.  It affects children from the first or second week
after their birth, till they are two years old. It sometimes
begins with  a diarrhoea, which continues for several days
without any  other symptom of indisposition;  but it more
frequently comes  on with a violent vomiting and  purg-
ing, and  a high  fever.  The matter discharged from the
stomach  and bowels is generally yellow or green, but the
stools are sometimes slimy and bloody, without any tinc-
ture of bile.  In some instances they are nearly as limpid
as water.  Worms are frequently discharged in each kind
of the stools that  has been described.  The children, in
this stage of the disease, appear to suffer a good deal of 
216          THE CAUSE AND  CURE OF

pain. They draw up their feet, and are never easy in one
posture. The pulse is quick and  weak.  The head is un-
usually warm, while the extremities retain their natural
heat, or incline to be cold. The  fever is of the remitting
kind, and  discovers evident exacerbations, especially in
the evenings.  The disease affects the head so much, as
in some instances to produce symptoms  not only of deli-
rium,  but of mania, insomuch that the children throw
their heads backwards and forwards, and sometimes make
attempts to scratch, and to bite their parents, nurses, and
even themselves.  A swelling frequently  occurs in the
abdomen, and in the face and limbs.  An intense thirst
attends every stage of the disease.  The eyes appear lan-
guid and hollow, and  the children generally sleep with
them half closed.  Such is the insensibility  of the system
in some instances in this disease, that flies have been seen
to alight  upon the eyes when  open, without exciting a
motion in the eyelids to remove  them.  Sometimes the
vomiting continues without the purging, but more gene-
rally the purging continues without the vomiting, through
the whole course of the disease.  The stools are frequent-
ly large, and extremely foetid, but in some  instances they
are without smell, and resemble drinks and aliments which
have been taken  into the body. The disease is sometimes
fatal in a few days. 1 once saw it carry off  a  child in four
and twenty hours.  Its duration  is varied  by the  season
of the year, and  by the changes in the temperature of the
weather.   A cool day frequently abates its violence, and
disposes  it to a favourable  termination.  It often  con-
tinues, with occasional variations in its appearance, for
six weeks or two months.  Where the disease has  been
of  long continuance,  the approach  of death is gradual, rf
and attended by  a number of distressing  symptoms.  An
emaciation of the body to such a degree, as that the bones
come through the skin, lived spots," a singultus,  convul-
sions,  a strongly marked hippocratic countenance, and
a sore mouth,  generally precede the fatal termination
ol  this disease.   Few children  ever recover, after the
last symptoms which  have been mentioned make  their
appearance. 
THE CHOLERA INFANTUM.
217
  This disease has been ascribed to  several causes of
each of which I shall take notice in order.
  I. It has been attributed to dentition.   To refute this
opinion, it will be necessary to observe,  that it appears
only in one season of the year.   Dentition, I  acknow-
ledge,  sometimes  aggravates it ; hence  we  find  it  is
most severe  in that  period  of life,  when the greatest
number of teeth make their appearance,  which is gene-
rally about the tenth  month.   I  think I  observed more
children to die of this disease at that age,  than at any
other.
  II.  Worms have likewise been suspected of being the
cause of this  disease.   To this opinion, I object the un-
certainty of worms ever producing an idiopathic fever,
and the improbability of their combining in such a man-
ner as to produce an annual epidemic disease of any kind.
But further, we often see the disease in all its force, be-
fore that age,  in which worms usually' produce diseases ;
we  likewise often see it resist the  most powerful anthel-
mintic medicines; and, lastly, it appears from dissection,
where the  disease has proved fatal, that not a single worm
has been discovered in the bowels.  It is true, worms,
are in some instances discharged in this disease, but they
are frequently discharged in greater numbers in the hy-
drocephalus internus,  and in the small-pox, and yet who
will assert either of those diseases to be produced by
worms.
  III.  The summer  fruits have been  accused of produc*
ing this disease.   To this opinion I object, that the dis-
ease is but little known in country places, where children
eat much more fruit than in  cities.  As far as I have ob-
served, I am disposed to believe,  that the moderate use
of ripe fruits, rather tends to prevent,  than to induce the
disease.
   From the discharge of bile  which  generally  intro-
duces the  disease, from the remissions and exacerbations
of  the fever  which  accompanies  it,  and from its oc-
curring nearly in the same  season with the cholera and
remitting  fever in adults, I am  disposed to consider it
as a modification  of  the  same diseases.  Its appearance
   vol. n.                 V e 
 218           THE CAUSE AND  CURE OF

 earlier  in the season  than  the  cholera and  remitting
 fever in adults, must be  ascribed to the  constitutions
 of children being more predisposed from  weakness to
 be acted upon, by the remote causes which produce those
 diseases.
   I shall  now mention the remedies which are proper and
 useful in  this disease.
    I. The first indication of  cure  is  to evacuate the
 bile from  the  stomach  and bowels.   This should be
 done by gentle doses  of ipecacuanha, or tartar emetic.
 The vomits should be repeated occasionally, if indicated,
 in every  stage of the disease.   The bowels should be
 opened  by  means  of calomel,  manna,  castor oil, or
 magnesia.   I  have generally found  rhubarb  improper
 for this purpose,  while the  stomach  was in a very
 irritable state.   In those cases, where there is  reason to
 believe  that the offending contents of the primae  viae
 have  been  discharged  by nature (which is often the
 case,) the emetics and  purges should by no means be
 given ;  but, instead of them, recourse must be had to
   II. Opiates.  A few drops  of liquid laudanum, com-
 bined in a testaceous julep, with peppermint or cinnamon-
 water, seldom  fail of composing the stomach and bowels.
 In some instances, this medicine alone subdues the dis-
 ease in two or three  days  ;  but where it does  not
 prove so  successful, it  produces a remission  of  pain,
 and of other distressing symptoms, in every stage of the
 disease.
   HI. Demulcent  and diluting drinks have an  agreeable
 effect in this disease.  Mint and mallow teas, or a tea
 made of blackberry roots infused  in cold water, together
 with a decoction of the  shavings of hartshorn  and gum
arabic with cinnamon, should all  be given in their turns
 for this  purpose.
   IV. Clysters made of flaxseed tea, or of mutton broth,
 or of starch dissolved in water, with a few  drops  of li-
 quid  laudanum in them, give ease, and produce other
 useful effects.
   V. Plaisters  of Venice treacle applied to the  region of
 the stomach, and flannels dipped  in infusions of bitter, 
              THE CHOLERA INFANTUM.          219

and  aromatic herbs in warm spirits, or Madeira wine,
and applied to the  region of the abdomen, often afford
considerable relief.
 # VI. As soon as  the more violent  symptoms of the
disease are composed,  tonic and cordial medicines should
be given.  The bark in decoction, or in substance (where
it can be retained in that form,)  mixed with a little nut-
meg, often produces the most salutary effects.  Port wine
or claret  mixed  with  water are likewise proper in this
stage of the disease.  After the disease  has  continued
for some  time,  we  often  see an appetite  suddenly
awakened  for articles of diet of a stimulating  nature.
I have seen many  children recover from being gratified
in an inclination  to  eat  salted fish,  and  the different
kinds of salted meat.   In some instances they discover
an appetite for butter,  and the richest  gravies of  roasted
meats,  and  eat them with  obvious relief to all  their
symptoms.   I once saw  a  child of sixteen months old
perfectly restored, from die  lowest stage of this disease,
by eating  large  quantities  of  rancid English  cheese,
and  drinking two  or  three glasses  of port wine every
day.    She  would  in  no instance eat bread  with  the
cheese,  nor taste the wine, if it was mixed with water.
  We sometimes  see relief given by the use of the warm
bath, in cases of obstinate pain.  The bath is more effec-
tual,  if warm wine is used, instead of water.
  I have had but few opportunities of trying the effects
of cold water applied  to the body in  this disease;. but
from the benefit  which attended its  use  in the cases
in which it  was  prescribed, I  am  disposed to  believe
that  it  would do  great  service,  could  we  overcome
the prejudices which  subsist in the minds of  parents
against it.
   After all that has been said in favour of the remedies
that have been mentioned, I am  sorry to add, that I have
very often seen them all administered without effect.  My
principal dependence, therefore, for many years, has been
placed upon
  VII. Country  air.  Out of many hundred children
whom I have sent into the country, in  every stage of this 
220           THE CAUSE  AND CURE OF

