NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Serrice 4 AN INQUIRY INTO TUB Nature and treatment OP THB PREVAILING EPIDEMIC, GALLED SPOTTED FEVER, IX THREE PARTS. BY JOB WILSON, M. B. BOStOX: PUBLISHED AND SOLD BY BRADFORD & READ, No. 58, Cornbill. 1815. George Hough, Printer, Concord, Ntw-Hamwhirt. New-Hampshire District.. fs. 3Be tt rememfcereO, That on this twentieth day of November, A. D. one thousand eight hunHred and fifteen, and in the fortieth year ol the Independence of the United States of America, JOB WILSON, M. B. of the said District, hath deposited in this Office the Title of a Book, the right whereof he claims as Author, in the" words following ...viz. *' An Inquiry into tbe Nature and Treatment of the Prevailing Epidemic, called Spotted Fever, &c. &c. In three parts. By Job Wilson, M. B." In conformity to the Act of the Congress of the United States, en- titled, " An Act for the encouragement of Learning, by securing the copies of Maps, Charts, and Books, to the Authors and Proprietors thereof, d. ring the times therein mentioned:" and also to an Act, en- titled, "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 times therein mentioned,' and extending the benefits thereof to the 3rts of designing, engraving, and etching historical and other Prints." GEO. W. PRESCOTT, Clerk U. S.C. Dist. N.D. Stotrobucttott. EVERY candid and experienced physician will doubtless allow, that the practice of physic, at the present time, is in a very unsettled and fluctuating condition. Such a change has happened in the nature and treatment of our diseases within a few years, that in many places, in one half or two thirds of the cases of fever that occur, the physician is without any guide ; he has merely heard something concerning the treatment of this new disease which prevails, or perhaps has read some scrap in the newspaper, or possibly in some periodical publica- tion, relating to the same. In these accounts he finds a great variety of the same disease, occurring in hardly any two places or years alike, with sub- divisions into a great number of grades of the same disease ; and these descriptions are from physicians who have different views of the disease, and who consequently recommend different and even opposite modes of treatment. This must tend very much to confuse even experienced and well informed phy- sicians, especially in the first cases which they are called to attend. This is too much the case even at the present day. For these reasons, I have attempt- ed an Inquiry into the Nature and Treatment of that most formidable disease, called Spotted Fever. It is not because I consider myself better qualified to investigate the nature of this disease than most of my cotemporaries ; but because no one has attended to this important subject.* Age after age has passed * Many eminent physicians, as Prs. Rush, Mitchell, &e. have done much in elucidating the nature of our epidemics, as will appear from their writings : but the cfloct which our climate has in pn'-luciag the diseases of this continent, appears never to have hrcu 'Virly in- vestigated. 4 INTRODUCTION. away, and no one has attempted an inquiry into the causes which appear so materially to affect the dis- eases of this country. That I should live in an age so eventful, and should, to my own conviction, be fully satisfied that the baneful effects which the inhabitants of these States sufFer,are principally to be attributed to the vicissitudes of our climate ; and when possessed of the most unquestionable facts (as appears to me) that respect the reality of'these particulars ; were I to let these things pass unnoticed or unrecorded, and see the sufferings of my coun- trymen as I do, it would discover an unpardonable degree of indifference, and want of feeling. I am aware, that my circumstances in many re- fpects are not the most happy to prosecute this Inquiry ; yet I shall endeavor to give the subject all the attention which the concerns of a young and dependent family, and the almost constant calls of my profession, will allow. Any mistakes which I may commit, or erroneous inductions which it may be my fortune to make, it is hoped that those who have better abilities and more leisure will correct. As to the facts which this work may contain, it is hoped they will be useful in investigating the dis- eases of our climate, whether I have been fortunate in my inductions or not. That the climate of all countries has a material effectci most of the diseases which visit them,appears to have been the opinion of physicians from the earliest ages to the present time ; and in respect to epidemics, if not the principal cause, yet doubtless a powerful auxiliary. Dr. Rush, in his account of the climate of Pennsylvania, makes this remark: " From a review of all the facts that have been men- tioned, it appears that the climate of Pennsylvania is a compound of most of the climates in the world. Here we have the moisture of Britain in the spring ; ilie Iwut of Africa in summer ; the temperature of Italy in June ; the sky of Egypt in autumn ; the cold, and snows of Norway, and the ice of Holland, in the INTRODUCTION! * winter * the tempests (in a degree) of the West-In- diefe, in every season ;■ and the variable winds and Aveatfte* of Great Britain in every month of the year. Ftom this history of the climate of Pennsyl- vania, k is -CD CO t5 CJ T3 Cm O 3 «m c Cm ft « 73 -o
  • u M bs CO 1 w rt < pared with fucceedihg years ; it Was cdrtijitfrativfely mild and temperate. The range of *he thermometer was 104°; the mean anntfal tefttperatur* 48,5$ the greateft heat 91; the mean difference of tempera- ture between the days and nights was 16,5; the greateft variation in 24 hours, 38. The ten laft days in February were uncommonly warm ; the mean temperature of the days, as feen in the table, was 41, and the nights 28. On the 26th day, the mer- cury fell fuddenly from 40 to 12, at night; and rofe the next day to 50. Thefe confiderable vari- ations of temperature appeared, with other concur- ring circumftances, to produce feveral cafes of rheumatifm, inflammatory fever, inflammation of the membranes of the brain, &c. eryfipelas,&c. which continued to be more or lefs frequent until the com- mencement of fummer. The countenance in the above difeafes wore a deep blufh, the face moderate- ly fwollen, the lips of a bright lively red ; the pulfe full, hard, and ftrong; the temperature of the body confiderably increafed. The cafes, which 1 faw of the above difeafes, were in general mild, were readily fubdued by bleeding, cathartics, and other deplecating means. In the months of June and July, but few fell fick. Auguft, September, and October, were dry, and the changes 36 Weather and Diseases of 1806. of temperature, as feen in the table, were confider. able. Dyfentery, cholera morbus, and bilious fever, were the prevailing difeafes. This fever might be confidered as a form of fynochus j it was in general fuccefsfully treated,by phlebotomy,at the commence- ment, a cathartic, and afterwards an emetic, follow- ed by gentle mercurial cathartics, blifters, &c, A Synoptical View of the Weather and Diseases, from February 1, 1807, to February 1, 1808. *>*? O 2 O g> J^'r* ^ > > ^ S ? p < r"S<*»*« g » a.p o- g- o O Co M» 0 to 0 M» 8 co M» 0 0 to 0 Ot 00 to <>■ to Oi to 0, to to to 0 Ml 0 to Co Ml to 0 Ml Ot to 0 0 Total heat of the days. M-CO M* "** O 09 CO oo 00 00 M» M to Ml Ot to Ml Mi to co Ml MA Ml at CO to to M» to CO cc 0 to c* to Total heat of the iiights Ot h3 tO Co £■ Ot CO ca Ot Ot 00 00 00 to 05 Ot 4-to to Mean temperature of the days. CO 00 Ot 10 to Cj to Ol 0 C7> Co to Ot CO *»■ to CO M Ml Ot 00 Of the nights. to M* M» to M» to M S CO Ot to 0 to to to Ot 0 CO 1^ to Difference of tempera-ture betw. da's &? ntt OS Ot to to to to Ot Ot to ** M o> P to o* Ot ■ Ot M» Ot. fc CO to Ot Mean temperature of the days and nights. 