AN ESS On the Bilious, or Yellow FEVER O F T A M A I C=~A._ ■*"*T Petet autem novum quoque confilium^ non ho rebuTtalentihus {ijia'enim dubia & incerta funt) fed ab his, qua explorari pojfunt ; id e/lt evidentibus Caufn. A Corn. Celsi. Praf. J A By JOHN WILLIAMS. Xivcston: Printed, by William Daniell, Printer and Book- ^Uer, at the New General Printing Office, the Corner oiJFa- fQk'm in King Street, near the Court Houfe, 175c. \*w • PREFACE. THAT no one hath yet endeavoured to ex- plain to the Public the Nature and Cau- fes of this fatal bilious, or yellow Fever ©/"Jamaica, is fomewhat Strange; and it is the more- Surprizing as we have hadPhyficians capable of doing it. Sure fuch a Task would not be unworthy of thofe learned Gentlemen Fortune hath placed above the necejjity ofpraftifing Phyfick for a livelyhoodl Tome it appears a Debt due to Mankind from every capable Perjon to communicate what may be ufefulto Society ; and more particularly what tenaf. to the immediate prefervation of the Species* When I have talked with fome judicious Gentle- men about the Nature and Caufes of this Fever;: and mentionyd my dejign of writing upon the SubjeSi j the Anfwer I commonly received was, That the Difeaie was fufficiently known ; but lit- tle could be done for the Patient: And that, in its greater Degree, this Fever was generally incurable. But as Lord Bacon obferves, to declare Difeafes incurable is toeftablifh Negligence and Careleffnefsi as it were by Law, ai*d to fcreen Ignorance from HOC iv PREFACE. Reproach*. Whether the following Sheet* win give any Light into this Difordtr ; or whether the real Nature and Caufes of this Difeafe; together with the proper Method of treating it* are pointed out, I leave ttcapablejudgesto deter rmm* Be-the Sue eft A new Comer whofe Head is fiWd with Theory and darlingHypothefes, byfome will be trufted before a Man who like honeft and carefull Sydenham hath made himfelf acquainted with the Difeafes of the Country, and prudently follows the Vejligia of Na- ture; never facrificing bis Patient to any favou* rite Hypothecs. Another Jhocking Confederation is, that Reputation in the practice of Phyfick is not acquired by medi- cinal Knowledge, Experience, and thofe Accomplijh- tnents which render a Phyfician ju(lly eminent in 0- thet t Qbaf, j. Stti. 20, tfacittt Difim&rh vf PREFACE. ther Places, but to the fanguine Endeavours of Party; fo that Men's Lives are facrificed to pique and prejudice; and that noble and ufefull Art the practice of Medicine (heretofore the ftudy of Princes) is now proflituted to the bafejl Ends I To releive a fellow Creature languifhing under Difeafe or tortured with excruciatingPains, is great and Godlike! And whofoever is capable of doing this, mujl in the exercife of his Profeffion (in my Opinion) enjoy the great eft Pleafure the human Mind is capable of The Honourable AJfembly hath wifely confidered that the gond, welfare and fecurity of this IJland depends greatly on the increafe of its white Inhabi- tants ; and to that End hath given (according to the accuflom'dgoodnefs and generofty of that Ho- nourable Houfe) the greateft Encouragement ever was given to Strangers to become Settlers in this Ifland. Andfhould not we as ardently feek after* Means to keep them alive when they do come here f I have feen feveral melancholy Inftances of Strangers who, upon their fir ft Arrival, by walking too brifkly, and carelejly expofmg themfelves to the meridian Sun have fallen into this Fever. Strangers have too great a prejudice to our IJland which I would willingly remove byjhewing them we ■ fazve no malignant or infectious. Air (as is general* ly imagind) but that the worjl of our Diforders are caufed by Errors in the Nonnaturals which mqy be PREFACE, vii 'Be avoided $ and prtedifpofing Caufes in Northern Bodies which may foon be removed: And that this Fever of which they have fo dreadful an Idea may be prevented, or cured. Many Obfervations and Cafes (feveral of which I have by me) might be added: But what is alrea* dy wrote may be fufficient for afirft Effays I conclude with addrefjlng myfelf to the Reader in that trite Quotation from Horace. Vive; vale, fi quid novifti reftius iftis, Candius imperti : Si non, his utere mecum, <§*@ At* V-L ../■ ' * . .- « "^Z^i -^-kii Vj^ \rJ^Z, S^S V^. Vo^,'!* >»^ \ ^XtkZ* V>-ii Sa*^ s»^4« S*i<#f*)*S~ AJww >T< >p tt t t *r j?1 y 41 ^* t 7 T t t t *V ^y^T^T-*!1 *r *y *r *T ^T* *T* ff1 *T-*r tttt T ^V T H*1^ A N ESSAY ON THE fiiLioos' Fever, &V, "HE bilious, or yellow Fever, fo called from the yellow Ap- pearance of the Skin fcom- monly moft remarkable in the Tunica conjunctiva) feems to be a Difeafe not unknown to the antient Phyficians, as is gene- rally fiippofed: For whoever will take the Trouble to fearch Hippocrates, will not only find this Fever pretty well delcribed, but ,alfo a proper Method of treating it. In his Book de Ajfetfionibus, he mentions a ■Fever with a Pain about the Procardia and Hypo- chonders, particularly the right in the Region of the Liver; and when on the 81 fourth or fifth Day, the Fever h more violent, the Pains mcreafe and the Patient appears fomewhat bilious or yel- B low. ( io ) low. And in his Epidemics in the third Confti- . titution in Thafus he mentions ardent Fevers, in which a Jaundice came on on the fixth Day: Thefe were relieved by a critical Di("charge by Stool, or Urine, or Haemorhage from the Nofe, or altogether; as he inftances in his Patient He- raclides. The twelfth Patient, in the third Book of popular Difeafes, was feized with a violent Fe- ver in the begining, which ended with all the Symptoms of our yellow Fever, black Vomiting, Hiccup and bleeding at the Nofe. This Author mentions frequently thofe Symp- toms, which are reckoned the Diagnoftics or dif- tinguifhing Marks of this Difeafe, as the Vomit- ing of black Humours, which he fays indicates fud- ,den Death * and a Fever with a concomitant Jaun- dice J which he reprefents as dangerous if the Jaun- dice comes on foon f which Remark holds good here: And further he adds in the fame Aphonfm, that in this Cafe a loofe Belly is favourable. This alfoholds good in Jamaica for a fpontaneous Dia- rhcea coming on in the beginning of this Fever is always ferviceable ; and it proves very dangeroua to flop it with Opiates or Alexipharmicks. In* deed the Fevers defcribed by Hippocrates were not fo foon determined j nor were his bilious or yellow Fevers fo acute as ours ; they ter- minating commonly in feven or nine Days, || fometimes in fourteen : This Difference probably ■** is * Lib. Pranot. % I Epidem. it izo.de Crif,\m. 20 Apt* 4, 64. de Crif.