disease, I have lost but three ; two  of whom were sent,
contrary tO my advice, into that unhealthy part  of the
neighbourhood  of Philadelphia called the Neck, which
lies between the city and the conflux of the rivers Dela-
ware  and Schuylkill.   I have  seen  one cure performed
by  this remedy, after convulsions had taken place.   To
derive the utmost benefit from the country air, children
should be carried out on horseback, or in a carriage, every
day; and they should be exposed to the open air as much
as possible in fair weather, in the day time.  Where the
convenience of the constant benefit of country air cannot
be obtained, I have seen evident advantages from  taking
children out of the city once or twice a day.  It is  ex-
tremely agreeable to see the little sufferers revive as soon
as they escape from the city air, and inspire the pure air
of the country.
  I shall conclude this inquiry by recommending the fol-
lowing methods of preventing  this disease,  all of which
have been found, by experience to be useful.
  1. The daily use of the cold bath.
  2. A faithful and attentive  accommodation of the dresses   £
of children to the state and changes of the air.
  3. A moderate  quantity  of salted meat  taken occa-
sionally in those  months in  which the  disease usually7 -
prevails.  It is perhaps in  part  from  the  daily  use of
salted meat in diet, that  the children of country  people
escape this disease.
  4. The use of sound old  wine in  the summer months.
From a tea spoon full, to half a wine glass full,  according
to  the  age  of the  child,  may  be given  every  day.
It is  remarkable,  that the  children  of persons  in  easy
circumstances, who sip occasionally with  their parents
the remains of a glass of wine  after dinner, are much
less subject to this disease, than the children of  poor
people, who are without the  benefit of that  article of
diet.
  5. Cleanliness, both with respect to the skin and cloth-
ing of children. Perhaps the neglect  of this direction may
be  another reason why the children of the poor are most
subject to this disease. 
             THE CHOLERA INFANTUM.          221

  6. The removal of children into the country before the
approach  of  warm weather.   This  advice is peculiarly
necessary during the whole period of dentition.   I have
never known but one instance of a child being affected
by this disease, who had been carried into the country in
order to avoid it.
  I have only to add to the above observations, that since
the prevalence of the yellow fever in Philadelphia after the
year 1793, the cholera infantum has assumed symptoms of
such malignity, as to require bleeding to cure it.  In some
cases, two and  three bleedings were  necessary for that
purpose. 
 
      OBSERVATIONS





          ON THE






CYNANCHE TRACHEALIS. 
 
OBSERVATIONS
               ON THE


CYNANCHE  TRACHEALIS.
    THE vulgar name of this  disease in  Pennsylvania
is hives.  It is a corruption of the word heaves, which
took its rise from the manner in which the lungs heave in
breathing.  The worst degree of the disease is called the
bowel hives,  from the great motion of the abdominal
muscles in respiration.
  It has been called suffocatio stridula by Dr. Home, and
cynanche trachealis  by Dr. Cullen.   Professor Frank
calls it trachitis, and  Dr. Darwin considers it as a pleu-
risy of the  windpipe.  By  the two  latter names,  the
authors means to convey the correct idea, that the  dis-
ease is the same in its nature with the common diseases
of other internal parts of the body.
  It is brought on by the  same causes which induce
fever, particularly by cold.   I have seen it accompany as
well as succeed, the  small-pox,  measles, scarlet-fever,
and apthous sore throat.  In the late Dr. Foulke it suc-
ceeded acute  rheumatism.   The late Dr. Sayre informed
me, he had seen it occur in a case of yellow fever, in the
year 1796.
  It sometimes comes on  suddenly, but it more  fre-
quently creeps on in the form of a common cold.  Its
symptoms are sometimes constant, but they more gene-
rally remit, particularly during the day.  It attacks  chil-
dren of all ages, from three months to five years  old.
But it occasionally attacks adults.  It generally runs its
course in three or four days, but we now and then see it
  vol. n.                 f f 
226
OBSERVATIONS ON THE
protracted in a chronic and feeble  form,  for eight and
ten days.
   Dissection  show  the  following  appearances  in  the
trachea.   1. A slight  degree of inflammation.  2.  A
thick matter resembling mucus.  3.  A membrane similar
to that which  succeeds inflammation in the pleura and
bowels,  formed  from the  coagulating lymph of  the
blood.  4. In some cases the trachea exhibits no marks
of disease of any kind.  These  cases are generally vio-
lent, and  terminate suddenly.  The morbid excitement
here transcends inflammation.  Similar instances  of the
absence of  the common  signs  of  disease after  death,
occur in other parts of the body.  Where the cynanche
trachealis has appeared  in the high grade which  has been
last mentioned, it has  been called  spasmodic.   Where
the serous vessels of the trachea have been tinged  with
red  blood,  it  has  been considered as  inflammatory.
Where a liquid matter  has been found in the trachea, it
has been  called humoral; and where a membrane  has
been seen adhering to the trachea, it has received from
Dr. Michaelis the name of  angina polypesa.  But  all
these different issues of the cynanche trachealis are the
effects of a difference only in in its force,  or  in  its dura-
tion : they all depend upon one remote,  and one  proxi-
mate cause
   In  the forming state of this disease,  which  may  be
easily known by  a  hoarseness, and a slight  degree  of
stertorious cough, a puke of antimonial wine, tartar eme-
tic, ipecacuanha,  or oxymel  of  squills, is for  the most
part an immediate cure.  To be  effectual,  it should  ope-
rate  four  or  five  times.   Happily  children  are seldom
injured by a little excess in the operation of this class of
medicines.  I have  prevented the formation of this dis-
ease many hundred times, and  frequently in  my  own
family by means of this remedy.
   After  the  disease is completely  formed, and appears
with the usual symptoms described by authors, the reme-
dies should be
   1.  Blood-letting.   The late Dr.  Bailie  of New-York
used to bleed until fainting was  induced.  His practice
has been followed by Dr.  Dick of Alexandria,  and with 
CYNANCHE  TRACHEALIS.          227
great success.  I have generally preferred small, but fre-
quent, to copious bleedings.  I once drew twelve ounces
of blood, at four bleedings, in one day,  from a son of
Mr.  John Carrol, then in the fourth year of his age.  Dr.
Physick bled a child,  of but three months old, three times
in one day.   Life was saved in both these cases.  Pow-
erful as the lancet is, in this disease,  its violence and
danger require that it should be aided by
  2. Vomits.  These  should be  given every day, or
oftener,  during the continuance of the  disease.   Their
good effects are much more obvious and certain in a dis-
ease of the  trachea, than of the  lungs, and  hence their
greater utility, as I shall say hereafter, in a consumption
from a catarrh, than from any other of its causes.
  3. Purges.   These should consist  of  calomel  and ja-
lap,  or  rhubarb, and should  always follow the use of
emetics, if they fail of opening the bowels.
  4. Calomel should likewise  be given in large doses.
Dr.  Physick gave half a drachm of this medicine, in one
day, to the infant whose case has been mentioned.  I have
never known it excite a salivation when given to children
whose ages  render them  subjects of it, probably because
it has been given in such large quantities as to pass rapid-
ly through the bowels.   Its good effects  seem to depend
upon its exciting a counter-action in the whole intestinal
canal, and thereby lessening the disposition of the tracheal
blood-vessels to  discharge the mucus, or form the mem-
brane, which have been described.
   5. Blisters should  be applied to the throat, breast, and
neck, and even to the limbs.
   6. Dr. Archer of Maryland commends, in high terms,
the use of polygola, or Seneca snake-root, in this disease.
I can say nothing in  favour of its exclusive use, from
my own experience,  having never given it,  but as an
auxiliary to other remedies.
   7. I have seen great relief given by  the use of the warm
bath, especially when it has been  followed by a gentle
perspiration.
   8 Towards the close of the disease, after the symptoms
of great morbid action begin to decline,  a few drops of
liquid laudanum, by quieting the cough which generally 
 228           OBSERVATIONS ON &C.