8 co *> to 0 CO 8 00 to 33 to to 00 to * Ot -* Greatest aev. of heat. * * *»■ o» to Ml to fc CO to Lowest dcg. of hect. ot Ot Co CO M» to to Co Co to Co to 00 CO co 00 0 Oi Ot CO C~ tC Greatest vari. in 2 4-1. to Ot Ot to to 00 to CO to to to Co Ml Ot «o to 0 to M> to to to 0 Number of fair days. 0- ot o Number of snowy days SaMc»»MS5e ^Number of rainy days Sm^qoomomOmm ^Number of cloudy day* otfto^QOoooo^oco No. ofsqwllu days. *2 mmiomnimmmwwm Nnrth-west. t"J pto^toooo^bstootooto Jyorm--wesu vj g_o. ^ottooto^to^toto^ North-east. ___ g mmOmOO^mmw^io mi South-east. ^ut8MMf.i?wo.OMOo South-west.___ ~ North. ato^OOOO««^MMO. East. {jSCjOCO^^O^'^OO South. oooc^oooooooo West. M» 3 9. The diseases which prevailed in the above months were as fallows—February, otalgia—March, pleurisy—April, pleu- risy—May, pneumonia—June, cephalalgia—July, cholera —August, influenza—September, influenza—October, syno- cha—Nov. pleurisy—Dec. synocha^-Jan. synocha. 3$ Weather and Diseases of 1807 and 1808. A Succinct Account of the Weather and Diseases in 1807 and 1808. This year is of a medium temperature with the others in the journal, viz. 46,6 ; and the range of the thermometer is 97, which is the leaft of any year mentioned in the tables. The mean variation in the months of February,* March, and April, are 35, 36, and 34 j but in this year they are 39, 53, 55: as likewife by noticing faid tables you will perceive that the diurnal variations are comparatively great, which great changes of temperature we mould readi- ly conclude would produce violent difeafes, which indeed we find has been the cafe. In the months of February and MarchirJiammatory difeafes were fre- quent, viz. abfceffes, violent inflammations of the head, affecting one fide more than the other; the pain was more acute over one eye in the frontal finus, or in the antrum-highmorianum or teeth, than elfewhere. During the months of March and April a pleurify of a more violent kind than ufual prevail- ed, but was readily relieved by biood-letting, cathar- tics, blifters, &c. as were likewife the other difeafes which accompanied it. May, June, and July, were more healthy; yet occafionally the above difeafes were noticed in May, but by the firft of June they had pretty generally ceafed. * On the 26th of February, 1807, there was a great fall of rain, which inundated the low lauds throughout a cotistderaBle part of this continent. This rain was imtnediatery followed by extrettfe cold weather, and this by diseases, as will appear by the history of th« weather and diseases of this mouth. Weather and Diseases of 1807 and 1808. 39 Auguft, September, and O&ober—The firft of thefe months, it will be feen by the table, was very changeable. The vibrations were great and frequent. The greateft mean variation (for thefe intemperate feafons) for the month of Auguft, as marked in the table, is 28 ; but in the prefent year it is 37. The atmofphere was uncommonly moift, and the fenfe of cold confequently far below that which was indi- cated by the thermometer. The number of rainy days were fifteen. This extreme moifture of the at- mofphere muft have caufed the changes of tempera- ture to have operated much more powerfully than they otnerwife would have done. Early \p. this month the influenza made its appear- ance, and continued with but little intermiflion till the firft of October. Its fymptoms were, laflitude, cold and long continued fhiverings, or a more than ufual fenfibility to cold, a difcharge of mucus from the nofe and eyes, attended with more or lefs fneez- ing, pain in the head, generally over one eye, more or lefs cough, the breathing a little obftrufled and hurried, with occafional pain in the fide or back, and a forenefs which appeared to be in the internal capillaries immediately in contact, with the bones. The fick, when expofed, were liable to a relapfe, which was often more fevere than the original dif- eafe. The pulfe was full, ftrong, rather frequent, and hard ; but fometimes foft. The firft attack was often fevere, but feldom fatal; the feverity of the difeafe generally abated in lefs than 72 hours from 46 Weather and Diseases of 1807 and ItOS. the firft attack; bleeding appeared to have a goocf effect—the head-ache, and other violent pains, im- mediately abating on this operation being performed. Cold applications, fuch as cloths wet in afolution of fac. faturni in water or vinegar, and applied to the head, &c. gave in general great relief. Cathartics, naufeating dofes of emetics, epifpaftics, and diapho- retics, were of advantage in the moft violent cafes. About the lft of October the difeafe loft its moft chara&eriftic fymptom, viz. a difcharge of mucus from the nofe, and was fucceeded by inflammatory fever, varying in its duration, from one day to fev- en, eight, and nine, attended with cough, pain in the head, and other fymptoms which appeared to partake of the nature of influenza. Several fevere cafes of pleurify likewife appeared in this month, which is with us uncommon. November was comparatively temperate, and the vibrations of temperature not great, or frequent; yet feveral new cafes happened ; but all on the ftor- my days, or immediately after, except one. One fingular cafe of fever occurred, in this month, at- tended with coma and hemiplegia j in other refpe&s it was fimilar to the prevailing epidemic. The above difeafes continued to prevail through December, which was the unhealthieft month for December that I recollect ever to have feen. A Synopikal View of the Weather and Diseases, from February 1, 1808, to February 1, 1809. 1$^ O 55 O g >'riT * > ^ ^ P * r p < r^«v: g,- a.- g- glgg&'S^feotSg 8$Totalheat ofthedays. M-l_fe M» O, MMWHW-MM o, **i-i»~i>-iw»~Mi.Mi t>#/l ^..i. Qcoo>Qioa>toooooiM»CBcW otal neat of the fi g> m ^S o c^ m _,\c j"c mI ff_Z^ nights ft ik *° £ •**■ ** ^**< ^T B *nsrcj ~—:—i—i—~~T »OsOo)MOi. h* to Co 4* ot C7> s Nrku ifi co to 5T? T —T~—T"* ? ^oti^oscsjoo^j^ot ooto> Mean temperature of ^5_____ot ot ot ot ot ot the days and nights. j& to ot Q..o? ^ '8 IS o S « c m Greatest aeg. of hi at. %■» »■* ►-"'» Co #>• Ot Ot C; M — " c* co k> to o MOaio^oo ■-* Lowest deg. of heat. t S ot 8 &1T& g gFg'gafirwtoy'^^faau. SESKSSSSSS:; S ^N^ber of fair days. op a? ^ £ £ co oo £ oo q? £ jo_g Number of foul day*. 8o>otoHiOOo5oto»ca Ar"w*fr of*nanvy days •gM»,o,b,»o,:0. ^Number of rainy daus & O co cot ^ co » to^ ~ to co Jfomfrr 0/ fWt/ rffo/g £~fr»ooo'QOO~ p"*^0' °f dually days. »-i ^b^q.m^^^ North-east.___ g «o,frco~~OOo~~~c» South-east. £. CiQcMwO^OWmsOO North. I0 0"-*''00»0>M<0MM*' East. 3 to South. *»00>300CO>*0000 West. Diseases which prevailed. J* 42 Weather and Diseases of 1808 and 1909. A Succinct Account of the Weather and Diseases of 1808 and 1809. The^ months of February, March, and April, as appears by the table, were mild and temperate for the feafon ; the variations for the prefent year may be confidered moderate. The unfavorable cir- cumftances, as refpedts the healthy ftate of the weather during thefe months, were a rain ftorm, which happened on the firft of February, and eight days of fouth and thirteen days of fouth-weft wind, which happened in February and March. In the month of January, 1808, feveral cafes of abfceffes occurred, affecting various parts, viz. the limbs, ears, throat, &c. In the laft of February and the firft of March, an extremely chilly wind blew for feveral days from the fouth, during which time feveral alarming cafes of pleurify, hemicrania, inflammation of the eyes, teeth, &c. occurred ; one fevere cafe of croup happened at this time. Phle- botomy had an excellent effect, in the abovemen- tioned cafes, and fo likewife had cathartics, expectorants, emetics, and blifters, in fome of them. The months of May, June, and July, were not remarkable for changes; though in June the changes were rather greater than ufually happen in that month. No remarkable difeafes occurred during thefe months, except a few cafes of bilious fever. Auguft, September, and October—thefe months were not remarkable for any fudden changes of temperature, or any difeafes which occurred in them, except October, which was wetter than that Influenza in Portsmouth, in 1807. 