-m. 5, 18, iv. 11. Coac.'x. 172. Aph. bz, See. 4. f $uibut per Febres Morbus ngius ante Diemftptimum Obartms futrit* mlu>* \ De Ajfefr aii. g. (II) is to he attributed to the Difference of Climate and Manner of living. Celfus the Prince of the Latin Phyficians men- tions particularly the Vomiting of black Hu- mours, || and fays in this Cafe the Belly ought to be moved, f Amongft later Authors, I think Hoffman de- scribes an ardent bilious Fever much like ours; and alfo the choleric Fever which we frequently have here in the latter End of the Year. X I do not apprehend this Fever is what we call a local Diforder ; for I have feen it upon the Coaft of Africa, and am well informed that in the Ri- ver Benin they have a bilious or yellow Fever a- cuter than what it was here at the Time of the Expedition to Carthagena: The Perfons feized with this Fever dying there in left than twenty four Hours. This Diforder is generally brought on by fuddenly cooling the Body and checking- Ferfpiration after hard Exercife in the Heat of the Sun ; for when the Sailors go to cut Wood for the Ships ufe, they are obliged to row feveral Leagues againft a Current and th§n jump into the Water in order to t:arry the Wood on Shoar.' Bontius gives an Account of fuch a Fever in the Eafl-Indies. Nor does this Fever appear to have any particular Conftitution ; for we have it at all. Seafons of the Year, and one of the higheft Cafes I ever faw was that of "a Gentleman who had it at a Time no other Perfon laboured under it. B 2 This || Pejpmum eji Atrttm vomere. ■j- Hit rtQe al'Out ducitur. % De Ftbribut aeutit, Sec, z. Ch£\ a. ' ( w )■ This Fever being fo general rand fatal at the Time of the Expedition, People looked upon it as a.Plague, and fhunn'd. the Sick as they would Contagion. And probably at that Time it might be contagious, for as Bellini obferves " Febris Pef- cf tilens cum nempe Febris maligna privata, fit Po- " pularis, eorum quos'invadit pier of que necans £f " contagiofa." As to that Phenomenon yellownefs of the Skin it ought not always to be reckoned a diftinguifh- ing -Mark of this-Fever, becaufe it is a common Appearance in all Fevers where there is a ftrorfg Eropenfity of the Juices to Putrifaction, as the ce- lebrated -Boerhaave takes Notice f. Indeed in the bilious. Fevers there.is a deeper and more remark- able yellownefs; and perhaps Galen's Opinion may be right when he fays, * The Bile offends * more -or kfs in all Fevers. ' Be that«s it will, I have obfervedin the Carribee IJlands and North America, different Sorts of yellow Fevers. Nay even in this Ifland of Jamaica! have obferved different yellow Fevers: For in the Year 1744, after the Hurricane, feveral Perfons laboured un- der a-putrid remitting yellow Fever, arifing from a manifeft Change of the Air. In this. Fever which I called a centralFever, dangerous nervous Symptoms foon came on, and Blifters, Camphire and Snake-root were ferviceable: For the Pulfe was low and opprefs'd and the Extremities cool. So there cannot be a greater, tho' general mil- take, than to imagine all yellow Fevers of the fame »*——^»——— ■ ■ _^^—_— . f Homo qui humorum JwtndineUdnrat 6tnfer f-cwefciriu&tt tfC teriori,* Pea*. Med. * C*3-> ■*&mtt*enus-t -and that they Thotild be all treated .in the fame Manner, as mall be obferved below. Many purfue Doctor WarrenH fudorific Me- thod both in the Iflands, and on the Continent of ^America, in fome Parts it anfwers, in others is deftructive. Laudatur ab his, culpatur ab Mis. Several Practitioners object againft this Method .in different. Places as too hot j being, it feems, convinced by their bad Succefs that it will not anfwer, yet all apprehending but one Sort of yel- Jow Fever, they follow implicitly Doctor War- ren's Method or fome other they are prejudiced in Favour of by hearfay only, and proceed, very ^frequently, contrary to the Endeavours of Nature and Indications of the Pulfe deftroyingthe Patient Jecundem Artem: fatal Miftake ! Doctor Warren wrote concerning a malignant Fever in Barbadoes, and I dont doubt but that ju- dicious Gentleman hath laid down the beft Me- thod he knew of treating it. I never read the ^Treatife; but I had fome Acquaintance with the Gentleman, and believe he juftly merited the great Character he bore. Shall the yellow Fever of Jamaica agreeing /perhaps only in one Phenomenon (yellownefs) with that of Barbadoes j or the Fever on the Con- tinent (may be a third Species of yellow Fever) be treated after the fame Method, when Experience, the beft Gu/ide, convinces us they require different •Methods of Curet For Inftance, thofe feiz'd with this»£ever in ffamaka generally have a full fre- quent ( 14) quent Pulfe to the very laft; nor is it funk much , by Evacuations; which in the Beginning they bear very well. A cooling Regimen, folutive and diluting Medicines fucceed beft, and the Difeafe foon arrives to its Acme ox State, and con- sequently is foon determined. In Virginia and other Parts of the Continent, the Pulfe finks fo as to be vermicular or fcarce per- ceptible whether you ufe Evacuations or no. The ftrongeft Alexipharmics and Sudorifics (which given in Jamaica in this ardent Fever I treat of would bring on a Delirium oxPhrenzy, and deftroy the Patient) will fcarce raife the Pulfe tho' given in immoderate Dofes. In Virginia, we are to promote, at all Events, xhtConcoclion of the febrile Matter by the Ufe of Alexipharmicks and Sudorifics, although by thefe we tranflate that fe- brile Matter to the Brain, bring on a Coma or De- lirium, which is often the Cafe, we mull keep up the Pulfe until the Crifis; which generally happens on the feventh, ninth, and fometimes the eleventh Day. In Jamaica all we can do is little enough to fupprefs the Fever; we give all fuch Things as powerfully cool, and condenfe the Blood, thereby preventing the Formation of the Fever. In Virginia nothing is fo ferviceable in the Re- mifTions as the Peruvian Bark, or even in the Height of the Fever 'after its firft Stadium) with- out^ Regard to the Exacerbations or RemifTions which, by the Way, is contrary to Practice. In Jamaica the Bark in all Forms hath fre- quently been tried in the RemifTions, but with- out Succefe. Incteed it generally does much Harm. Are ( 15 ) Arenot thefe Difeafes and Methods of Cure dia- metrically oppofite to each other ? yet are they both yellow Fevers. What hath been faid may be fufTicient to prove that there are different yellow Fevers; and that yellownefs of the Skin is not always-a diftinguifh- ing Mark of, and particular to this ardent bi- lious Fever. Let us now confider the Nature and Caufes of this dreadful Fever of Jamaica, heretofore fo fatal to Strangers. Let us trace it up to its O- rigin if we can : For, as the great Doctor Mead obferves X, " The firft Step towards the Cure of a " Difeafe is to know its Origin. " Let us then reafon from Effects to their Caufes, that is from the prefent Symptoms or Appearances, let us find the real Difeafe: at leaft let us honeftly endeavour it for the good of our fellow Creatures. We firft know by Experience what Evacuations Medicines and Regimen fucceed beft in this Dif- eafe: And then, as judicious Sydenham obferves, we endeavour from the Nature of the Diforder to account for their Effects. The diftinguilhing Symptoms, or Diagnoftics of this Diforder are, befides what is common to Fe-, vers, great Anxiety, Heat and Pain at the Scro- biculum Cordis-, proceeding from an Obftruction of the Bile and fomeDegree of Inflammation of the Liver which frequently caufes a Jaundice, bilious Vomitings, or Ejections, or both j fometimes an acute, fometimes a denfe Pain about the Region