 succeeds it, often produce the most salutary effects. They
 should be given in flaxseed, or  bran, or onion tea, of
 which drinks the patient should drink freely in every stage
 of the disease.
   The cynanche trachealis is attended with most danger,
 when the patient  labours  under  a constant  and, audible
 stertorous breathing.  The danger is  less,  when a dry
 stertorous cough attends, with easy respiration  in its  in-
 tervals.  The danger is nearly over when the cough, though
 stertorous,  is loose, and accompanied with a discharge of
 mucus from the trachea.
   An eruption of little red blotches,  which frequently
 appears and disappears two or three  times in the course
 of this disease, is always a favourable symptom.
   I once attended a man from Virginia, of the name of
 Bampfield, who, after an attack  of this disease, was much
 distressed with the stertorous breathing and cough which
 belong to it. I suspected both to arise from a membrane
 formed by inflammation in his trachea.   This membrane
 I supposed to be in part detached from the trachea,  from
 the rattling noise which attended his  breathing.  He had
 used many remedies for it to no purpose.   I advised a
 salivation, which in less than three weeks perfecdy cured
him.
   Since the general adoption of the remedies  which have
 been enumerated,  for the cynanche trachealis,  instances
 of itj  mortality have become very uncommon in the city
 ©f Philadelphia. 
          AN ACCOUNT


               OF THE


BILIOUS REMITTING FEVER,


            AS IT APPEARED
   V

         IN PHILADELPHIA,


     IN THE SUMMER AND AUTUMN OF THE TEAR 1780. 
 
AN ACCOUNT
                    OF THE


BILIOUS REMITTING FEVER,  &c.
     BEFORE I proceed to describe this fever, ii will
be necessary to give a short account of the weather, and
of the diseases which preceded its appearance.
   The spring of 1780 was dry and cool.  A catarrh ap-
peared among children between one year and seven years
of age.  It was  accompanied by  a defluxion from the
eyes and nose, and  by a cough  and dyspnoea, resem-
bling, in some instances,  the cynanche trachealis, and in
others a peripneumony. In some cases it was complicated
with the symptoms of a bilious remitting and intermitting
fever.  The exacerbations of this fever were always at-
tended with dyspnoea and cough.  A few patients expec-
torated blood.   Some had swellings  behind  their ears,
and others were affected with small  ulcers in  the throat.
I met with only one case of this fever in which the pulse
indicated bleeding.   The rest yielded  in a few days to
emetics, blisters, and the bark, assisted by the  usual more
simple remedies in such diseases.
  An intermittent prevailed among adults in  the month
of May.
  July and August were uncommonly warm. The mer-
cury stood on the 6th of August at 94|, on the 15th of
the same month at 95°, and for several days afterwards at
90°.  Many labouring people perished during this month
by the heat,  and by drinking, not only cold water but
cold liquors of several kinds, while they were under the
violent impressions of the heat.
   The vomiting and purging prevailed universally, dur-
ing these two warm months, among the children, and with
uncommon degrees of mortality. Children from one year 
232              ACCOUNT OF THE
to eight and nine years old were likewise  very generally
affected by  blotches and little  boils, especially in  their
faces.  An eruption on the skin,  called by the common
people the prickly heat, was  very common at this  time
among persons  of all ages.   The  winds  during these
months blew chiefly from the  south, and south-west.  Of
course they  passed over the land which lies between the
city, and the conflux of the rivers Delaware and Schuyl-
kill, the peculiar situation of which,  at that time, has been
already described.
   The dock, and the streets of Philadelphia, supplied the
winds at this season, likewise, with a portion of their un-
wholesome exhalations.
   The moschetoes were uncommonly numerous during
the autumn.   A certain sign  (says  Dr. Lind) of an un-
wholesome atmosphere.
   The remitting fever made  its first appearance in  July
and August, but its symptoms were so mild,  and its ex-
tent so confined, that  it excited no  apprehensions of its
subsequent more general prevalence throughout the  city.
   On the 19th of  August the air became suddenly  very
cool.  Many hundred people  in the city complained, the
next dayr,  of different degrees of indisposition, from  a
sense of lassitude to a fever of the remitting type.  This
was the signal of the epidemic.  The weather continued
cool during  the remaining part of the month,  and during
the whole month of Septemper.   From the exposure of
the district of South v. ark (which is often distinguished
by the name of the  Hill) to the south-west winds, the fever
made its first appearance in that appendage of the  city.
Scarcely a family, and,in many families, scarcely a member
of them, escaped it.  From the Hill  it gradually travelled
along the  second street from the Delaware,  improperly
called Front-street. For a  while it  was confined to this
street only, after it entered the  city, and hence it was called
by some  people  the  Front-Street fever.  It gradually
spread  through other parts of  the city, but with very dif-
ferent degrees of  violence.   It prevailed but  little in the
Northern  Liberties.  It was scarcely  known  beyond
Fourth-Street from the Delaware.   Intemperance in eat-
ing  or drinking, riding  in the  sun or rain, watching 
BILIOUS REMITTING FEVER.        233
 fatigue or even a fright, but more frequently cold,  all
 served to excite the seeds of this fever into action, where-
 ever they existed.
   All ages  and both sexes were affected by this fever.
 Seven of the practitioners of physic were confined by it
 nearly at the same time. The city, during the prevalence
 of the fever, was filled with an unusual number of stran-
 gers, many of whom,  particularly the Friends  (whose
 yearly meeting was held  in the month of September,)
 were affected by it. No other febrile disease was observed
 during this  time in the  city.
   This fever generally came on with rigour,  but  seldom
 with a regular chilly fit, and often without any sensation
 of cold. In some persons it was introduced by a slight sore
 throat, and  in others by a hoarseness which was mistaken
 for a common cold.  A giddiness in the head was the fore-
 runner of the disease in some people.  This giddiness  at-
 tacked so suddenly, as to produce, in several instances, a
 faintness, and even symptoms of apoplexy. It was remark-
 able that all  those persons who were affected in this violent
 manner, recovered in two or three days.
   I met with one instance of this fever attacking with
 coma, and another with convulsions, and with many instan-
 ces, in which it was introduced by a delirium.-
   The pains which accompanied this fever were exqui-
 sitely severe in the head, back, and limbs.  The  pains in
 the head were sometimes in the back  parts of it, and at
 other times they occupied only the eyeballs.  In some
 people, the pains were so acute in their backs and hips,
 that they could not lie in bed.  In others, the pains affected
 the neck and arms, so as to produce in one instance a diffi-
 culty of moving the fingers of the right hand.  They  all
 complained more or less of a soreness in the seats of these
 pains, particularly when they occupied the head and eye-
 balls.   A few complained of their flesh being sore to the
 touch, in every part of the body. From these circumstan-
 ces, the disease was sometimes believed to be a rheuma-
 tism; but  its  more general name  among all classes  of
 people was, the break-bone fever.
   I met with one case of pain in the back, and another of an
f VOL. II.                G S 
254               ACCOUNT OF THE
 acute ear-ach,  both of which  returned periodically every
 night, and without any fever.
   A nausea universally, and in some instances a vomiting,
 accompanied by a disagreeable taste in the month, attend-
 ed this fever.  The bowels were, in most cases, regular,
 except where the disease fell with  its whole force upon
 them, producing a dysentery.
   The tongue was generally moist,  and tinctured of a
 yellow colour.
   The urine was high coloured, and in its usual quantity
 in fevers.
   The skin  was  generally moist,  especially where the
 disease terminated on the third or fourth day.
   The pulse was quick and full, but never hard, in a sin-
 gle patient that came under my care, till the 28th of Sep-
 tember.
   It was remarkable, that little,  and,  in some instances,
 no thirst attended this fever.
  A screatus, or constant hawking and spitting, attended
 in many cases through the  whole disease, and was a fa-
 vourable symptom.
  There were  generally remissions in this fever every
 morning, and sometimes in the  evening.  The exacer-
 bations were more severe every other day, and two exa-
 cerbations were often observed in one day.
  A rash often appeared on the  third and fourth days,
 which proved favourable.   This rash  was accompanied,
in some cases, by  a burning in the  palms of the hands,
and soles of the feet.  Many people  at  this time, who
were  not confined to their beds, and some, who had no
fever, had an efflorescence on their skins.
  In several persons the force of the disease seemed to
fall upon the face, producing swellings under the jaw and
in the ears, which in some instances  terminated  in ab-
 scesses.
  When the fever did  not terminate on  the third or
fourth day,  it frequently ran  on to the  eleventh, four-
teenth, and even twentieth days, assuming in its progress,
according  to  its duration,  the usual  symptoms  of the
typhus gravior,  or mitior, of Doctor Cullen.   In  some
cases, the discharge of a few  poon-fulls  of blood from, 
             BILIOUS REMITTING  FEVER.        235