45 month ufually is ; and, as is feen by the table, fuf- fered greater changes than is ufual. In this month the typhus mition was frequent. November, December, and January, were not remarkable for the prevalence of any difeafe, or va- riation of temperature. Account of the INFLUENZA* which happened in Ports- mouth, New-Hampshire, in the year 1807. By Lyman Spalding, M. D. [See Medical Repository, Vol. V. Hex. 2. page 311.] Portsmouth, the capital of the State of New- Hampfhire, is fituated in 43° *' north latitude, and 6° 26' eaft longitude from Wafhington, and con- tains about 7000 inhabitants. On the 23d of January, at funrife, the thermometer was 10 deg., on the 26th 13 deg. below Zero ; the coldeft weather ever recorded in this town.* By eight o'clock on thofe days, the town was completely filled with an intenfely thick fog or vapour from the Pifcataqua river, fo as to render it almoft im« poflible to fee acrofs the ftreets. A fevere rain ftorm immediately followed each of thofe days. Between the 23d and the 26th, the influenza made its ap- pearance ; and after vifiting almoft every family in town, fubfided early in May. * 1807, January 23, the thermometer at this place, (Salisbury, New-Hampshire, latitude 43° 20. north) at sunrise, was 5° below 0 ; th,e weather was hazy, and the wind south-east : on the 26th, 13° 5 below 0 ; the weather squally, the wind north-west. 44 Warm Day at Northampton. About the middle of Auguft, the influenza made its fecond appearance, which was more fevere than the firft, fparing none, not even thofe who fuffered the moft in the former attack. After deftroying a few, and predifpofing many to confumption, it difappeared in December. The mild typhus fever appeared in October, and prevailed through the yean Warm Day at Northampton, Massachusetts On the evening of the 27th ult. the wind ihifted fuddenly from a foutherly to a fouth-weftern point, and blew moft violently chief of the night. As foon as the wind ihifted, a very uncommon heat of the air was fenfibly felt, fo very warm, that opening a door of a room where there was a good fire, the air abroad was much warmer than in the room, and occafioned a fenfation very fimilar to the effect of the heat of an oven, or the Waft of a furnace. [Northampton paper, Dec. 2, 1807.] The 27th of November, 1807, ftands marked on the journal for that month, 4,5°. The wind at this place, (Salisbury, New-Hampfhire) had been eaft; it had been rainy, and the wind probably veered round from the eaft to the north-weft : there is no mention made in my journal of its being fouth, or fouth-weft, on that day. Facts concerning the Winter of 1806 and 1807, and the Spring of 1807, at Albany, State of New-Tork. (See Med. Repos. Vol. IV. Hex. 2. page 104.) The feason (the winter and fpring) has been extraordinary, on account of its fudden changes I facts concerning the Winter 3fl866 and 1807. 45 from extreme cold to moderate weather, with fre- quent snows, which were foon taken off by rain, or a warm fun, On account of the frequent recur- rence of violent gales of wind, which fometimes would continue without intermission for fixty hours, with a cloudy atmofphere; at other times, for eighteen or twenty-four hours, the air perfectly clear, and always in a direction from fouth-weft to north-weft, but generally from fouth-weft to weft, on account of the remarkable frefhets or floods that occurred in the month of February, in different parts of all the New-England States, Vermont, part of this State, and fome of the fouthern States, fweep- ing awajfcmills and bridges, and inundating the flat lands near to the rivers. The coldest day experien- ced here was February 9th, when the mercury, at funrife, stood at 20 below O : it may be truly faid, that this was the coldeft weather ever experienced in Albany. On the.fame morning, at funrife, the mercury at Augufta, Maine, flood at 34 below O, or 65 below the freezing point, which is nearly equal to the Greenland atmosphere, and probably never experienced before in the limits of the United States. On the Slst of March, a violent snow ftorm fet in with heavy winds, which moderated a little on the 1st of April, and increased in violence on the 2d ; from which time to the 5th the wind blew a gale from the fouth-weft; the fnow lay about three feet deep, with severe cold weather; but it foon grew warmer, and the fnow melted gradually away.—It 46 History of the Influenza in the City of New-fork. has been conjectured, that some late lingular junction of the planets, particularly the total eclipse of the fun, which occurred laft June, has produced these extraordinary changes in the earth. .*> History of the Influenza, as it appeared in New-Tork City, in the year 1807. By Shadrach Ricketson% Physician in New-Tork. Published in the Med. Repos. Vol. VI. Hex. 2. This difeafe has prevailed, in North-America, many times prior to 1807, particularly in 173S, 1737, 1747, 1756, 1757, 1761, 1772, 1781, 1789, and 1790 ; but at no time within my recollection has it prevailed fo generally and fo feverely as in 1789 and 1807. Before defcribing the hiftory and fymptoms of this difeaie, it may not be improper to obferve the ftate of the weather during the two laft fummer months in which it appeared. This cannot be done better than by recurring to the meteorolog- ical tables of that time, from which it will appear, that a great deal of rain had fallen, and that although the weather had been hotter than that of the pre- ceding fummer, yet there had been two remarkable tranfitions to a cool ftate of the air, viz* in the evening of the 28th of the fecond fummer month, and on the 22d of the laft. Indeed fome judged that the former fudden change was the cause of the difeafe ; but a few cafes were obferved nearly two weeks before that time. It might, however, have aggravated it j for it was remarked to increafe in History of the Influenza in the City ofNew-tork. 47 feverity, and to fpread rapidly foon afterwards, fo that in eight, ten, or twelve days, it was at its height. It being ufual, in recording the hiftories of epi- demic difeafes, to mention fuch diforders as imme- diately precede, accompany, or follow them, it may be proper to obferve, that a violent fpecies of ophthalmia prevailed fomewhat generally before it. This affection of the eyes, though it was fudden and fevere, and produced in fome inftances an immediate fuft'ufion of the adnata, yielded moflly to the ufual remedies. Some cafes of this complaint continued after the appearance of the influenza j but it did not fecure the fyftem againft the latter ; for fome had both. Some inftances of the influenza occurred as early as the middle of the fecond fummer month ; but it did not become general till about the firft of the next, when it increafed fo rapidly that in a few days it was judged that nearly one half of the citizens were affected with it. It fpared neither age nor fex, though more children escaped it than adults, and I think fewer women were violently affected than men. It was moft fevere with people whofe fituation or occupation expofed them to the inclemencies of the weather. Thefe fuffered moft frequently from relapfes. It is eftimated that three-fourths of the inhabitants had, fooner or later, more or lefs of the difeafe; but although it was fo general, it rarely proved mortal, and did not in every inftance require medical attend- ance, moftly yielding to regimen and fimple domef- 4S History of the Influenza in ibt City of New-tor k. tic remedies. The fymptoms, which characterized this difeafe, were not much different from thofe that attend a heavy cold. The fevereft cafes were gene- rally uihered in with an ague chill, or fenfation of cold, a hoarfenefs, forenefs, and, as fome eapreffed it, a rawnefs of the throat, lungs, and ftomach, ac- companied with an urgent cough, or hawking. Pains in the head, cheft, back, or limbs, and frequently in all, with a lafiitude, reftleffnefs, and great prof. tration of ftrength, almoft univerfally attended. The pains in the head were often fevere, accompanied in a few inftances with a vertigo, or flight delirium \ in fome cafes it centered much in the frontal ^ufes; in others, it affected the jaws, exciting great fore- nefs in the parts, with tooth-ache; and in a few, it pervaded the ears, occafioning tinnitus aurium and deafhefs. The pain in the preaft reiembled that of pneumonia, particularly the peripneumonia notha, or intercoftal rheumatifm. Thofe of the bach and limbs were often fevere, and fimilar to the pains ac- companying the acceflion of typhus and other fevers. The pulfe were rarely full, or hard ; the blood was not, except in fome particular cafes, muchfizy. The moft robuft patients very commonly fwooned under the operation of venafection. Dr. Ricketfon, in the cure of this difeafe, recom- mends emetics,blifters, and particularly diaphoretics, fuch as rubbing the patient in warm vinegar,the gen-< eral warm bath, or the femicupian blankets wrung out of warm vinegar as hot as could be borne, and applied to the patient, fo as to produce a general but Dr. Powell's Description if the Influenza. 