ef the Liver, all manifeft Signs of Inflammation and ^ Pre/ate to bit EJJay on Poijonh ( 16 ) and ltrong Propensity of the Juices fo Putrifae-'. tion. Sometimes we find the right Hypochonder tumified, trcquently hard. Many cannot bear Preflure on the right Side, or to lie on the left, as may be obferved on proper Examination, and a nice Attention to the ComDlaints of the Patient. From thefe Symptoms to worfe, —- ftrong and continual Convulfions of the Diaphragma inter-* coftal Mufcles, and Stomach, iEruginofe Vomit- ings, ---then vomiting of black aduft Bloody appearing like the Grounds of Coffee mixed with a*ci id unfinifhed Bile, the Juices of the Stomach- and Pancreas both very fharp,----bleeding from the Emunctories, or Delirium, or Phrenzy, ge- neral gangrene and Death. Thefe are indeed- dreadful Symptoms; but thefe it is our Bufinefs to prevent, and I apprehend we may point out Caufes adequate to thefe Effects, without accufing our Air of Malignancy; without the aliquid Di- vinum of Hippocrates, or occult Venom &ct and that in a plain and mechanical Manner. I am not ignorant, that to underftand the re- mote Caufes of Difeafes, as what they call the; morbific Difpofition of the Ait", the poifonous Effluvia or fubtle Miafmata that occafion Feversv or are faid to occafion them, nor that particular bad Contexture of the contaminated Juices confe- quent, is not abfolutely neceffary to the Cure of Fevers. As Pitcairn obferves, " No Matter whe- '.' ther Fevers are occafioned by the Miafma from " without, or the Humours be changed within *« to morbific Matter, for all Things will happei* " in the fame Manner." h ( »7 ) It is fufficient if we know how to remove that Dyicracy of the Blood, to alter or to divide and attenuate the preternatural Cohefions, correct its Acrimony ; and render it foft, fmooth and bal- famic as in a State of Health. It is enough ge- nerally if we underftand the prefent Phenomena and can afcertain its Genus by the prefent conco- mitant Symptoms. Yet I believe it will not be denied, that fometimes a Knowledge of the re- mote and primary Caufes ferves to illuftrate the Nature of the Diforder; and from that Know- ledge we may pofiibly draw Indications for the Cure. The Caufes of this Fever feem to be a fuddea Check to Perfpiration, a Redundancy of Bile, than which nothing is more likely to happen to Strangers, furely a moft dangerous Plethora \ Stoppage of fome natural Evacuations, drinking large Draughts of cool Liquors when the Body is overheated, vehement Exercife, hard Drinking, &c. but above all, Exercife that is violent or long continued in the Heat of the Sun. Among the Praedifpofing Caufes we may rec- kon the rigid Fibres and thick Blood of Europeans and North Americans, their almoft callous Pores which wiU not permit, it the ExprefTion may be ufed, an Evaporation equal to the effervefence raifed within j whence the thin fine parts only are drained of, or tranfude, whilft the more grofs and fuliginous are confined in the VefTels, or block up the PaJTages. Thele are, at leaft in my Opinion, fufficient Caufes to deduce all the dreadful Symptoms from ( 18 ) we fee in the yellow Fever, without having re- fource to Malignancy, or occult Venom, &c. e. g. Should a Perfon fanguine and plethoric with rigid Fibres and ftiff contracted Pores (as moft of the Northern People have) ufe any vehe- ment Exercife in the Heat of the Sun j by this Heat, and the Action of the Mufcles, the Blood would be greatly rarified, and the Celerity of its Motion increaled ; now the Tenfe mufcular Coats of the Arteries ftrongly conti acting, impel for- ward the Blood heated and rarified, fafter than it can pafs into the Veins; the thiner fine Fluids from the extreme VefTels on the Surface of the Body are in a great Meaiure exhaufted : For this Confumption, as Santtorius takes Notice X muft be the Confeqnence of any violet) t Exeicile : And here can be only of the finer Fluids ; for, as was before obferved, the Pores are too ftiff, ip ingy and contracted to admit through the gi offer Particles, whence the Serum is infpiflated ; ind by the increafed Velocity of the Blood's Motion too intimately mix'd and blended with the Craf- famentum; and the more fo as the thinner Parts are more exhaufted; whence its difpofition to ftagnate, ftop to the Circulation of the Lymph, ge- neral glandular Obftruction. Or, which is often the Cale I beleive, when the Blood is rarified and ex- panded beyond the natural Diameter of the Vef- fels, the Arteries forcibly, and perhaps fuddenly contracting, force fome of the globular Part of the Blood into the Arteria ferofa p'rimi G»- fxris t Exerdtium Ammi is Corporis vMettfim rtddtt Corpora iei/iorii ( '9 ) neris, their Coats being un; h !efs capable of Refif- tance tlian tne (anguine Harries conlequL-ntly the more liable to diftend: And fome Part of the yellow Serum in the Vaja fir of a primi Generis, is forced into the ftill finer und weaker VefTels Arteria ferofia fecundt vel tertii Generis, or Vafa Lymphatica; whence tnat moderate yellowneis in the Begining of this Fever. The Liver, which is a foft and yeilding Vifcus, being lefs capable of Refiftance than many other Parts of the Body, the heated rarified Blood is thruft into it in greater Quantity than ufualj and fome part of the Biood is forced into the lateral VefTels of the vena Porta along with the Bile; whence a partial Obftrudtion, and inflammation of tne Liver. The Bile is regurgitated by the Ven$ cava whence a Jaundice, a deeper yellow. From this Extravafation, or ingrefs of Fluids, whole compounding Parts are too large to pafs the VefTels, muft arife a moft dangerous glandu- ler Obftrudtion, ftop to the Circulation of the Lymph &c. and of Confequence a dangerous Fe- ver: For the Biood now hath no longer Lymph to cool and dilute it ; But is rendered more acrid by the Mixture of the Bile ; whence a Putrifaction of the Juices, an Erofion of the VefTels; or great Relaxation from the long continuedP/^/wv?; their contractile reftitutive Power being almoft totaly deftroy'd; as well as the Texture of the Blood ; whence bleeding from all the lateral VefTels general gangrene, Death. That this Extravafation of the Blood frequently •happens; nay a rupture of the Arteries themfelves, (whofe Coats abear a much greater Proportion to C 2 thehr ( 2°) their Diameters than the Arteria ferofa primi Ge* r-'ris •, And thefe again bear a much greater Pro- portion to their Diameters than the Arteria (errfa fecund: vel tcrtii Generis &c.) is pretty evident; for feveral Perfons have dropp'd down dead through exccflive Heat of the Sun in Philadelphia and other Countries where the great Heats are not fo ulual, nor Fibres fufriciently relaxed to give way to the fudden Expanfion of the Blood in the carotid and cervical Arteries, Several after Fighting or other vehement Exercife, have died appoplectic by drinking cold Water, or cooling too (uddenly ; which proceeded from too ludden a Contraction of the Arteries before mentioned, with their too great fpringinefs and ftiffhefs; for did they fuffi- ciently dilate to the expanfive Force of the Blood this would not