the nose accompanied a solution of the fever on the third
or fourth  day ; while in  others, a profuse haemorrhage
from the nose, mouth, and bowels, on the tenth and ele-
venth days, preceded a fatal issue of the disease.
   Several cases came under my care,  in which the fever
was succeeded by a jaundice.
   The disease terminated in some cases without sweating
or sediment in the urine ; nor did I observe such patients
more disposed to relapse than others provided they took
a sufficient quantity of the bark.
   About  the  beginning  of  October the weather became
cool,  accompanied by rain and  an easterly  wind.   This
cool and  wet weather continued for  four days.  The
mercury in the thermometer fell to 60°, and fires became
agreeable.   From this time the fever evidently declined,
or was accompanied by  inflammatory symptoms.   On
the 16th of October, I met with a case of inflammatory
angina ; and on the next day I visited a patient who had
a complication of the bilious fever with  a pleurisy, and
whose blood discovered  strong marks of the presence of
the inflammatory diathesis. His stools were of a green and
black  colour.  On the third day of his disease  a rash
appeared on his skin, and on the fourth, in consequence of
a second bleeding, his fever terminated with the common
S)rmptoms of a crisis.
   During the latter end of October, and the first weeks in
November, the  mercury in the thermometer fluctuated
between 50 and 60°. Pleurisies and inflammatory diseases
 of all  kinds  now  made their  appearance.  They were
 more numerous and more acute, than in  this stage of the
 autumn,  in former  years. I met with one case of pleurisy
 in November, which did not yield to less than four plentiful
 bleedings.
    I shall now add a short  account of the method  I pursued
 in the treatment of this fever.
    I  generally began by  giving a gentle vomit of tartar
 emetie.  This  medicine, if given  while the fever was  in
 its forming state, frequently produced an immediate cure;
 and if given after its formation, on the first day,  seldom
 failed  of producing a  crisis on the third or fourth day.
  The vomit always  discharging more or less bile.   If a 
236
ACCOUNT OF THE
 nausea, or an ineffectual attempt to vomit continued after
 the exhibition of the tartar emetic, I gave a second dose
 of it with the happiest effects.
   If the vomit failed of opening the bowels, I gave gen-
 tle doses of salts and cream of tartar,* or of the butter-
 nut pill,f so as to procure two or three plentiful stools.
 The  matter discharged from the bowels was of a  highly
 bilious  nature.   It  was sometimes so acrid as to excori-
 ate the rectum, and so offensive, as to occasion, in some
 cases,  sickness and faintness both in the patients and in
 their  attendants.  In  every instance  the patients  found
 relief by these evacuations, especially from the pains in
 the head and limbs.
   In  those  cases,  where the prejudices of the patients
 against an emetic,  or where an  advanced  state of preg-
 nancy,  or a habitual predisposition  to a vomiting of blood
 occurred, I  discharged the bile entirely by means of the
 lenient  purges that have been mentioned.  In this prac-
 tice  I  had  the example  of  Doctor Cleghorn,  who
 prescribed purges  with  great success  in a  fever  of the
 same kind  in  Minorca,  with that  which has been des-
 cribed.J  Doctor  Lining  prescribed  purges with equal
 success in an autumnal pleurisy in South Carolina, which
 I take to have been a  form of a bilious  remittent, accom-
 panied by an inflammatory affection of  the breast.
   After evacuating  the contents of  the  stomach and
 bowels, I gave small  doses of tartar emetic, mixed with
 Glauber's salt.   This medicine excited a general prespi-
 ration.   It  likewise kept the  bowels  gently open,  by
 which  means the bile was discharged as fast as it was
 accumulated.
   I constantly recommended to my patients, in this stage
 of the disorder, to lie in bed.  This favoured the eruption
 of the rash,  and the solution of the disease by prespira-

  • I have found that cream of tartar renders the purging neutral salts
 less disagreeable to the taste and stomach ; but accident has lately taught
 me, that  the juice of two limes or of one  lemon, with about half an
 ounce of  loaf sugar, added to six drachms of Glauber's or Epsom  salt,
in ha^f a,pint of boiling water, form a mixture that is nearly as pleasant
 i;s strong  beverage.
  t This pill is made from an extract of a strong decoction of the inner
 feark of the white walnut-tree.
  t The  tertiaua interposita remissione tantum of Dr. Cullen, 
BILIOUS REMITTING FEVER.
237
 tion.  Persons who struggled against the fever by sitting
 up, or who attempted to shake it off by labour or exer-
 cise, either sunk under it, or had a slow recovery.
   A clergyman of a respectable character from the coun-
 try, who was attacked by the disease in the city, returned
 home, from  a desire of being attended by his own fami-
 ly, and died in a few days afterwards.  This is only one,
 of many cases, in which I have observed travelling, even
 in the easiest carriages, to prove fatal in fevers after they
 were formed, or after the first symptoms had shown them-
 selves.  The quickest and most  effectual  way of con-
 quering a fever, in most cases, is, by an early submission
 to it.
   The drinks I  recommended to my patienjs were sage
 and balm teas, weak punch,  lemonade, wine whey,  ta-
 marind and apple water.
   The apple-water should  be made by pouring boiling
 water upon slices of raw apples.   It is more lively than
 that  which is made by pouring the  water  on  roasted
 apples.
   I found obvious advantages, in many cases, from the
 use of pediluvia every night.
   In every case, I found the patients refreshed and re-
 lieved by frequent changes of  their linen.
   On the third or fourth day, in the forenoon, the pains
 in the head and  back  generally  abated, with a sweat
 which was diffused over the whole body.   The pulse at
 this time remained quick  and weak.  This  was, how-
 ever, no objection to the use of the bark,  a  few doses
 of which immediately abated its quickness, and prevented •
 a  return of the fever.
   If the fever continued beyond the third or fourth day
 without an intermission, I  always had recourse to blis-
 ters.  Those which were applied to the neck, and behind
 the  ears,  produced the most immediate  good  effects.
 They seldom failed of producing  an intermission in the
 fever, the day after they were  applied.  Where delirium
 or coma attended, I applied the blister to the neck on the
first  day of the  disease.   A  worthy family in this city
"will always ascribe the life  of a promising boy, of ten 
238
ACCOUNT OF THE
years old, to the early application of a blister to the neck,
in this fever.
   Where the fever did not yield to blisters, and assumed
malignant, or typhus symptoms, I gave  the medicines
usually exhibited in both those states of fever.
   I took notice, in the history of this fever, that it was
sometimes accompanied with symptoms of a dysentery.
Where this disease appeared, I prescribed  lenient purges
andopiates.  Where these failed of success, I  gave  the
bark in the intermissions of the pain in the bowels, and
applied blisters to the  wrists.  The good effects of these
remedies led me to conclude,  that the dysentery was the
febris introversa of Dr. Sydenham.
   1 am happy in having an opportunity,  in this  place, of
bearing a testimony in favour of the usefulness of opium in
this disease, after the necessary evacuations had been made.
I yielded, in prescribing it at first, to the earnest solicita-
tions of my patients for something to give them relief
from their insupportable pains, particularly when they were
seated in the eyeballs and head. Its salutary effects in pro-
curing sweat, and a remission of  the fever, led  me  to
prescribe  it afterwards in  almost every case, and always
with  the happiest effects.  Those  physicians enjoy but
little pleasure  in  practising physic, who know not how
much of the pain and anguish of fevers of a certain kind,
may be lessened by the judicious use of opium.
   In  treating of the remedies used in this disease, I have
taken no notice of blood-letting.  Out of several hundred
patients whom I visited in this fever, I did not meet with
a single case, before the 27th of September, in which the
state  of the pulse  indicated this evacuation.  It is true,
the pulse was full, but never hard.   I acknowledge that
1 was called to several patients who had been bled without
the advice of a physician,  who recovered  afterwards  on
the usual days of  the solution of the fever.  This only
can be ascribed to that disposition which Dr.  Cleghorn
attributes to fevers, to preserve their types under every
variety of treatment, as well as constitution.  But I  am
bound to declare further, that I heard of several cases in
which bleeding was followed by a fatal termination of the
disease. 
            BILIOUS REMITTING FEVER.         239