40 moderate fweat, expectorants, and naufeating ddfes of emetics. A few inftances, heobferves, were faid to put on a typhoid character, or to degenerate into a fever of that type, when they were to be treated accordingly. Dr. Ricketfon obferves, that in moft of the communications received in anfwer to a circu- lar, letter, (the object of which was to obtain infor- mation refpecting this difeafe) the fymptoms of the difeafe were defcribed as being more inflammatory, and denoting a greater phlogiftic diathefis in the fyf- tem, than was obferved in the city of New-York.—■ This may account Jbr the more liberal ufe of the lan- cet, which appears to have been ufed in many places as a general remedy. Extract from a description of the Influenza, as it prevailed in Clinton county, State of New-Tork,, in 1807—By Dr. Horatio Powell, of Chazy. [See New-York Med.Repos. VoI.VI. Hex. 2. p. 347.] During the months of April, JVIay, and June, and the beginning of July, the weather wasj unufually cool; in the two former months, much rain fell. In April, many in this vicinity were affected with acute rheumatifm, coughs, and other inflammatory • difor Jers. These patients, I observed, were prin- cipally among that clafs of people who, from their occupation, were much expofed, being immerfed for feveral hours in the day in the cold water of the lake, up to their knees, or waift, for the* purpofe of making rafts of boards, &c. Blood-letting, cooling O 5a Dr. Powelh Description of the Influents. cacnartics* antimonials, and fudorifics, were fo* the moft part fufficient to work a cure. In May and June, the bilious remitting and intermitting fever prevailed very confidefably. July was healthy. The Influenza made its apparance in this vicinity about the 10th of Auguft; from whence this wide rereading ailment originated, or by what laws of nature or of the animal economy it traverfed, with &ch uninterrupted regularity, this and the neigh* boring States, uniformly from fouth to north, I am unable to determine. From its extenfive prevalence, it did not appear to be merely endemical, neither was it contagious, but doubtless was owing to a peculiar ftate of the atmofphere, which peculiar ftate is beft known by referring to meteorological tables kept during the continuance of this memorable epidemic. Patients, for the moft part, on the firft attack of this difeafe, complained of being unufually chilly ; all the fymptdms of a common cold, or coryza, foon came on j their noftrils were completely flopped ; they had an inceffant tickling cough, and head-ache, and dull, and fometimes inflamed eyes. In fome, the puHe were foft; in others, hard and frequent; they foon loft their ftrength: in general the appetite failed ; fome, however, continued to crave food as ufual. Moft commonly their bowels were in good order, urine high colored. Some fweated eafily upon exertion ; others had their skin obftinately dry. September 11th, the influenza ftill raged. Many were at this time firft feized with a pain in one or both ears j fome with pain in one or more teeth, Dr. Amelts Account of the Influenza. 51 efpecially if any were carious j and fome were firft affected with a fevere pain in the fsaall of their back; others in the back part of their head, complaining that the tendons of their neck were fore; all com- plained of a difagreeable bitter tafte in their mouths, efpeciafly on firft awaking in the morning.—Cold feet are not anunfrequeat fyroptom, whilft the head, in fome, at the fame time, is extremely warm. Some patients are affected with fevere chilliness, conftantly for 24 hours previous to any preternatu- ral heat or fever. Our treatment has been to eyJwUt emetics, nau> feating medicines^ venefection wljien ,the pulfe are hard, the feet to be kept warm, and the liea4 jCQoI* Dr. David Arnelfs account of the Influenza*, in IQ&l, as it appeared in tbe county afDrJuege, State of New- York. During the courfe of the hft fpring, pdeurifies, pneumonia, and inflammatory complaints, were very rife ; but they almoft entirely disappeared by the middle of April. In the autumn, inftead of the ufual forms of fever which had prevailed, the influ- enza made its appearance. The firft cafes which L faw of it, were on the 5th day of Auguft.* Mr. *It appears by Dr. Arnell's journal, that on the 30th day of July. at 6 o'clock. A. M. the thermometer was as low as 54° ; on the 31st, at 2 o'clock, P. M. it had risen a> high as 82°; making a variation ot 28° in 32 hours : on the 1st day of August, at 6 o'clock, A. M. it had fallen as low as 53* ; making a variation of 29° in 16 hoars ; and the variation probably had been still greater, as the sun, on the l>t day *f AmrHst, at 6 o'clock, A. M. must have been one hour and a hal. high, "during which time the thermometer will generally use b er 7« after a very cool night. 52 Dr. ArnelTs Account of the Influenza. James Clark and his family, confifting of five befide himfelf,were all attacked with it in the courfe of one night. They were taken with cold chills,hoarfenefs,, pain in the head, breaft, and fide, which was foon fucceeded by thirft, fever, dry tongue, coryza, and a defluxion from the nofe ; the pulfe were full and hard. Treatment—Phlebotomy, cathartics, tepid, and mucilaginous drinks. The fubjoined meteorological table is taken from Dr. Arnell's diary of the weather and difeafes which occurred during the time therein mentioned. The temperature of thefe months, as will appear by the table, is remarkably low for the latitude of the place j which I confider in part to be occafioned by the moifture of the place*, caufed by vaft fwamps, or drowned lands as they are called, creeks, and rivers, together with the abundance of rain that fell during the fummer months ; the evaporation from the furface muft of courfe be great, and at the expenfe of the temperature of the air. O i« I* ^c3 •is c3 May- June July ' August Septera Octob. \4! • 2/3 I* *"* * R *>5 * *m *■*; «f* *s ** * (S ' , " ^ . C . se a > R ■" s • sT* a .•♦* .,5 . £ £ * S •o•« -^ ^* • £ '^ -^ -3 ioro* 85S-66-58'*3 195M682-65-56 • 9 2215-1869-71-6Q-11 2213-1730-ri^6-15 1925-1598'64-53-H 1489-1126-JT7-43 14 8 is < • . 13 . .-si . 0s »»•**••,§•*. ^•*. • *u as »2 • ** sf.^j a? s» 5» o>. 5\ *'8.-j;.8.is.fe.b.fc s. w O l» k? k? 1? 1? ^ *£ *S '& '^ '^ *fc '^ 59 78 40«30* 7' 10* 4» 6 607948 19*13-17'IG* 7 65-82-54 26*13-18-H* 7 63-77'4829'13-18'H' 7 5871 -48'Sl'SO-lO* 6* 4 50-67'33'28'17' 9* 6* 3 Direction of the wind. *$ 1 0« 4* 1 • 0* 5* 4* pleurisy, cephaUa, odontal. 2# 7* 1* 2* 4* 7* pneumonia, phrenitis 3. 3. \. 2.. 6'IV pleurisy, dysentery, ophthaL gill. V 1» 2* 7* influenza,pleurisy,rheumat. 0« 5* 2- 1* 4* 9* influenza, diaphragmrtis 0* 4» 3' V 5. 6' influenza, pleurisy The above table is taken from Dr. Amelias diary, made at the village of Scotchtoxvn, County of Orange, State of New Tork, in 1807, in latitude N. 41° 42'. longitude W. 75. The thermometer was placed m the open air on the north side of the home. The observations were made at 6 o'clock in the morning and at 2 o'chci in the afternoon. 