happen. Where this Extravafation happens within the Cranium, it is plain the immediate Confequence m-ift be fudden Death : And this often happens in the Courfe of this Fever, except prevented by plentitul Bieeding in the Beginning, or a large Hemorrhage from the Nofe. But if an Inflammation happens from the Caufes before obferved in the Liver (which feems to be frequently the Cafe) an ardent Fever with a Jaun- dice muft fucceed; from whence may be dedu- ced all the dire Symptoms of this Fever, without that vague Notion of Malignancy, as the learned 1 Boerhaave obferves + " From the variou- Kind " of Jaundice and Affections of the Liver mav be " underftood many Symptoms occurring in acute Diiedfet t Apbor. Pratl. ( 21 ) «• Difeafes, whofe Reafons being unknown, have " given Birth to all the Tales about Malignancy •c in Dileafes ; for from the Liver do depend all " the Bowels of the Abdomen, and confequently " all their Actions of Digeftion, Affimilation and " Nutrition, $V." He fays alfo that great Anx- iety (fo remarkable in this Fever) proceeds from ftagnating Bile *. Moft of the antient Phyficians, Greeks and Arabians reckoned Bile the Caufe, of malignant and putrid Fevers. Barbette of Fevers in general, fays very well, " Partes affect* " funt Ventriculus Intejlinum duodenum, Hepar, 4t Pancreas, Glandulo mefenterii Caufiafiuccus pan- " creaticus non bene fife mificeat, cum Bile chyloque% et fie Bills praternaturaliter regurgitat per Venam ■• cavam ad Cor totumque Corpus'* Bellini reckons amongft the principal Caufes of Fevers whatever accumulates Bile II. Hippocrates obferves that Perfons labouring in the Sun, fuch as Mowers and Travellers, overheat themfelves in Summer Time ; and by that Means throw off too great a Quantity of the thinner Part of the Blood, by whicn Means the thick Blood of thofe Perfons does not pafs through the Liver, but is there accumulated. What fo often brings on this Fever as overheating the Body? The Conftitution of the Air, and the Difeafes in the Ea/t-Indies, according to Bontius, leeni to reiembie the Air and Difeafes of this Country. He remarks that the Liver in that Country, is very * H\nc ob Stagnattonum Biiu Anxietat oriebatur donee moritbantur &gri. $ De Febribus. («) very often inflamed by the perhiclous Cuftom of drinking Arrack (very common amongft the Sai- lors) and afterwards lying down expoled to the Air and Dews, and drinking, when much heat- ed, large Draughts of cold Water; from which Obftrudtion and Inflammation of the Liver, and an acute Fever frequently mortal. His Account is fo exactly parallel! to the Cafe of our Brittijh Sailors in the Well- Indies, by a too free Ufe of Rum, that I have quoted it below in his own Words J. Bontius obferves that the Jaun- dice is often fatal in that Countiy : And in all thefe Cafes, where the Liver is affected, he attempts the Cure with Phlebotomy, folutiy^ Purges and Diuretics. Let us now confider the Mechanifm of the Liver, its connexion with the otner Vificera, the Nature of the Bile, and whether it is not very probable a Stagnation may happen frequently in the fine Ramifications of the Vena porta. The Liver, as before oblerved, is a foft yielding Gland 5 From which loofe Texture I fuppofe an Obftruc- tion % Nullum Vifcm frequentiusin hit Regionibus inftjlatur quamjecur ; quod prtetertnijfa jam toties difta, Viclus Ratione mala, a potu iftiut mzltdiRi Arac, non tantum in temperamento immutatur, fed etiam in Sub/fantia fua corrumpitur : Dum enim ejus haujiu Ebrioji Mi excale- faili; ingentem Aqu& ropiam in Ventriculum higerunt, ut eonceptum jEflum reftinguant, dein humi tanquam Pecudes procumbunt. &f in Hwvibui ft rat (qui pop jtcundam aut tertiam Nocli. boram copiofe hit cadit) exponunt: Vnde venenata! Vapores e Terra erumpentes, intra Corpus rtcipiunt, Iff fie Objiru&ionem Hepatii facillime incurrunt, cut edeft tenfi-va in Hypocbondrio dextro gravitas, Jolorque obtufus ac quafi fondere premens : DifficiJi' quoque adefi fpiratio, propter graiiitatem vtjcerii^ Diapbragma deorfum trabentis, cui mtdiante Ligaminto fuf- pen/brio anneclitur : Hac infarlliojiperftn morrhaee is lb violent it cannot eafily be reftrain- D 2, ed, ( 2? ) el This was the Cafe of D^or Beyer .;nd of fl-, it othei;. Before we point out a Method of Cure drawn f:; ;n the Nature and Symptoms of thib Dilea.e ; agreeable to rhe Precepts cf the beft antient and ir, '.j:'ii Phvficians in nmilar Fevers ; and wn-.t is more confirmed by experience ; it may not be amits to examine thtle Gentlemen's Reaions wi u ?:e io fond of giving Alexipharmics and Sudori- fic: in the very beginning of this Fever. Thefe Gentlemen argue, That from fome oc- cult Venom, Contagion, Miafma, or Je nejais q. c;'t t. the Texture of the Blood is broke, whence u is ( turned into a vapid and putrid Mafs, no longer <■ fit for the Uies of the animal OEconomy runs off" / through the Glands, ftrainers deftined to excem V \ a much thinner Liquor ; therefore imagine the Biood to be in the fame State as in peitilential Fevers and ^ive Sudorifics and what are called A- kxifl 'mucks as rn the Peftis; infifting the moft lik-.- iy Means to fave the Patient is to keep open the Skin. The yellownefs they apprehend proceeds only from the broken texture of the Biood ; for lay they, take the red globules of Blood, break them in a Mortar with the addition of a little Water and they will break into a yellow Fluid. This The- ory feems to be built upon the fuppofition that a fubtle elaftic Air fills the Spherulce of Blood • which Spherule? or globules when broke, and their elaftic Air exhaufted the Blood remains a vapid and putrid Mafs no longer fit for the Secretions. This Pages 29-34 missing Pages 29-34 missing ( 35') Parts adjacent, volatiles and cardiacs will act in con- junction with it, and the defcendingBiood Veflels will be ftill more comprefs'd ; the dangerous con- fequences of which are obvious from what hath been faid before. This digreflion upon the Su- dorific or AlexipharmickNLQthad I hope carries its excufe with it. Since it is plain from a juft attention to the Na- ture of the Difeafe; as well as from the immedi- ate Putrefaction and livid Colour of Perfons who i n dye of this Fever, and infpedtion of their Vifce- ^ra ; that whatfoever is the Caufe, the Diforder smay be juftly termed a general Inflammation often (if not prevented) terminating in a general gan* 4 grene or Death: So that we are to endeavour by -all poflible Means to prevent this general gan- ygrene. And here let us tonfider by what Means Nature endeavours to help herfelf. Let us follow ^ the Foot-fteps of that wife Guide; and not con- ' sv tradict her in her Intentions, 01 counteract her as , too many do. The critical Difcharges here are uncertain as the critical Days. Sometimes we have a crifis by the i Skin in Sweat, Eruptions, or fmall Boils ; which t as was before obferved, are the moft favourable and fureft terminations of all Fevers in this Coun- try ; often by a Diarrhoea,, or Urine. Twice I have feen a crifis by a Bubo and Parotis as in the Plague. Haemorrhage from an Artery is fome- times critical and faves the life of the Patient; at other Times (and that frequently) it carries (hem off, D z. Hippocrates 4 .