  In this fever relapses were very frequent from exposure
to the rain, sun, or night air, and from an excess in eating or
drinking
  The convalescence from this disease was marked by a
number of extraordinary symptoms, which rendered pa-
tients the subjects of medical attention for many days
after the pulse became perfectly regular, and after the crisis
of the disease.
  A bitter taste  in the mouth, accompanied by a yellow
colour on the tongue, continued for near a week.
  Most of those who recovered complained of nausea, and
a total want of appetite. A faintness, especially upon sitting
up in bed, or in a chair, followed this fever. A weakness in
the knees was universal. I met with two patients, who were
most sensible of this weakness in the right knee.  An in-
flammation in one eye, and in some instances in both eyes,
occurred in several patients after their recovery.
  But the most remarkable symptom of the convalescence
from this fever, was an uncommon dejection of the spirits.
I attended two young ladies, who shed tears while they
vented their complaints of their sickness and weakness.
One of them very aptly proposed to me to change the name
of the disease, and to call it, in its present stage, instead of
the break-bone, the break-heart fever.
  To remove these symptoms, I gave the tincture of bark
and elixir of vitriol in frequent doses.  I likewise recom-
mended the plentiful use of ripe fruits; but I saw the best
effects from temperate meals of oysters, and a liberal use of
porter. To these was added, gentie exercise in the open air,
which gradually completed the cure. 
 
       AN ACCOUNT






           OF THE








SCARLATINA ANGINOSA,







            AS IT






  APPEARED IN PHILADELPHIA,







      IN THE YEARS 1783 AND 1784»
VOL. II.
h h 
 
AN ACCOUNT
              OF THE


SCARLATINA ANGINOSA.
     THE beginning of the month of July was unusu-
ally cool; insomuch that the mercury in Fahrenheit's ther-
mometer stood at 61° in the day time, and fires were very
comfortable, especially in the evening. In the last week
but one of this month, the weather suddenly became so
warm, that the murcury rose to 94 V°, at which it remain-
ed for three days.   As this heat was accompanied by no
breeze from any quarter,  the sense of it was extremely
distressing to many people.  JLJpwards  of twenty persons
died in the course of those three days, from the excess
of the heat, and  from drinking cold water.   Three old
people died  suddenly within this space of time.  This
extreme heat was  succeeded by cool weather, the mercu-
ry having fallen to 60°,  and the month closed with pro-
ducing a few intermitting and remitting fevers,  together
with several cases of inflammatory angina.
  The weather in the month of August was extremely
variable.   The mercury, after standing for several days
at 92°, suddenly fell so low, as not only  to  render fires
necessary, but in  many places to produce frost.
  Every form of fever made its appearance in this month.
The synocha was  so acute, in several cases,, as to require
from three to four bleedings.  The remitting fever was
accompanied by an uncommon degree  of nausea and
faintness.  Several people  died, after a few days illness,
of the malignant bilious fever, or typhus gravior, of Dr.
Cullen.  The intermittents had nothing peculiar  in them,
in their symptoms or method of cure.
  Towards the close of the month, the scarlatina anginosa
made its appearance, chiefly among children. 
244           SCARLATINA ANGINOSA.
   The month of September was cool  and dry, and the
 scarlatina anginosa became epidemic  among  adults as
 well as young people.  In most of the patients who were
 affected by it, it came on with a chilliness and a sickness
 at the stomach, or a vomiting; which last was so invaria-
 bly present, that it was with me a pathognomonic sign of
 the disease.  The matter discharged from the stomach
 was always bile.   The  swelling  of the throat  was in
 some  instances  so  great, as to produce a  difficulty of
 speaking, swallowing, and  breathing. In a few instances,
 the speech was accompanied by a squeaking voice, re-
 sembling that which  attends  the  cynanche  trachealis.
 The ulcers on the tonsils  were deep,  and covered with
 white, and, in some instances, with black sloughs.  In
 several cases, there was  a discharge of a thick  mucus
 from the nose, from the beginning, but it oftener occur-
 red in the decline of the disease, which most frequently
 happened on the fifth day.   Sometimes  the subsiding of
the swelling of the throat was followed by a swelling be-
 hind the ears.
  An eruption on the  skin  generally attended  the symp-
 toms  which have been described.   But  this symptom
 appeared with considerable variety.  In some people it
 preceded, and in  others it followed  the ulcers and swel-
 ling  of the  throat.  In some,  it appeared only  on the
 outside of the throat, and on the breast;  in others, it ap-
 peared chiefly on the limbs.  In a few it appeared on the
 second or third  day of the  disease,  and never returned
 afterwards.  I saw two cases of eruption without a single
 symptom of sore throat.   The face  of one of those pa-
 tients was swelled, as in erisipelas.  In the other, a young
 girl of seven years old, there was only a slight redness on
 the skin.  She was seized with a vomiting, and died de-
 lirious in fifty-four  hours.   Soon after her death, a livid
 colour appeared on the outside of her throat.
  The bowels, in this degree of the  disease, were in
 general regular.   I can recollect but  few cases which
 were attended by a diarrhoea.
  The fever which accompanied the disease was general-
 ly the typhus mitior of Dr. Cullen.   In a few casls it as-
 sumed symptoms of great malignity. 
ACCOUNT OF THE              245
   The disease frequently went off with a swelling of the
hands and feet.  I saw one  instance in a gentlewoman,
in whom this swelling was  absent, who  complained of
very acute pains in  her limbs, resembling  those of the
rheumatism.
   In two cases which terminated fatally, there were large
abscesses; the one on the outside, and the  other on the
inside of the throat.   The first of these cases was accom-
panied by troublesome sores on the-ends  of the fingers.
One of these patients lived twenty-eight, and  the  other
above thirty days,  and both appeared to die from the
discharge which followed the opening of their abscesses.
   Between the  degrees of the disease which  I have de-
scribed, there were many intermediate degrees of indis-
position which belonged to this disease.
   I  saw in several cases a  discharge from behind the
ears,  and from the nose, with a slight eruption, and  no
sore throat.  All these patients were able to sit up, and
walk about.
   I saw one instance of a  discharge from the inside of
one of the ears in a child, who had  ulcers in  his throat,
and the squeaking voice.
   In some, a pain in the jaw, with swellings behind the
ears,  and a slight fever,  constituted the whole of the
disease.
   In one case the disease came on with a coma, and in
several patients it went off with this symptom.
   A few instances occurred of adults, who walked about
and even transacted business, until  a  few hours before
they died.
  The intermitting fever, which  made its appearance in
August, was not lost during the month of September.  It
continued to prevail, but with several peculiar symptoms.
In many persons it was accompanied by an eruption on
the skin, and a swelling of the hands and feet.  In some,
it was  attended  by a sore throat and  pains behind the
ears.   Indeed, such was the  predominance of the scarla-
tina anginosa, that many hundred people complained of
sore throats, without any other symptom of indisposition.
The slightest occasional or exciting cause,  particularly
cold, seldom failed of producing the. disease. 
246          SCARLATINA ANGINOSA.