54 Dr. Willey91 Account of the Influenza. Account of the Influenza, as it appeared on Block Island, in 1807. By Dr. Aaron C. Willey. [New-York Med. Repos. VoL V. Hex. 2. page 271.] Dr. Willey ftates, that the influenza made its appearance on Block Ifland early in February 1807, but in fo mild a form that it was nothing thought of. In March, three cafes only occurred that required afliftance ; but in April, it became more violent, and fometimes affumed an alarming afpect. The milder forms put on the appearance of common colds, fuch as hoarsenefs, fneezing, cough, forenefs and flinging of the throat, and difcharge of mucus from the nofe. But the more violent generally commenced with chills, alternating with flumes of heat, and great pain in various parts of the fyftem, as the head, fide, breaft, bowels, &c Some patients were coftive, others loofe. Some were afte&ed with puking. One cafe refembled a phrenitis; feme refembled pneumonia, and others rheumatifm. Many were afiected with vitiated tafte. The diforder was moft fevere with children. In them was generally great oppreflion, and rattling in the lungs, the tongue moift and frequently covered with a white fur, the pulfe various. In one inftance it proved fatal: this cafe was attended with coftivenefs, fubfultus ten- dinum, a weak fluttering pulfe, and hurried ref- piration. As warm weather advanced, the difeafe in fom e meafiire difappeared ; but during the laft days of Auguft it returned, and became as prevalent as ever. It now for the moft part began with pain in the eyes, head, pofterior part of the neck, back, and Dr. Williamson's Account of the Influents*. 55 bowels, with laflitude, and forenefs of the flefh, forenefs of the throat and cheft, cough, and ex- pectoration, increafed fecretion of nafal mucus, and many times febrile fymptoms. In fome cafes I found a preternatural flownefs of the pulfe. Some cafes were obftinate and ferious, but in general they readily yielded to medicine. Relapfes were fre- quent. Extracts from Observations on the Influenza,, in 1S0T» as it appeared in Maryland. By Dr. G. Williamson, of Baltimore. In a Memoir, read before the Medical Lycaum of the City. [$*e Medical Repository, Vol. I. Hex. S, page 145.]. The laft two years have been pregnant with epidemics, and have confequently been exceedingly interefting to the medical philofopher. Amongft the number who have written on the influenza which prevailed the laft year, but few if any have accounted for, or even attempted to account for its origin. Is it one of thofe fuoje&s which muft forever remain a my&ery ? or is it only to be ac- counted for in that vague manner which appears to be the fafhion of the day ? or, is it to be attributed to fome unknown caufe floating in the circumam- bient atmofphere ?—Reafoning from philofophical principles, it appears rational to fuppofe that the origin of epidemics ought to be accounted for, and that in a fatisfaaory manner. But the language of experience to the medical inquirer feems to have been," thus far fhalt thou go, and no farther." 56 Dr. Williamson*s Account of Influenza. Owing to the multiplicity of bufinefs, which I was engaged in the laft year from my private pratf* tice, with that of the difpenfary, I was prevented from keeping a diary of the weather ; nor was I able to be as particular with my observations and hiftory of the difeafe, as defirable. Thefe reafons are fufficient to deter me from attempting what I am fo folicitous to fee accomplifhed. I am how- ever induced to believe, that the fudden tranfitions of the weather had a very material effect, as refpe&s this difeafe. Laft year the fpring was remarkable for being cool; as late as May there was froft j it was *' Winter ling'ring in the lap of May i*9 and although there were fome hot days in June, yet there was much cool weather even after this. Never did I experience fuch fudden, frequent, and great changes in the weather, as during the fpring and fummer of 1807. After the fummer com- menced, days as cold almoft as winter occurred, as though they had b.een tranfpofed from January to June. One day the thermometer would be from 80° to 90°, and the next not above 70°. This was fo much the cafe, that it was almoft impoflible todrefs to fuit the climate. One day a fummer drefs would be fcarcely cool enough, and the next a winter one not too warm. Thefe tranfitions were remarkable throughout the feafon ; but not fo remarkable in July and Auguft as in the preceding months ; and foon after the influenza made its appearance, there- were feveral weeks of very warm weather. '" Dr. Williamson'* Account of the Influenza. &l I muft undoubtedly confider the influenza as a fpecies of catarrh ; many of the cafes that came under my care differed but little, if any, from the ordinary catarrhs to which we are annually fubjecr* That a fudden tranfition of the weather is an active caufe in producing this difeafe, is a truth fo univer- fally known, that to give a. fingle cafe to prove It, would be impofing upon you. It commenced about the 12tfi of Auguft. From the 20th of Auguft to the 10th of September it was prevalent. From this period1 it gradually declined. Although this difeafe appears to have vifited all America, yet it progrefled with tardy fteps income directions. It commenced, frequently with fneezing y fome- times a cough, and at other times a pain in the head, breaft, or fome other part of the fyftem, preceded the attack j and at other times, the eyes were firft affected. Some were attacked fuddenly; others were predifpofed to the difeafe feveral days previous to a formal attack. When laffitude, accompanied with a forenefs of the mufcles and a depreffion of the fpirlts, took place, the difeafe might be expected; and if, in addition to thefe fymptoms, there was a Jieavinefs about the eyes, with a fenfe of intumefc cency in the palpebral, coryza, and occafional fneea* ing, the perfon was almost as fure of having the difeafe as if he were then laboring under it. In the treatment of this difeafe, after a few of the firft cafes, which were more of an inflammatory nature, in which the lancet was ufed, Dr. Will- iam ion obferves, thofe who were now attacked with II && Dr. Johnson's Account of the Influenza. the influenza, complained of great general proftra- tion of ftrength ; and as there was evidently left inflammat ory action than at firft, I began to miftruft the propriety of the general ufe of the lancet; and from a few more trials was induced to difcontinue it, except in thofe cafes where there were more than ordinary fymptoms of pneumonia, and the pulfe indicative of confiderable inflammatory action. Extracts from an Oration, delivered before the Medical Society of South-Carolina. By Joseph Johnson, M. D. President of the Medical Society of South-Carolina. The prefent year (1807) fet in with the moft uniform cold weather that has been known fince the commencement of our Journal in the year 1793. Occafional fhowers alone prevented the occurrence of ice on every night in January, except the laft. The thermometer, though not fo low at any time as in February, flood at a much lower average, having until the laft day of the month ranged at 33°, and including the heat of the laft day, averaged at 36°. On the 18th there was a fall of fnow. The winds prevailed twenty-two days from the northern, and nine from the eaftern points of compafs. Throughout the continent, the feverity of the cold was in proportion. In Bofton the thermometer fell to 0, and in Portfmouth to 8° below O. The chan- ges in February and March were very great and fudden; on the 6th the thermometer fell 32° in 17 hours, and had probably been lower. On the 10th it had increafed 27° in 31 hours; and many Dr. Johnson's Account of the Influenza. 