( 3« ) Hippocrates that accurate obferver ofNature and ner Operations and Endeavours, fpeaking ut a Fe- ver with a concomitant J m uiice, lays, t^u'ddam etiam fiexto die morbus regius prehendit, verum i/l$s per veficam expurgatio, aut commota alvus, cut co- £io{a Sanguinis e naribus profufw fiublevavit.* * We fhall now confider the evacuations that may afTift or contradict Nature, how beft to promote thofe Difcharges are critical, and in what ftige of the Fever Inch evacuations are proper. As to 6weats I think enough hath been laid to prove they fhould not be attempted by Sudorifics; nor «an be expected from the Ufe of them. Vomits too are very injudicioufly adminiftred \ for vomiting is always here fymptomaiical pro- ceeding from the Inflammation of the Liver and Parts adjacent (as before obferved) for were itcri* tical as Decker takes Notice t then relief would cniue from the exhibition of a Vomit: But expe- rience convinces us of the contrary. Barbette fays Vomiting and Hiccup are concomitant with an Inflammation of the Liver.X And that this fymotomatical Vomiting is very dangerous. || If this troublefome Symptom is not prevented in the K':.inning it grows more and more Violent, fo as to prevent the Sick from taking Drink, Food, or Medicine, until it comes to the Vomiting of biack Blood mixed with aduft Bile and the iharj» Juices of the Stomach. It * Epidtm Lib. i. ■j D, -vomitu. X Prax. Md. vl Vide Deckers'* Rtmarh on &dxbt&sfublifbcd in Latin, at Lejdm. (37) It then appears to be our Duty to fupprefs or mitigate this Vomiting if poflible : or to prevent by keeping open the Body with Solutives from the beginning; and by that Means direct the courfe of the Bile and other fharp Humours downwards. Thefe Solutives fhould be continued (at leaft) un- till the State of the Fever. Hippocrates takes Notice ; and fo does Celfust that a loofenefs fupprefTeth Vomiting: We are convinced by Experience it doth in this Fever. Further it will appear piain to any one who urt- ■derftands the animal OEconomy, or the mechan- ilm of Vomiting, that where there is any Infla- mmation of the Vifcera, Vomiting muft very much increafc the Mifchief; and alio how likely it is tto bring on an Inflammation of theDiaphragm andin- tercoftal Mufcles; whence inceffaM Vomiting anil that dreadful Symptom Hiccup. Now let usconfider bleeding an evacuation that hath been much difputed about. And here I muft be of Doctor Sydenham's Opinion, whefc Speaking of the Plague itfelf, he lays, "lhsy whb condemn bleeding have not bled m Time, or elfie to6 Jparingly.* Bleeding feems highly neceflary in the begin- ning of this Fever ; not only in eafing the PainS and Anxiety which are a great Part ot the Difeafe; but alio in reducing the degree of Heat; for as Wainwright obferves, The heat of an animal is in a compound Proportion of his quantity of Blood and the celerity of its Motion^ So that by dimi- nifhinn * De peftt. f Dtmorbit asutit% (3M turning the quantity of Blood we leffen the Heat and Thirft ; for tewer of the thin Paris will be ditfipated ; and consequently by this we reduce in fome Degree the Fever. Be fides the Heat yds as a univerfal Stimulus, whereby the Diametc g of all the VefTels fecretory and excretory are ftrait- ned ; fo that we cannot expect any releiving glan- dular Difcharge until we have lowered the De- gree of Heat. We ought then by all poihbte Means todiminifh theHeat,tofupprefs theOutrage, Rarefaction andEfflatus of thtBiood thereby pre- venting iheFormationof the Fever; and its dreadful Confequences: For if we cannot prevent the hor- mation of the Fever, we can do but little in the kCourfe of the Diforder: It proving of very bad Confequence to endeavour to force a Crifis when jthe Fever is formed and fixed upon the whole iSyftem. This is agreeable to the precept of the divine old Man, Incipientibus morbis fi quid mo- yendum videatur move; vigentibus vero quiefcere melius eft. § This Author advifes bleeding in a- cute Diforders where the Difeafe is violent and the Patient in the flower of his Age, or hath fuffici- ent Strength to bear it, f Aretceus who amongft the Antients was next to Hippocrates fays, if there is any remarkable Inflammation in the Liver or Praecordia, we fhould bleed the Patient ad deli* quium. Riverius § Seel. 2. aphor. 29. •|- At in morbis acutis fanguinem detrabes, fi vehement fumt mar- tin, fcf qui csgrotant atatt Jiorenti fuerint fcf virium robore *val*eri0+ deratimvict.inmerb.ottt. 336. (39) Riverius fpeaking of the Plague fays, Si ve- ro ipfo morbi initio & viribus adhuc vigentibus va- catur medicus, & aut plethoram, aut Jebrem aaefi fie advert at, metufque fit ne ad Cerebrum aut par- tem aliam principem fiat metafiafis Sanguinis, fieri videatur miJJio, & earn infiituere intrepide poteril Medicus, habita tamen, natural'JEgrotantis, '& vi- rium ratione, fie etenim modo ditla prcecavebuntur imminentia pericula, fiebris compeficetur & majus Spatium Sanguini ad circuitum fiuum continuant dum procurabitur. The Arabians bled plentiful- ly in all ardent Fevers and in moft acute Difor- ders. Pro/per Alpinus takes Notice that the JE~ gyptians, who are obnoxious to ardent and inflam- matory Fevers not unlike thefe we have in Jamai- ca bleed in all Ages, Sexes, and Conftitutions with great Succcfs. * And Bontius fays he did the fame in the ardent Fevers in the Eaft-Indies* Galen fays we ought to regard only the Strength of the Patient and bleed proportionably. Willis fays the Haemorrhages before and after Death plainly demonftrate it was Wickednefs to omit bleeding. Notwithstanding I think from the Rea- sons and Authorities above corroborated by Ob- fervation and Succefs in Practice, that we fhould bleed plentifully in plethoric northernPeople who have the thickeft and reddeft Blood with tenfe e- laftic Fibres ; yet after the firft Stage, or beyond ths Increment of theFever it cannot be fo proper; as it may interrupt Nature in her Intentions and prolong the Crifis if it does no further Miichief. * Nor ' __________________________ i i ■ T f V* mtditiaa JZg&timBh ( 4c } Nor fliouTd we bleed in my Opinion after the VefTels are in any confiderable Degree relaxed. Arteriotomy is much commended by fome of the Antient. in all high and inflammatory Difor- ders where the Blood hath too great a Degree of exaltation. I have feveral Times divided the temporal Ar- tery with great Succefs where the Patiem was feized with a Delirium or Phrenfy on the verv firft attack of the Fever : which happens fometimes to thofe Perfons whofe Fever arifes from extreme Motion in the heat of the Sun. An Argument for Arteriotomy fin my Opi- nion a very good ont) is, many Peifonsin ihe higheft Degree of this Ftver have been faved by an Haemorrhage from an Artery ; even when there was not the leaft H>pes or Profpect of Recovery. This happened in the Cafe of the Hon, Wafihing- ton Shirley, Efq; Commander of his Majefty's Ship the Renown, who in the beginning had loft a' confiderable quantity of Blood, yet feveral Hours after Cupping upon the Shoulders when the Scarifications were clofed, the Blood forced- its way through, and he bled three or four Days ; and the cCarifications although very fuperficial were cauterized by his own Direction to ftop the bleeding at laft. This was the Cafe of Mr Jones the Attorney fand many others^ who bled im- moderatly from the Nofe, had the Vomiting of black Humours and Hiccup, yet recovered by the Haemorrhage. Arteriotomv or Cupping with fcarifications feems to excell Venaefection for the following Kealon.: ( 4i ) Reafbn: Thofe Perfons who die of ardent Fe* vers, or acute Diforders, have their Arteries full and Veins empty; on the contrary, thofe who die with flow Fevers, or chronic Diforders have the Veins full and Arteries empty.