   The month of October was much cooler than Septem-
ber, and the disease continued, but with less alarming
symptoms.  In several adults, who were seized with it,
the hardness of the pulse  indicated blood-letting.  The
blood in one case, was covered with a buffy coat, but
beneath its surface it was dissolved.
   In the month of November, the disease assumed several
inflammatory symptoms, and was attended with much less
danger than formerly. I visited one patient whose symp-
toms were  so inflammatory as to require two bleedings.
During the decline of the disease, many people complain-
ed of troublesome sores on the  ends of their fingers.  A
number of children likewise had sore throats and fevers,
with eruptions on their skin, which resembled the chicken-
pox. I am disposed to suspect that this eruption was the ef-
fect of a spice of the scarlatina anginosa, as several instances
occurred of patients who  had all the symptoms of this
disease, in whom an eruption of white blisters succeeded
their recovery.  This form of the disease has been called
by Sauvage, the scarlatina  variolosa.
  I saw one  case of sore  throat, which was  succeeded
not only by swelling, in the abdomen and limbs, but by
a catarrh, which brought on a fatal consumption.
  A considerable shock of aYi earthquake was felt on the
29th of this month,  at ten  o'clock at night,  in the city of
Philadelphia ;  but no  change was  perceived in the dis-
ease, in consequence of it.
  In December, January, and February, the weather was
intensely cold.   There  was a thaw for a  few days in
January, which broke the ice of  the Delaware,  but it was
followed by cold so excessive, as to close  the river  till
the beginning of March.  The mercury, on  the 28th and
29th of February, stood  below 0 in Fahrenheit's  ther-
mometer.
   For a few weeks in beginning of December, the dis-
ease disappeared in the  circle of my patients, but it broke
out with great violence the latter end of  that month, and
in the January following.  Some of the  worst  cases that
I met with  (three of which proved fatal) were in  those
two months.
   The disease  disappeared in the spring,  but it spread 
ACCOUNT OF THE              247
afterwards through the neighbouring states of New-Jer-
sey, Delaware, and Maryland.
   I shall now add an account  of the remedies which I
administered in this disease.
   In every case that I was called to, I began the cure by
giving a  vomit joined with calomel.  The  vomit was
either tartar emetic or ipecacuanha, according to the pre-
judices, habits, or constitutions of my patients. A quan-
tity of bile was generally discharged by  this medicine.
Besides evacuating the contents of the stomach, it cleans-
ed the throat  in its passage downwards.  To insure this
effect from the calomel,  I always directed it to be given
mixed with syrup or sugar and water,  so as to diffuse it
generally  over every part of the throat.  The calomel
seldom failed to produce two or three stools.  In several
cases I was obliged, by the continuance of nausea, to re-
peat the emetics^ and always with immediate and obvious
advantage.   I  gave the calomel in  moderate doses  in
every stage of the disease.  To restrain its  purgative ef-
fects, when necessary,  I added to it a small quantity of
opium.
   During the whole  course  of the disease, where the
calomel failed of opening  the bowels, I  gave lenient
purges, when a disposition to costiveness required them.
   The throat was  kept clean by detergent gargles.  In
several instances I saw evident advantages from adding a
few grains of calomel to them.  In cases of great difficul-
ty of swallowing  or breathing, the patients found  relief
from receiving  the steams of warm water  mixed with a
little vinegar, through a funnel into the throat.
   A perspiration kept up by gentle doses of antimonials,
and diluting drinks,  impregnated  with  wine,  always
gave relief.
   In every case which did not yield to the above reme-
dies on the third day, I applied a blister behind each ear,
or one to the  neck, and, I  think, always  with good
effects.
   I met with no cases in which  the bark appeared to be
indicated, except  the three in which the disease proved
fatal.  Where the sore  throat was  blended with the in-
termitting fever,  the  bark was  given with  advantage. 
248             SCARLATINA ANGINOSA.'
But in common cases it was uunecessary.   Subsequent
observations have led me to believe, with Doctor With-
ering, that it is sometimes hurtful in this disease.
  It proved fatal in many  parts of the country,  upon its
first appearance;  but wherever the mode  of treatment
here delivered  was adopted, its mortality was soon check-
ed.   The calomel was used very generally in New-Jer-
sey and New-York.  In the Delaware state, a physician
of character made it a practice not only  to give calomel,
but to anoint  the outside of the throat with mercurial
ointment. 
ADDITIONAL' OBSERVATIONS
UPON THE
        SCARLATINA. ANGINOSA.




  THIS disease had prevailed in Fhiladelphk, al: differ-
ent seasons, ever since the year 1783,  It has blended
itself occasionally with all our epidemics  Many cases
have come under my notice since » j^g"™- £
which dropsical swellings have ^ceed^d tte tever
some instances  there  appeared to be.e™?10"? ,hnrax
ncTonly in the Umbs and abdomen but  in the^thorax.





 with a typmis minor.                    vomiting of
 nine years  of age.  Shenw^erbrelst but discovered no
 bile and an efflorescence £*££#£* till the six-
 TVuTTherfevS whlTswelllig appeared on the
 SriteS ner  thrL, and after her recovery, a pun and

 swelling in one of.1f .^"',. a number of people were
    In the month of July. 1787, ja numo     ^nd%veUds.
 affected by sudden swellings of the.Mips      ^
 These swellings general^ came on.n the n^ ^  wo ^

 tended with little ^nTy o'ne case 'n which there was
VOL. II* 
246        ADDITIONAL OBSERVATIONS.

liberal  use of bark and wine,  proved fatal in the course
of twelve days.
   In the  months  of June and July, 1788, a number of
people  were affected by sudden swellings, not only of the
lips, but of the cheeks  and throat.  At the same time
many  persons were  affected by an inflammation of the
eyes.   The swellings were attended with more pain than
they were the year before, and some of them required
one or  two purges  to remove them ;  but in general they
went off without medicine, in two or three.days.
   Is it proper to refer these complaints to the same cause
which  produces the scarlatina anginosa ?
   The prevalence  of the scarlatina anginosa at the same
time in this city ;  its disposition to produce swellings in
different parts of the  body; and the analogy of the in-
termitting fever, which often conceals itself under symp-
toms that are foreign to its usual type, all seem to render
this conjecture probable.  In one of the cases of an in-
flammation of the eye,  which came under my notice, the
patient was affected by vomiting a few hours before the
inflammation appeared,  and  complained of a  sickness at
his stomach for two or  three  days afterwards.  Now a
vomiting and nausta appear to be very generally symp«
toms of the scarlatina anginosa.
   In the  autumn of 1788, the  scarlatina  anginosa ap-
peared with different degrees  of violence in many parts
of the city.   In two instances it appeared with an obsti-
nate diarrhoea ;  but it  was in young subjects, and  not in
adults as described by Doctor  Withering.  In both cases,
the disease proved fatal; the one on the third, the other
on the fifth day.
   In the month of December of the same year,  I  saw
 one case in which a running from one of the ears, and a
 deafness came on, on the fifth day, immediately after the
 discharge of mucus from the nose had ceased. This case
 terminated favourably on the ninth day;  but was suc-
 ceeded, for several days  afterwards by  a troublesome
 cough.
   I shall conclude this essay by the following remarks :
    1.  Camphor  has often been suspended in  a bag from
 the neck, as a preservative against this disease.  Repeated 
         UT0N THE SCARLATINA ANGINOSA.      247