59 other changes of 15 to 24 degrees were obferved in fhort periods during thefe months. Snow fell two hours and an half on the 3d of February ; and on the 13th there was fmart thunder. The thermom- eter fluctuated from 24 to 69 degrees. Seven inches and three tenths of rain fell in this month, and fix inches and fix and a half tenths in March. The country was overflowed, and the roads for a time were impaflible to carriages. The fpring was un- ufually cold and backward; as late as the 3d of May there was froft. The fpring having been fo backward, the acceffion of fummer was rapid in proportion ; and the 11 th of June was one of the hptteft days to which our climate is fubject; the thermometer Handing at 92° in a very cool fituation, and at 94° generally through- out the city. The average; ,heat of July was 86°, a range confiderably higher than had been obferved fince 1796, and fomewhat exceeding the great heat of that year. From the 26th of July to the 18th of Auguft, there had been but one fhower, the heat being fteady and confiderable ; the endemial caufes commenced about the latter date, and was aggra- vated by the extremely hot weather from the lft to the 5th of September, when the thermometer at noon, in the coldeft fituation, varied from 90 to 92°^. Influenza is noticed as occurring in March and ,April, although not fanctioned by our Journals. My opinion was thenfupportedby the concurrence of fev- eral eminent phyficians, and has fince been confirmed by a correfpondence of fymptoms with that which prevailed in the fall. On the firft of its appearan ce Go Dr. Waikins's Desttoption of the influenisk. in the latter period, the fymptoms' were fo mild that * few required the attendance of a phyfician. Thii lulled many into a fatal fecurity ; and when about half the inhabitants had been attacked by it, a cold change took place in the weather, during which many relapfed, and feveral loft their lives. So gen^ etal was the prevalence of this difeafe about the middle of October, that many families had from fifteen to twenty fick at a time* Dr. Johnfon mentions, that ofi the 20th Gf Octo- ber there was froft within two miles of the eky £ that for more than three months the weather had been extremely dry ; that relapfes Were very fre* quent, and in all fuch cafes the fyhlptorns were greatly aggravated, and'frequently accompanied by violent determinations to the pleura, and medi- aftinum ; that the number of deaths in Charlefton by the influenza'j'in the month of September, was 114 ; that bleeding and other evacuants, with emollient dririks, were the only remedies neceflary at firft ; but-frequent bliftefs were afterwards re- quifite ; that the influenza was ftill more fatal in the interior and northern parts of the State ; and that in thefe parts bleeding was faid to have been injurious. Description of the Influenza, as it appeared in Nafhville, Wefl-fehneffee, in 1807 / in a letter to Dr. Mitchell, " from^Dr. Thomas G. Watkins ; published in the New- Tork Medical Repofitory, Vol. 6. Hex. 2. Nashville is fituated about the S6th degree of north fatitucte. A Ion£, dry, and fultry courfe of Dn Fofffth's Avctoenttf- tin toflaenva. CI treathcr. preceded 'the appearance of the influenza. Grais and corn blades were fuddenly parched up early in Auguft, and continued fi» through autumn, and a grfcat many conftant fprings were dried up entirely, or funk from their ufual level, fb as tu fail. Thh ftate of things continued until a fhort time before the lft of November. About the lft or 2d day of this month, the fudden arrival of the influenza ufhered in, by cold north-eafterly windi and rain. It feemed to fall upon all at once. Its progrefs feemed to be from eaft to weft. It travelled in this direction withgpeat celerity. Fewer negroes were laid up with it than whites, under equal cir^ cumftances j but more negroes died of it than whites. Account of the Influenza, as it appeared in Wheeling, State tf Ohio, in the year 1807. By Dr. Gideon C. Forsyth. [See N. Y. Med. Repos. Vol. VI. Hex. 2. p. 350.] There is perhaps no river in the United States fo fubjeft to fudden falling and rifing of its waters as the Ohio, and the rivers which run into it. Sometimes it can be forded with eafe ; and again it will admit of large veffels to pafs it with fafety. I have obferved, that its fudden rife is generally attended with affeftiohs of the lungs. In my note book for May 20th, 1807,1 find the following re- mark : " for feveral weeks paft, the influenza has prevailed in this and the adjacent counties ; fup- pofed to be caufed by the fudden melting of the <>2 Account of the Spotted Fever in Winchester. fnow on the mountains, which produced a very- great rife of the waters in the Ohio ; the air very damp, and cold wind north and north-weft. Its fymptoms were cold fhiverings, pain in the head, generally acrofs the eyes, full pulfe, fore throat, an ichorous difcharge from the nofe and eyes, coughs and pain in the limbs. The influenza appeared general in this country twice in 1807, viz. May and baober." ACCOUNT OF THE SPOTTED FEVER, in the year 1807, in the town of Winchester, Connecticut. [See N. Y. Med. Repos. Vol. XIII. p. 44 ] " This difeafe appeared in the town of Win- chefter, in Litchfield county, in April 1807, when the froft was diflblving, and the ground breaking up ; and was noticed to make the attack, moft frequently, in rainy weather. Young people under the age of puberty were moft liable to it ; and among adults, females were more liable than males. No age or fex, however, were free from the attacks. It affumed, in different fubjects, all grades of difeafe, from a mild fever to a perfect plague. The fymp- toms were various, according to its inveteracy. Its attacks were with laflitude, chills, great proftra- tion of ftrength, eyes red and watery, pupils dilat- ed in fome cafes, in others fmall like dying perfons after delirium, with exquifite pain in the head, great anxiety at flomach, with tolling of the body : nau- fea, and often troublefome vomiting, a pain and hmenefc in fome of the limbs, often uftiered in the Account of the Spotted fever in Winchester. 63 diforder. There was a forenefs of the flefh, and generally fpots on the fkin, the fize of half a com- mon turkey fhot, fcattered over the body, refem- bling blood bliflers: likewife efflorefcences of various fizes and fhapes, in different parts, which were dark or florid ; and a dark or light color of thefe fpots and efflorefcences gave a clue to a favorable or unfavorable prognoftic: the darker, the more dangerous. In fome, after the chills, there was great heat; which was of the thrilling, flinging kind. The pulfe, like other fymptoms, were vari- ous j fometimes confiderably full, but generally very weak, quick, and irregular. The difeafe, fometimes in this feafon, affumed the inflammatory type j fometimes the fynochus; but generally the typhus.. The violent fymptoms were great laffitude, with univerfal pains in the mufcles j chills, heats, if any, were of fhort dura- tion ; unufual proftration of ftrength; delirium, with fevere pain in the head ; vomiting, with in- defcribable anxiety at the ftomach ; eyes red and watery, and rolled up; the head drawn back with fpafms ; pulfe quick, weak, and irregular; petechia and vibices all over the body ; a cadaverous coun- tenance ; and finally death often clofed the fcene in ten or fifteen hours after the firft attack. Some however furvived all thefe fymptoms. Thofe who died, generally appeared to fink away under the load of the difeafe ; became cold, and low, and died comatofe, with all the marks of general mortifi- cation : others went off fuddenly, apparently apo- pledic—The body, near the fatal period, and foon 64 Mw#t of tfc S&Hedl&ier m Winek*&** after, became as fpotted a» an adder, and demorir ftrated a general diflblution of the fluids. Thoi* who futvived thefe fymptoms, appeared to owe their life. tQ a veuy liberal ufe of ftrong ftimulanta, and tonics v and when the vital fi>me began ta be rekindled-. in the fyftem, ibme grievous external ^ affedion moft certainly appeared j fuch as inflam- mation of the joints like the, acute rheumatifm, or an er-yfipelatous affection of the fkin, or racking pains without any morbid. external appearance, convulfions, fpafms, &c. Thefe external affecfcWa* often proved very lingering and tedious ; and* *»' fome inftances, quite exhaufted the patient. TJiis* however, proved a manageable ftate of the difeafe, *nd rather to be defired than feareo1. Thofe who died, chiefly went off with lownels, which took place early in the difeafe j fome in five or fix hours j but, they generally died between twtnty-four and forty-eight hours after the attack. If they furvived forty-eight hours, the difeafe a& fumed the type of fever, and became manageable, like other febrile difeafes. Some died at a later period, but no more than are commonly carried off by other bad conditioned fevers. In September following, the difeafe made its appearance in the village of Wenftead, attended with lefs inflammatory fymptoms. The eruption on the fkin was not fo general, nor the inflamma- tion of the joints fo fevere, as in Winchefter the preceding fpring. The difeafe, in this feafon, fre- quently fucceeded the influenza; and more generally affumed the typhus form. Bleeding was- tried, but Account of the Spotted Fever in Winchester. 