* Solutive purges and apozems with Manna. &c. feem to be abfolutely necefTary in the beginning of this Fever; for they cool and eafe the Patient immediately, moderate the Heat, Thirft and Anxiety, prevent (as was before obferved) that terrible fymptomatic Vomiting fo trouble- fom in the Courfe of the Difeafe! Befides Solu- tives are plainly indicated by Nature; for a fpon- taneous Diarrhoea is always a favourable Appear- ance in the beginning of this Fever : therefore where there was not one, I have always endeavour- ed to bring one on. The Ejections difcharged here are.generally hot, fharp, cholerick or bilious; fermenting like Yeft, and commonly very foetid : And as thefe are immediately derived from the Liver, Spleen, Pancreas,&c. they muft, and do wonderfully releive *in this, and in all central Fevers, thofe Vifcera. In the epidemic bilious Fever at Pifia Anno 1661, thofe who recovered were relieved by a Diarrhasa.t » One of the divine Hippocrates his Precepts is to Purge *n very acute Difeafes the firft Day, if there is a Propenfity of the Humours to go off F that * Bonetus in fepukhreto anatomico, 1$ Herman. Boerhaave $* febributingenere. i Borell.apudMalpigb, What induced me to try Medicines of this Kind was (what hath been taken Notice of be- fore) that where there was a fmartDiarrhcea fpon-* taneous or procured by Medicine the Vomiting never was violent, if any at all: And the Diarrhoea * proved very ferviceable in relieving or abating all the other Symptoms. Further I confidered the Stomach would nof bear any great Quantity of the moft agreeable Li- quor, much lefs a fufficient Dofe of Manna or a^- ny other lenient Purge or folutive Medicine ^ which at this Time muft be given in a great quantity to increafe the Periftaltic Motion of the Inteftines confiderably ; thereby forcing the Hu- mours ftrongly downwards. The Antiemetick Draught generally ftops the Vomiting for a little Time, until the Cathartic pafles the Pylorus: Sa that it generally anfwered the Intention, releiving that troublefome Symptom, cooling and eafing; the Patient, and reducing, in a confiderable De- gree the Pulfe, Pain and Anxiety. Clyfters folutive and emolient are of great Service, as they are an immediate Fomentation to all the Bo wells of the Abdomen ; promote Perfpi- ration internally, foften and relax the tenfe and heated Inteftines, and gently follicit the evacua- tton of the Bile and other offending Humours. The Ufe of Clyfters is fo manifeft, fo obvious (efpecially during the ardency of the Fever; that' I have no further Occafion to infift on their being" Serviceable 5 or to bring Authorities (many of tShich I could) to fupport my Opinion. F z Bliftersj. t 44 ; Blifters, the Ufe and Abufe of them, at what Time and in what Circumftances they fhould be apply'd, requires much Care and Confideration, for they are often beneficial in Fevers, and often verv pernicious. Firft, it may not be amifs to examine their Ac- tion on the human Body, Secondly, to examine theOpinion ofaGentleman juftly celebrated for his medicinal Knowledge throughout all Europe, who (peaks much againft Blifters * and Laftly conclude with fome Obfervations of the learned Doctor Mead upon the U{q of Blifters, with our own Obfervations and Reafons. Blifters act by increafing the reciprocal Ofcilla- tions between the Solids and the Fluids, ftimula- ting, irritating, and exagitating the whole Sy- ftem ; as is plain by the bloody Urine and Stran- gury the Occafion : Hence it feems they cannot be good in the beginning of ardent Fevers where all irritation increafes the general Inflammation j and every Caufe of Inflammation increafed, it foon goeth into a Gangrene, Yet thefe have been ofcen applied in the very beginning of ardent and highly rarefactive Fevers by fome that Practice in Jamaica.; and without previous Bleeding, relax- ation, or confiderable Evacuation of any Kind ! The learned Boerhaave fays of Blifters, or Can- tharides. Totum genus nervofumfiimutant FibriU las & fiolvum, and, puto vero maxime nocere ubi bumores nimis fioluti & acres fiunt% nee in morbis acu- tis, neeininfiammatione convent re, nee ubi eft incli- natio o»———»—^—_________- • H. Boerhaave Prax. Med. matio in alcali, & miror quod a tot egregijs Viris ad- ' hue iaudantur, namfaciunt Febrem maximam, Anx- ietates, halitum cadaverofium, Urinam Jcetidam, &f. Doctor Mead's Obfervations on the Ufe of Blif- ters, are contradictory to Doctor Boerhaave's O- pinion, and are confirmed by Experience: For he fays, That in the confluent Small-Pox; whe^e the Blood was in fuch a State of DiAblution, li- vid Spots appear'd, and Blood was difcharged from the Emunctories, he applied Blifters with Succefs where the Patient was delirious. I am far from believing that Doctor Boerhaave himfelf would forbid the Ufe of them in all Sta- ges of acute Fevers: For certainly they are often indicated by Nature ; particularly when fhe en- deavours to throw out anEruption, which is always critical ; and if Nature, or the Vis Vita (which I mean by Nature^ hath not Strength fufficient to do her Work, it feems highly neceffary that we fhould afiift her. After the firft Irritation, caufed by Cantharidese, is over, their fubtle active Salts dilute the Blood by reftoring the circulation of the Lymph: For I fuppofe thefe fcour the Lymphatics as Cathartics do the inteftines—break and attenuate theputrify- ing, ftagnating Serum and fit it for Excretion through the Skin, whence that Halitum cadave- trofum Dcxffcor Boerhaave mentions. Thefe Salts alfo break and attenuate the putrifying ftagnating Bile; fit it for excretion by the Kidneys and car- 9y it off that way with fome of the grofter Parts oT (46 ) of the putrifying Serum, occ. whence that Un- nam ficettdam, this learned Author takes Notice of. In all central Fevers, Blifters are certainly fer- viceable by transferring the Inflammation to the Superficies, by preventing an Inflammation of fome noble Vifcus, by relieving the ConvuJfiona of the Diaphragm and intercoftal Mufcles, occa- fioned by the Afflux of hot,, fharp rarified Blood on thofe Parts ; whence a continual Vomiting: that being a Convulfion of the Diaphragm and intercoftal Mufcles ; as Monfieur Chirawc proves by Experiment, Experience teaches us that Blifters mitigate vi- olent Vomiting and Hiccup : Yet I would by no. Means recommend the Ufe of them in the begin- Ding of Fevers, whilft theFervor of the Blood and