observations have taught me, that  it possesses, little or
no efficacy for this purpose.   I have had reason  to enter-
tain a more favourable opinion of the benefit of washing
the hands and face with vinegar, and of rinsing the mouth
and  throat  with  vinegar and water every morning, as
means of preventing  this disease.
  2.  Whenever  I  have been called to  a patient where
the scarlatina appeared to be in a forming  state, a vomit
of ipecacuannha  or  tartar emetic, mixed with  a few
grains of colomel, has never  failed of completely check-
ing the disease, or of so far mitigating its violence, as to.
dispose it to a favourable issue in a few days ; and if these
observations should serve no other purpose than to awaken
the early attention of patients and physicians to this speedy
and effectual remedy, they will not have been recorded in
vain.
  3.  When the  matter which produces this disease has
been received into the body, a purge has prevented its
being excited into action, or rendered it mild, throughout
a whole family.   For this practice I am indebted to some
observations on the scarlatina, published by Dr. Sims in
in the first volume of the Medical Memoirs.
  4.  During the  prevalence of the inaflmmatory consti-
tution of the atmosphere,  between  the  years 1793 and
1800, this disease occurred occasionally in Philadelphia,
and yielded, like  the other epidemics of those years, to
copious blood-letting, and other depleting remedies. 
T

rn: :.. 
     AN ACCOUNT






           OF







  THE MEASLES,





          AS THEY







APPEARED  IN PHILADELPHU,






       IN THE SPRING OF 1719. 
,    „A
* jl *.* 1 
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 thermometer 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 was very cold.   The mercury fluc-
tuated during these days between 4° and 10° above 0.
   In  the  intervals between these cold days* the weather
frequently  moderated, so that the Delaware was frozen
and thawed not less than  four times.   It was not naviga-
ble 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 backward spring.
The peaches  failed almost universally.  There were no
strawberries or cherries  on the 24th  of May,  and every
other vegetable product was equally backward. A coun-
try woman of 84 years  of age informed me, that it was
the coldest spring she had ever known.  It was uncom-
fortable to sit  without fire till the first  of June.
   The measles appeared first in the Northern Liberties,
in December.  They spread slowly in January, and were
not universal in the city till February 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  occur-
red, in some instances, several days before the  fever, but 
256             AN ACCOUNT OF THE
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 Jamaica.  I shall now proceed to mention the symp-
toms  of the measles as they appeared in the different
parts of the body.
  1. In the head, they produced great pain, swelling 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  convulsions.  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 a copious  expectoration.  In two cases,  I
saw a constant involuntary  discharge of phlegm and mu-
cus from the mouth,  without any cough.   One of them
terminated 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 erup-
tion made its appearance on the fourth day, and one which
was accompanied by all the usual symptoms of the cynan-
che trachealis.
  3. In  the stomach the measles produced in many instan-
ces, sickness and  vomiting.  And
  4. In the bowels, griping, diarrhoea, and in some instan-
ces, bloody stools. The diarrhoea oc urred 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.                                   J
  There was a  great variety in this disease.   1.  In  the
time of the attack of the fever, from the time of the recep-
tion  of the contagion.   In general the interval  was four- 
MEASLES IN 1789.              257
teen days, but it frequently appeared before, and some-
times later than that period.
   2.  In the time of the  eruption,  from the beginning 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.
   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 mortification.   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 families
who were  exposed to it.
   The  symptoms which continued in many after the
retrocession of the measles, were cough,  hoarseness,  or
complete aphonia, which continued in two cases for two
weeks ; also diarrhoea, ophthalmy, a bad taste in  the
mouth,  a defect or excess of appetite, and a fever, which
in some instances was of  the intermittent kind, but which
in more assumed the more dangerous form of the typhus
mitior.  Two  cases of internal dropsy of the brain followed
them.  One was evidently excited by a fall.  They both
ended fatally.
  During the prevalence of the disease I observed seve-
ral persons (who had  had the measles, and who were
closely confined to the rooms of persons ill with them)
to be affected with a slight cough, sore throat,  and even
sores in the mouth.  I find a similar fact taken notice of
by Dr. Quier.
  But I observed further, many children to be affected
by a fever, cough, and all the other  symptoms of the
measles which have  been mentioned,  except a general
   vol.  ii.                K k 
258             AN ACCOUNT OF THE
 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
 " catarrh (for  by that name I then called it) appeared 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."
   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 per-
 " sons, 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 com-
 mon fever, marked by  the reigning epidemic, and pro-
 duced in the same manner, and by the same causes, as
 the variolous fever described 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 in a boy
 of ten years old, with all the symptoms which attend that
 disease when it  follows the regular measles.

 tw\ II afflCted a Culd  in, °ne family' on the same dav
 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, 
MEASLES IN 1789.              259
  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 persons who  have
had them what are called the nurse pock.  They follow
likewise the analogy of another disease, viz. the  scarlatina
anginosa.  In the account  of the  epidemic for 1773,
published in the third volume of 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 pre-
viously had the sore throat had a  scarlet eruption,  but
the throat remained free  from  the distemper.  All other
persons who were affected had both.
  From these facts, I have taken the  liberty of calling it
the internal measles,  to distinguish it from those which
are external.  I think the discovery of  this new state of
this disease of some application to practice.
   1. It will lead us to be cautious in declaring any dis-
ease 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 dis-
honourable  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 impossible, for that  I had in 1783  attended her for
the same disease.  I suspect the anonymous author be-
fore-mentioned has fallen into the same error.  He adds
to the account before quoted the following words. " Others
" who had undergone the measles formerly,  had  at this
" time a fever of the erysepelatous kind,  with eruptions
" like  to  which nettles cause, and all the previous and
" concomitant symptoms of the  measles, from the begin-
" ning to the end of the disease.
   2. If inoculation, or any  other mode of lessening 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 exposed to it. 
260
AN ACCOUNT OF THE
   I shall  now  add a short account of my method of
 treating this disease.
   Many hundred families came through the disease with-
 out 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 succeed-
 ing spring.  Dr. Huxham says, he once saw the measles
 attended with peculiar mortality, during  a late cold and
 damp spring in England.  It was  much  more fatal (ce-
 teris 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 1 found it necessary
 to repeat this remedy.   But 1 met with many cases  in
 which it  was forbidden by the weakness of the  pulse, and
 by other marks of a feeble action in the blood-vessels.
  2. Vomits.  These were very useful  in removing a
 nausea;  they  likewise  favoured  the  eruption  of the
 measles.
  3. Demulcent  and diluting drinks.   These were bar-
ley water, bran, and flaxseed tea, dried  cherry and raw
apple water, also beverage, and  cider 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, accord-
ing 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 troublesome cough
 or diarrhoea attended.
  6. Where a catarrhal  fever ensued,  I  used  bleeding
 and blisters.  In those cases  in which this fever termi-
 nated in an  intermittent, or in a mild typhus fever 1 gave
 the bark with evident advantage. In that case of measles
 formerly  mentioned, which was accompanied by symo'
 toms  of  cynanche  trachealis, I  gave calomel with the
 happiest effects.  In the admission oi fresh air  I observ
 ed a medium as to its temperature, and accommodated
 it to the  degrees of action in the system.   In different 
MEASLES IN 1789.
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 inflam-
matory small-pox. The same people who were so much
benefitted  by cool air, I was informed, 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 advantages arose in all the
cases which I attended,  from patients leaving their beds
in the febrile state of this disease.  But this was practis-
ed only by those in whom inflammatory diathesis prevail-
ed, for these alone had strength enough to bear it.
  The convalescent state of this disease required  particu-
lar attention.
   1.  A diarrhoea often continued to be troublesome after
other  symptoms  had abated.  I relieved  it by opiates
and demulcent drinks.   Bleeding has been recommend-
ed  for it, but I did not find it necessary in a single case.
  2.  An ophthalmia 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 vegetable 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 gentle 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,







IN THE AUTUMN OF 1789, IN THE SPRING OF 1790. AND IN THE WINTER OF 1791. 
n
I 
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 after it ended, there had  been no
 rain. In the beginning of October, a number of the mem-
 bers of the first congress, that had assembled in New-York,
 under the present national government, arrived in Philadel-
 phia, 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  were 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 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 weari-
 ness, 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 dis-
 charged themselves through the nose.   The pain in one
 of these cases, before the rupture of the abscess,  was so
 exquisite  that my patient informed me that he felt as if
 he should lose his reason.   Many complained  of  a great
 itching in the eye-lids.  In some, the eye-lids were swel-
led.   In  others, a copious effusion of water took place
from the eyes; and in a few, there was a true ophthalmia.