65 1 believe always did harm. Sweating, produced by external heat, and internal ftimulants, proved moft fuccefsful. In December following, the difeafe appeared in the town of Gofhen. In the fpring following, and fore part of fummer, the difeafe appeared in various towns adjoining ; the firft mentioned, with fymp- toms confiderably different. An eruption on the fkin fo feldom appeared, that it could no longer be Confidered a characteriftic fymptom of the difeafe. Thofe fpots, the fizeof half a fhot, refembling blood- blifters, have not appeared in thofe cafes which I have feen j and inflammation of the joints, above- mentioned, are now feldom noticed. All the at- tacks for the year paft, which I have feen, are of the low typhus kind. Generally the difeafe, the year paft, has been much milder than before." [See New-Tork Med. Repos. Vol. XIII. p. 42.] I A Synoptical View of the Weather and Diseases, froth February 1, 1809, to February 1, 1810. * ' »rj Table 5. &ojc>on>~»$~S! Total heat of the days. *® ^£E££££c*k» Total heat of the £ 52&lg?8g3aS_g _^£_______ WWWt Ss?23SSS tM*<™ temperature of the days. ______ "La .— k» t>S .£■ >£• CT>'"5> O *»• Co »— £___ 5^2SSSSSSS£ t Difference °f**"*Pf*- IS"g^"g^^TS~fe 3 ^Meantemperature of oVVo._________* "U ^g *&«/* and nights. ut3O>K(O"-K>Ousni!jH03 Lowest deg. ot neat. _*_*_*_________________* *--------P . - ---— — ,. bibtto^uisKtsKiuNiu ^Greatest vari. tn 24rk. CO cjui-ico^cis^i^^ooO^______________—— Js* M-Kw»MMWHt-MM <-+Number of fair days. p ^^-^j-i-i-j-n*^^ Number of foul days. *£ ^^s««^«.„, > Number of snowy (lays •^ ~ ~ E t^ . , Number of rainy days *" , v* r. v« v* ,. .Number of clouaydiys ~ ~ -* ^ ,-> -^ _.^^ -M. of squally day*. _3j: ££ .*E£££S££ ot North-west.___ £ 10 0»tOJOK>i-k©©Co>-»OtCrtJOV9 North-east. *0 South-east. South-west. OOGaW<0N3N>ON)ON>R>'-&3 North. East. KOhCHO«0«»OM»Oi- South. t-o^ooocooooop West. £ *> § § l"^- § § 3 * Diseases which 8.1' 2- S. S. I-S-S £ ? S. prevailed. ft a a * d Ft. Weather and Diseases of 1809 and 1S10. 67 A Succinct Account of the Weather and Diseases in the years 1809 and 1810. There were no remarkable circumftances which occurred in the firft eleven months in this table, except the uncommon low temperature, and ex- treme wet weather. The changes of temperature and difeafes, which happened in thefe months, are not unufual, except in a few inftances, which I noticed ; when the pulfe were low and foft; the extremities colder than natural, purpliih, and moderately fwollen. It will appear by the table, that all the months (in this calculation) are feveral degrees below their mean temperature, except October and December. The mean temperature of thefe months is 48° and 24°5 ; but in the table, their temperature is marked 56° and 28°5, which makes the former 8 degrees warmer than common, and the latter 4. The number of fair days is 2 J 6; and foul, or rainy, fnowy, cloudy, fqually, &c. 149, making 14,5 of foul weather more than ufuaL There are likewife 4 days excels of north wind, and a diminution of 5 days fouth wind, which make in the whole 23,5 days, which were unfa- vorable to the increafe of temperature. The mean temperature of the prefent year is but 43°,0 ; and the mean annual temperature of thefe very cold feafons is 46°, 1.* From which ftatement we per- * President Fitch makes the mean temperature of the fire summers immediately succeeding the summers in 1804 and 160.5, one and three-fourths of a degree lower than the mean temperature of the mimmers in 1804 aud 1805. If we add this difference of temperature to the mean annual temperature of late years, it will stand tnu», 46,11 + 1,75=47,86; which is probably sufficiently low for our real mean annual temperature ; and if our mean annual temperature 68 Weather and Diseases of 1S09 and 1810. ceive, that the diminution in the mean annual heatis3°,l, which is equal to the heat produced by the fun in our climate for 23 days and 80 parts of a day. Notwithftanding this great diminution of heat this year, yet moft of our fruits ripened, peaches excepted. The crops of grain and grafs « were very good ; and even Indian corn, exception wet or frofty ground, came to maturity ; but the crop was very fmall in this State ; and in the State of Vermont and the Province of Canada it almoft entirely failed.—The weather, as appeafs by the table, was fteady, but uncommonly cool and wet. There is no month until January, in which any great or fudden vibration of temperature happened, and the feafon was of courfe healthy. A few cafes of typhus mitior occurred, but they were uniformly mild. The temperature, though it was very low, yet the heat was diftributed in a very favora- ble manner. The warm feafon continued until the 25th of O&ober, when we had the firft killing froft. The month of October, and firft part of the winter, was as remarkable for being mild, as the fpring and fummer were cool. From the lft to the 19th of January* 1810, the weather was milder than common. The mercury frequently rofe as high as 38 and 40°, and never fell below 5°. On the Ibth, 17th, and 18th, the tem- perature of the nights was from 29 to 31°, and the days from 37 to 41°. During thefe moderate days, mav be considered to be 47°,86, the difference will be 4°,768 (as" 473,86—1:>°,092==4°.768) which is a diminution iu the mean heat of our cli:nate of 4°,763 ; and is equal to the whole heat produc- ed by the 6uu that year in our climate, for 40 days and 386 parts of a, day- Weather and Diseases of 1809 and 181.0. 69 the topi f the ground had thawed, and the fap of trees was faid to»have circulated freely, and the ground was moflly bare. On the evening of the 18th there fell a fmall quantity.of fnow, perhaps half an inch, from the fouth-weft The evening was remarkably calm and ftiil until ten o'clock, at which time a very great and fudden change took place ; the firft appearance of which was, very dark, denfe, and heavy clouds, fettled or rather rolled from the mountains in the weft, attended with a Angular undulating roar : the wind varying from fouth- weft to north-weft, and thence north, and from north back to north-weft ; the fky was covered with a thick haze ; the cold was dreadful, and the wind ftronger than perhaps was ever before known. The thermometer, at funrife on the 19th, was confidered to have flood at 19° below 0 ; and at 10 o'clock in the morning at 23c below 0: after 10, the wind. veered into the north-weft, the haze difappeared, and the weather moderated. On the morning of the 20th, the thermometer flood at 15» below O, and at 5 o'clock, P. M. at 12' below O. On the 2lft in the morning, at funrife, at 16° below 0; at 5 o'clock, P. M. 10° below 0. On the 22d, at funrife, 11 ° below O ; at 5, P. M. 10» above 0; and on the 2Sd,at funrife, 5o above 0; at 5 o'clock, P. M. 21° above O. During this fevere froft, feveral lives were loft by the extreme cold. The hoofs and horns of cat- tle were likewife frozen. Trees, particularly the exotics, as apple trees, peach trees, quince trees, and Lombardy poplars, &c. fuffered much. Many died $0 Weather and Diseases ef 1809 and 1S10. this year ; though moft of them leaved out in the fpring, but foon after died. Others died but in part. Even the fturdy oak and the elm were not found hardy enough to endure the violence of thii froft. Several perfons, as was before obferved, loft their lives by its immediate operation. Others, fome of whom I vifited during this period, were affected with a fevere chill, from which they gradu- ally recovered. 