Itenfity of the VefTels continues: For it is then our Bufinefs to fupprefs the Fervor and EfJlatus of the Blood, and relax.the Solids, After all, Blifters in my Opinion are feldom qeceflary in this Fever : In fome few Cafes I have found them ferviceable ; but they ought never to fce apply'd without due Care and confederation. And if we do apply them we fhould fupplyt t]ie Patient plentifully with diluents and fmooth cooling Drinks, fuch as Emulfions with Gum. arab. &c. And indeed thefe are necef&ry almofl through the whole Courfe of the Fever: But now fhould be given in greaterQuantities to {heath* and dilute the cauftic Salts of the Cantharides. In this Fever, as in moft acute Diforders, dilut- ing and relaxing Diet and Medicines are moft pro- Ret* ' 47) per ; and the Patient fhould be kept cool aspof- fible ; by no Means ftifling him up with a load of Bedcloaths, or excluding theAir from him, accord- ing to Doctor Boerhaaves * and excellent Celfius his Advice; who fpeaking of a Patient in a Fever fays, etiam amplo conclavo tenendus, quo multum & purum aerem trahere pojjit: Neque multis ve/timen* tis flrangulandusA It would be very happy for poor fick Strangers if we could get them large perflated Rooms in- ftead of the Holes they are cramm'd into. What convinces me this Iaft Precept is Right, I have often obferved that thofe Perfons who had this Fever on board of the VefTels in the Harbour^ who feldom drank any Thing but cold Water, np Beds to lye on, or Cloths to cover them, with « free admiflion of Air, frequently recovered. Such Things as relax an dilute muft be pro- per here, for all the Fibres are tenfe and dry: And fo long as the Heat, Siccity, Thirft, and Swift Puife continue, fo long all diluents, the thinneij Fluids are proper: Water itfelf is Convenient; for: the Drought, and Contradtion of the Vefiels arc a very great Part of the Diforder. The warm Bath, or rather partial Fomentations with Vinegar and warm Water muft be very fer- Yiceable, as they relax and cleanie the CUticulaC Glands, Acids of which this Country produces the fineft in th# World ; and perhaps the greateft Variety, muft * Prax. Med. f Lib. *. Ca$. Jf. ( 4* ) muft be very ferviceable : So muft Vinegar and Water mixed; and acid Medicines fuch as Spt. Vi- triolt, ol. Sulph. per campanam, Spt. nitri dulc. Gfr. The neutral Salts much diluted and given in fmall Quantities, elfe they increafe Thirft: all thefe muft be very ufefulljudicioufiy exhibited: Somuft folutive acid Fruits fuch as Tamarinds and Caflia boiled in Water for common Drink according to the Man- ner of the JEgyptians as Profiper Alpinus ob- ferves * Jamaica Sorrel or the Jelly of it diflblved ia Barley Water, and all our fine vegetable Acids are not only moft agreeable to the Sick, but are alfo the moft ferviceable, as they abate the In- flammation, allay Thirft, refift that general pu- trifadlion of the Juices, correct the Bile, promote its' difcharge byUrine, and gently open the Body, So Manna alfo diflblved in Barley Water and aci- dulated with Lime or Lemon Juice is a very pret- ty Draught ; and might be frequently taken to keep the Belly foluble; and by that Means eafe the Anxiety, Heat and Pain. Brifiol hot-well Water when it arrives here feems to be only the pureft Water ; having loft all the Minera or Calx it may be impregnated with at the Well; 'as it is a pure cool Drink, vaftly agreeable to the Sick it may be drank plentifully after the Increment, about the State of the Fever; then there cannot be a better Liquor ufed to dilute, cool and temper the hot inflamed and almoft boiling Bloodias.well as to prol tnote any critical Difcharge. r.______________Galen * De Mtdkina JEgyptionw. ' ( 49 ). Galen recommends the drinking of cold Water in continual Fevers ; fo do the Arabian Phyfi- cians, particularly Avicenna, who gave it through the whole Courfe of ardent and bilious Fevers, as he fays, to allay Thirft, and to temper and promote the Concodtion of the Bile * indeed warmed Liquors or tepid, are the beft in the be- ginning becaufe they relax moft. The Divine Hippocrates in acute Diforders gave Ptifan of Bar- ley and the cooleft and thinneft Rood f Willis Barley-water with Honey and Vinegar. Boer- baave recommends in all Diforders where the Jui- ces are inclined to putrify; Tamarinds, Juice of Lemons, Rhenifh Wine, Butter-milk ftrained through Flannel to take out the Butter and Cheefe. He fays the poor People in Amfterdam at the Time of the Plague drank a mixture called de tribus, the Bafis of which was Vinegar; by the Ufe of which Liquor many recovered. Tachenius in a fevere Plague in Italy, fays he preferved himfelf and feveral others by the Ufe of acid Spirit of Sulphur. Sydenham fays, in that worft fort of Small-pox whrre the Humours were fo ftrongly inclined to purify that nine out of ten died ; which as he ob- serves, fcarcely happens in the Plague itfelf: And until he gave the Spirit of Vitriol plentifully in Small-beer he found no remedy. *' I have found the following Medicine to be very ufeful in the beginning of this Fever. * Lomm.us defebri us continuis. + Dt rat. *viti. morb. asut. ( 5° ) RSpt. nitri dulcis ----Salis dulcis aa Drachmas duas. — Vitrioli Drachmam unam, mifce Sumat gl. xxx vel xl Subinde in quovis vehicu- lo. This Medicine greatly refifts putrefaction, and corrects the Bile ; for it is exceeding ferviceable in fome kinds of Jaundice as well as in this Dileafe. From all thefe Obfervations we may fairly con- clude, Acids muft be of great Ufe here where the Juices are fo ftrongly inclined to putrify. But it is to be obferved, that Acids fhould not be given through the whole Courfe of ardent and putrid Fevers; but only fo long as the alcaline putri- dity continues. As the fatal termination of this Fever is a gene- ral Gangrene; and the peruvian Bark is the beft Kemedy known in a local Gangrene ; we are rea- dy to conclude from Analogy, that it muft be good here, until Experience convinces us of the contra- ry- It may not be amifs to examine why this no- ble Medicine given in the remiffions of this Fever does not anfwer our Intention, The action of the Bark renders the .Fibres more tenfe and ela- ftic, and enables them to fubdue thatLentor in the Blood the caufe of intermitting Fevers : To ac- count philofophicaly for its Action is not to our Purpofe: We can only fay then, from the fpeci- fic configuration of its Particles it hath thefe Ef- fects : But here that very Action and thofe Ef- fects produced from the Bark are very Pernicious; And muft be particularly fo when the caufe is an Inflammation ' 5* ) Inflammation of the fmall VefTels conftituting the larger. The Mifchief muft be increafed, it is ve- ry obvious, from the rough conftringing and fti- mulating Power of the Bark. Our utmoft endea- vours here fhould be to relax the VefTels; for the Tenfity of the VefTels will hinder all the glandular Difcharges; and muft alfo increafe the Pains, Heat, Sorenefs, Anxiety, Thirft, &c. In a particular Gangrene in an extreme Part where the circulation is languid, and the VefTels weakned with contufion, or any Thing which hath occafioned too great an Afflux