  VOL. II.                 L I 
*66
OF THE INFLUENZA
Many complained 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 swelling 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 to inflame the nostrils and the up-
per lip, in such a manner as to  bring on swellings, sores,
and scabs in may 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 diffi-
cult.   In  some, there was a total defect  of taste.  In
others, there was a bad taste in the mouth,  which fre-
quently continued through the whole course of the dis-
ease.   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  swclled-jaws, and  many
complained  of  the tooth-ach.  I saw  only one case in
which the disease produced a coma.
  Many were affected with 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
patients in whom the disease affected  the trachea chiefly,
producing great difficulty of breathing, and, in one case,
a suppression of the voice, and I heard of  another in
which  the disease,  by  falling on the trachea, produced a
cynanche trachealis.  In most of the cases which termi-
nated fatally, the patients died of pneumonia notha.
  The stomach was sometimes  affected by nausea and
vomiting ; but this was far from being a universal symp-
tom.                                              l
  1 met with four cases  in which the whole force of the 
in 1789, 1790, and 1791.          $67
disease fell upon the bvweis, and went off in a diarrhoea;
but in general the bowels were regular 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.
  There was no appearance in the urine different from
what is common in all fevers.
  The disease had evident remissions, and the fever sel-
dom continued above three or four days: but the cough,
and some other troublesome symptoms, sometimes con-
tinued two or three weeks.
  In a few persons, the fever terminated in a tedious and
dangerous typhus.
  In  several pregnant women it produced uterine  he*
morrhages and abortions.
  It  affected adults of both sexes  alike.   A few  old
people escaped it.   It passed  by children  under eight
years old with a few exceptions.  Out of five  and thirty
maniacs in the Pennsylvania hospital,  but three were af-
fected by it.  No profession 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.*
  Even previous and existing diseases did not protect
patients  from it.   It insinuated into sick chambers, and
blended itself with every species of chronic 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

  * Mr. Howard informs us that the use of tobacco is not a preservative
against the plague, as has formerly been supposed ; of course that apolo-
gy for the use of an offensive weed should not be admitted. 
268              OF THE INFLUENZA

who worked within doors.   A body of  surveyors, in the
eastern woods of Pennsylvania, suffered extremely from
it.  Even the vigour of constitution which is  imparted
by  the savage life did not mitigate  its violence.  Mr.
Andrew  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 this disease was 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 Philadel-
phia,  took it a  second time in New-York, and a third
time upon her return to Philadelphia.
  Many thousand people had the disease, who were not
confined to their houses, but transacted business 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 ser-
vice scarcely intelligible in  the churches.
  A few persons who were exposed to  the disease escap-
ed it, and some had it so lightly  as  scarcely to be sensi-
ble of it.  Of the persons who were  confined  to their
houses, not a fourth part of them kept their beds.
   It proved fatal (with few exceptions) only to old peo-
ple, and to  persons who had  been previously debilitated
by consumptive  complaints.   It likewise  carried  off
 several hard drinkers.   It  terminated in asthma in three
 persons  whose  cases came under my notice, and in pul-
 monary  consumption, in many more.  I  met with an in-
 stance  in  a lady,  who was  much relieved of a chronic
 complaint in her liver; and 1 heard of another  instance
 of a clergyman whose general health was much improved
 by a severe attack of this disease.
    It was not wholly confined to the human species.  It
 affected two cats,  two house-dogs, and one  horse, with-
 in the sphere of my observations.   One of the dogs dis- 
in 1789, 1790, and 1791.          269
turbed 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 ap-
peared again after the influenza left the city.   Nor was
the remitting  fever  seen during the prevalence of the
reigning epidemic.
   I inoculated about twenty children for the small-pox
during  this prevalence of the influenza, and never saw
that disease exhibit a more favourable appearance.
   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 mo-
derate  bleeding.  In a  few  cases  in which the  symp-
toms of pneumony attended, I bled a second time with
advantage.  In all these  instances of inflammatory affec-
tion, 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 forbade
every kind of evacuation.   I saw several instances of
persons who had languished for a week or  two with the
disease, who were  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 suspending the  cough, but by easing  the pains
in the bones.
    I met with a case of an old lady who was suddenly and
 perfectly 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 
270             OF THE  INFLUENZA.

the United  States to  several  of the West-India isl-
ands.   It  prevailed in the  island  of Grenada in the
month of November, 1789, and  it was  heard of in trie
course of the ensuing winter in  the Spanish settlements
in South-America.
  The following  winter was unusually mild,  insomucn
that the navigation of the Delaware was not interrupted
during the whole season, only from the seventh to the
twenty-fourth of February.   The weather on the third
and fourth  days of March was  very cold, and on the
eighth and ninth days of the same month, the mercury
in Fahrenheit's thermometer stood at 4° at seven o'clock
in the morning.   On the tenth and eleventh, there  fell
a deep snow.   The weather during the remaining part
of the month was cold, rainy, and variable.   It conti-
nued to be variable during the  month of April.   About
the middle of the month there  fell an unusual quantity
of rain.   The  showers which  fell on the night of the
seventeenth will long  be connected in the memories of
the citizens of Philadelphia with the time of the death
of the celebrated  Dr.  Franklin.   Several pleurisies ap-
peared during this month  ; also a few cases of measles.
In the last week  of the month the influenza made  its
appearance.   It  was  brought to the city  from  New-
England, and affected, in its  course, ali the  intermedi-
ate states.  Its symptoms were nearly the same as they
were  in the preceding autumn, but in many people 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 window.
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.  Several  complained of constant  chills, or con-
stant  sweats;  and some  were much alarmed by an un-
common blue and dark  colour  in their hands.   I saw
 one case of ischuria, another of an acute pain in  the
 rectum, a  third  of anasarca,  and a fourth of a palsy 
              in 1789, 1790, and 1791.          271

in the tongue and arms;  all of which appeared 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
remedy than plentiful bleeding.  A patient of Dr.  Sa-
muel Duffield informed  me,  after his recovery,  that
he had had no other symptom of the disease  than an
efflorescence on his skin, and a large swelling in his groin,
which terminated in a tedious abscess.
   The prisoners in the jail who had it in the autumn, es-
caped 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  twelfth 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.
   I remarked that  purges of all kinds worked more vio-
lently than usual in this disease.
   The convalescence from it was very slow, and a gene-
ral 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 seventeenth, on which day  the 
 272             OF  THE INFLUENZA.

 navigation  of the Delaware,  which  had  been  com-
 pletely obstructed by the  ice, was opened so as to admit
 of the arrival of several  vessels.   During the month of
 December many people complained 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 influenza.   This  suspicion was soon confirmed
 by accounts 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  inflamma-
 tory diseases of the winter bore the lancet as usual, it
 was remarked that patients who were attacked by the  in-
 fluenza, 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 qualities 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  greatest 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 are upon
record, that  neither  climate,  nor  the  different states
of society,^ have produced any material change in the
 disease.  This will  appear  from  comparing the ac*
 count  I have  given,  with the 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  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
physicians. 
              in 1789, 1790,Vand 1791.  #■*    273

   I have hinted in a former  essay at  the1' 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 morbid  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 im-
pressions of water colours.
END OF THE  SECOND VOLUME.