of Blood on the Part for fometime, by which continued Ple- thora the VefTels are Overftretched, and their contractile reftitutive Power in fome Degree loft,;. or in old Age where the Blood is vapid, the Cafe is quite altered* for here is no increas'd tenfity of the Solids, nor undue exaltation of the Blood. Young robuft Perfons who have the tenfeft Fi- bres are moft obnoxious to this Fever ; to thefe alfo it proves moft Fatal : Women and Men of lax habits are feldom feized with it; or when they are come through with much lefs Danger and Difficulty. This leads us to take Notice how fatal this Fe- ver hath been to Strangers, Europeans and North Americans, efpecially to thofe who abound with a great quantity of good Blood rich with Salts* are in the heat and prime of Life, and whofe Fibres G 2 are * Omnis homo qui perfefle Sams eft &f abundat bono Sanguine, tile ttiam eft callidij/ims, ideo nullus bomopronior eft ad putredinem gtf- m Uif' «oerla*v*/Vtf*. M& (St) ^:c tenfe and elaftic: Thele are moft obnoxious to Inflammations lor the Reafons before given t and are with the greatefl difficulty cured. X When a Stranger arrives here from a Northern Climate the Blood muft be in fome Degree r..ri- fled ; Which Rarefaction may be called a Pletho- ra; for the VefTels do not relax immediately in Proportion. The circulation/ is now rendered quicker by the Stimulus Heat, whence all the fe- cretions, recrementitious and excrementitious are increafed; except perhaps, the two expurgatory by Stool and Urine, by which only the Bile can be carried off, that is now feperated in a greater Quantity than ufual by the increaled circulation, heat of the Climate, Ufe of fpirituous Liquors, or whatever caufes may increafe the Bile : Hence a redundance of Bile, which together wi:h that ftiflfnefs of the Fibres, and richnefs of the Blood, are obvious and fufficient Caufes of their pronenefs to this Fever. Since this appears to be the Cafe, would not a Method of preventing the redundancy of Bile, taking away the plethora, and relaxing thePores be highly expedient for all Strangers at their firft Ar- ► rival; to be continued until fuch Time their So* lids were relaxed, and Juices aflimilated to the Air of the Country ? The Method I would propofe is this. Upon the arrival of a Perfon with a Northern Conftitu- tion -f £>ui habent temperiem ealidam morbis acutis Sunt valde obnoxij. X Hinc homines putrijaftionibus obnoxij fcf qui habent Sanguinem- ruberimum crafjiftmum 1$ Fibras rigidas dijicilime abhocmorbo curat* J*r. Vidt Boerhaave Prax. Mtdit. ( S3 ) tion let Blood be drawn from his Arm if fanguine and plethoric : This bleeding will ieflen the De- gree of Heat, and abate the Nifus of the Particles o the Blood. After bleeding (if no favourable Lax intervene) take fome folutive Purge, fuch as Manna and Cream of Tarter once or twice a Week, fufficient to move the Belly three or four Times. Ufe every Day for fome Time a warm Bath to relax the cuticular Glands and promote a free Tranfpiration, as well as cleanfe them ot any Sordes that may obftruct; rub dry with a Cloth and anoint with a fmall Quantity of fine Oyl ac- cording to the Cuftom of the Antients, to prevent what is commonly call'd catching ol Cold : This warm bathing appears to me to be of great Con- fequence ; therefore I think fhould not be omitted* Perhaps bleeding again, or at certain Periods may be rcquifitc . But this fhould not be ventured up- on without Advice ; nor indeed Bathing or Purg- ing : For thefe ought to be proportioned to the Conftitution, Habit, Age, Sex and Temperament of the Pcrfon ; fome requiring to bathe long and often, others leldom or a thort Time ; others who have Habits fufficiently relaxed not at all: And Perfons too much relaxed fhould rather ufe the cold Bath. To keep the Body cool, and to afford a con- ltant fupply to the Blood whofe thinner Parts may be exhaufted, or too much diffipated by Exercife or the Heat of the Climate, drink fmall but fre- quentDraughts of Sherbet of very weakacidPunch.v A Draught in the Morning may not be amifs to cleanfe the urinary Paftages where fome foulnefs, are ( 54 ) are apt to be acculumulated during Sleep: Or per- haps Tamarind Water, Orange Whey, or fuck- • ing fome of our acid Fruits would anfwer the In- tention as well; for as was before obferved, acid Fruits and acidulated Liquors cool and condenfe the Blood, refift Putrefaction, correct the Bile, and promote the Difcharge by Urine. As to Diet that which is light, cool, eafy of Digeftion and acefcent is the beft, becaufe it pre- vents the alcaline putridity of the Juices. But I would by no Means advife any particular Form; becaufe it is very certain that free Livers, provi- ded they fall into no Excelles, are not more liable to the ardent Fevers of this Country than the moft temperate and exact; or if they do fall into them efcape the beft. Vinegar and Salt refift Putrefac- tion ; and upon that Account feem to be necefla- ry: In my Opinion it would not be amifs to ufe them freely with all animal Food. Nothing conduces more to the prefervation of Health in this and all Southern Countries than a proper regulation of the Paffions of the Mind. I lay in this and all Southern Countries, becaufe in Northern Countries the Effects of the Paffions are not fo violent, or fo foon difcernible; they may help to lay the Foundation of chronic Diforders in Northern Countries; but here they will imme- diately bring on acute Difeafes: Thus Yipfct,.jy* Anger or extream Grief will immediately, or in" a fewHours, bring on a Jaundice, or biliousFeverj and the fear of dying, perhaps, kills more than the Climate, Thus «'* n^ TBushave Iniithfjjlly-pBp-ibed the Natii.. • *nd fcaiifes of this Fever (as fhey appear to me) fointed out xhtjuvantia and la?dentia ; and hope have laid a Foundation for a perfect Knowledge fDf this Difeafe 5 or given fuch ufeful Hints and Obfervations asjmay be improved by fome Gen- tleman of fupeiw Knowledge ^n the medical Art. I apprehend when the Nature and Caufes are ex- plained of a bifejue, the curative Indications are i obvious; and are to be found by Experiments made with fuch Medicines as frorr. their known Properties are likely to fucceed. I mall conclude in the Words of he-great Doc- tor Mead, I have nowfinifhed this Ififay fiuch as it 4S; tontentious and ill^fufd^Men, may probably find Fault with »*, but I hope' ^m prove ufefull my Countrymen j which is to be defired above all Things: For a confiioufnefs of an ufeful Under- taking and an upright Mind is beyond all kind of Praife: This Satisjaclion will never be wanting tt him who fhews that he has the public good at.Heart s tfind that he thinks himfelf not fornfor bimfelf but for Mankind*. ■. -^-^^-r And let me add, I fear not Ceniure nor deft* Applaufe> He that ditapproves of this Effay, let him (hew his ddike Ky Writing ***** gtt ^ V >• \ r\ ":•!-* ■, s- ^ ^ >.• ,,* '^•-^ rf » ** *«/ ■A r<» / >«-■ . . . . ?*./*• ►v »- * v- *-/^ ^J tZc **■* 4?0 &> s y /. <■ *»r- ^ / ■ ii<* u 2 -v a. /» cy -a ■•••i '♦/y* *■ /^X £✓* s* * ^. A> ^ ^ r,^ *-» *r-? >>* " „••$ *?'*>*. ,1 'j ys* y ^s ■'* * /A • ? ■J \ '€ *F ✓ ^\>