4 A Synoptical fiew ef the Weather and Diseases, from Feb. 1, 1810, to Feb. 1, 1811. Table 6. «0 MKMMMMMMH «5$S$2S£«SS Z^Totalhcatoftheday* O O O » 00 MM mRb(QO» ________________ Hto55ntt>o»t»w»oo5______ vtibiios^9>sbiOf»i(ii 0,-flirwwj temperature of C3_________________thedays £«*ooo>oiSto£^toeftWN>t>st0O3*0 K> Greatest vari in 9A A r* nQONca ovo> oo to *>. w -^ en i*reatcii van, tn z^n. a- is-----■----------------------------------------■---- § UMMMMMwMi-MMt- *° Number affair dau* ' SwoqwooodSomOooS ^Number of foul days So»g)Moooo00t>o> M.Afafftfor of snowy days ccomo^cSo^^o,^ & Number of rainy days ScoOM»,woHotoK» ^Number of cloudy days sooooooooocoOto ^Numberofsquallyd. eo huo MMi-iM^^HAta Wnrlh.iop&t S ts^MCsO)0>o>s»tO Qivort/i wrat «... & wowM^mos^M^. q North-east £ t0O>-4t^cSOOQ..*Ol-tM ^South-east § £o»*K)OQi-+>-*oo.j>.»« ^South-west *■•*> ^ ^.North '.East g t 4^ «0K9tO<3>i~»O9^.£.to o. o, o ^«y««'A 3 i 0 Sphacelus 0 Spot. Fever 0 0 0 CephaUa 0 Diarrhoea. 0 Bil. Synocha 7 Ditto 0 Synocha Diseases which prevailed. 72 Climate and Diseases in 1810 and 1811. A Succinct Account of the Climate and Diseases in the years 1810 and 1811. Since the great changes which happened in Jan- uary, 1810, as will appear by the table, no remark- able change has taken place. The feafons have been comparatively mild and temperate, except the month uz October, which has fuffered rather greater changes than are ufual, even in thefe intemperate feafons. The mean greateft variation in 24 hours for October, is 30°,75 j but in this table the greateft variation in 24 hours is S3°, making an excefs of 2°,25. In the month of Marcli, one fufpicious cafe of fever occurred. The perfon, who was the fubject of it, was accuftomed to fit in a warm room in the day, and was expofed to the chills of an evening air. The conftitutions of many people appeared to have fuffered a change. Cold and purplifh hands, rather fwollen, were common. Ulcers fimilar to thofe which formerly healed readily, now healed with difficulty ; and were occafionally affected with mortification, and confequent floughing away of the foft parts ; and a repetition of mortification, which, eventually in fome inftances, from a very fmall and apparently trifling fore, produced exten- five ulcers, fometimes proved fatal to the patient. The mortifications, which happened at this time, were of a peculiar nature. The mortified parts re- tained nearly their natural color, until they Hough- ed away. On the 30th of April, an unequivocal cafe of fpotted fever occurred j but the patient had been Climate and Diseases in 1810 and 1811. . fs very much expofed. Her feet, to the ancles, were faid to have been immerfed for a confiderable time in cold water the day before fhe was taken ill.— May 4th, another cafe occurred, which appeared at firft very dangerous. This perfon likewife had been very much expofed. She was out, for feme. time, in a fhower of fleet, which fell this day, and immediately after was attacked with violent fhiver- wig fits.—In September and October, a bilious fever was frequent j and though it differed Confiderably from the fever which had formerly prevailed at this feafon, it admitted of Weeding.—December 1810, and January 1811, were mild for the feafon ; and' compared with thofe months in preceding years^ were not remarkabfe for any fudden change. The only circumftance unfavorable to the temperature of thofe months, was an excefs of wind from the north and eaft, in January. There occurred five days north wind, and feven eaft, which is an excefs of 2± north, and 41 eaft. Five rainy days like- wife occurred in thefe months. Account cf the Spotted Fever, in 1S10, as it appeared in the town of Petersham, Massachusetts ; in a letter from the Rev. Festus Foster, to the Editor of the Wor- cester Spy, dated March 6th, 1S10. [See N. Y. Med. Repos. Vol. I. Hex. 3. p. 392.] " Sir—I haftcn to give you a fket;h of the fpot- ted fever in this [lace. It made its fiift appearance about the beginning of January laft j but the in- 74 Account of the Spotted Fever in 1810. fiances were few and difhnt from each other, until laft week. Although it had proved fatal in moft inftances, feven only had died, belonging to this town, previous to the 25th of February. Since that time, the diforder has come upon us like a flood of mighty waters. We have buried eight perfons within the laft eight days. About twelve or fifteen new cafes appeared on Thurfday laft; many of them very fudden and violent. This was the moft melancholy and alarming day ever witneflr ed in this place. Seven or eight phyficians were continually engaged in the neighborhood north of the meeting houfe; and I believe not half an hour paffed in the forenoon without prefenting new cafes. Pale fear and extreme anxiety were vifible in every countenance." Account of the Spotted Fever in 1810. The year 1810 was very remarkable on account of the general prevalence of the fpotted fever to the fouth-weft and north-weft of this State, particularly in the States of Maffachufetts, Connedicut, and Vermont, and in the Province of Canada. In this and the neighboring towns, a ftrong predifpofition was very evident in many of the inhabitants ; but, as will appear by the table, the feafon, after the great changes which happened in January 1810, was in this place comparatively favorable. The number of cafes occurring were few, and had the appearance, as far as I have knowledge, of being produced by accidental expofure to cold. A Synoptical View of the Weather and Diseases, from Feb. 1, 1811, to Feb. 1, 1812. 2 3 £ ?po>>T^2>2? Tablet. to o >— Oi 00 £»■ to OJ M to ^i M?SSfell2i§3 'foal heat ofthedays. to tO 00 JO <0 -r to qc O v' to K) ^ O) co 4* to 03 *-> o to n. i *s o» to 4»- lO 71// ... oca^tcjoo-^tocjto oo Mean temperature oj the days. •^ •— Ki u>4-toOJaJCJ4-ojiJtii ^03 •<* 09 totoocotocTiMixtooo Difference oj tempera-ture betw. d.i's & nts 4- >—■ tO M N ^ ►^ to <0 4>- to +- ^ o o> 09 to «p to S' oj ^ i< t ^ a;t temperature of to to to 'to to the dm/.'i andni.q-hts. to c» oo o". J- to oj ct ■ Zidre.itr.st ■■'■?. o* ln-.oot«o^toa>oo Ml.mvrst a.^. oj heat. 03 oo to 4^ to oa «8~£tocSwoto prettiest vari. in 2\h. to 03 -* 1— to M 00 SSJ?§SS§S?Sr M""^r o//«* <%*. p C>3 M M O 4> co ^ctc^^w^toto £ Number of. foul days. C3 i-fc to O CJ -haoooo^jow-. Number ojsnoxoy auys to O *>• o>ojVo£oooo~-~ Numbir oj rainy days C3 )h U O) '^toto-^^joKo^to Number of chut.y aays *a <-*■ o o o o o O O'O o o - Ae- 0/ •v7"w/^ ««$*• tO -30 «£ Ototo^(jjoot<3oo4v»o wrtn-w- si. \p. 4* MM to ~0~OK>+.9n*,.i»io*c'rth'ea*Tm £ to to to o to MOm To W *» ts -----------— - --— ■ <>h wtatocoi-*4v^iot0"-' oouth-e-.tst S- »-*Oto»-toCJ03i3 0 o**0'1**1 west- <2 OO — *>• O O fc> 4* to to A or in. tj. to o> o o 4-oo O to O O ^ M^.HOO|i.MO>S« .St, nth. 3* O O 00COOO~OO " <•':"• ^ ^ b b b P ? &»© ^ a ?•"<« 3"s^?<« ^.'i* Diseases which S-^S.S.5* S-^-S-r^ prevailed. ^ ^" • » « » « cj Y6 Climate and Diseases in 18 U .and 1 SI 2. A Succinct Account of the Climate and Diseases th 1811 and 181?. February, as will appear by the table, was more mild than ufual. March, notwithflanding its greateft vibration, is marked one degree below the medium for this month, occurring in thefe intem- perate years. Yet, it will appear by the journal, that great variations of temperature were frequent in this month. There were fix great variations, which fland thus, 29—30—32---35—32 and 35. Thefe variations were likewife aggravated by north* weft and north winds fucceeding a morft and damp fouth wind; yet March, and the other fpring t months, were comparatively warm, and the vari- ations of temperature were not fo great as have happened in the fime months for feveral preceding years. A fingular eruption occurred this feafon, which I then called eryfipelas; but have fince con- fidered it to be a grade of fpotted fever. The patient appeared rather more dull and drowfy than ufual. An eruption, or rather dhperfed blifters, made t!:eir appearance on the face; but this was not invariably the cafe. They fometimes appeared on the arms, neck, &c. Thefe blifters, in fome patents, fpread and occupied the whole face, which foon became very much bloated. They appeared to confift of an effjfion of coagulated lymph, im- mediately under the cuticula. In a fhort time the' thinner parts were aMurbed by the capillary veffels, and evaporated by the atmofphere ; fo that the remaining more grofs and adhefive parts of this e.iufion were dried into a cruft of a hard and com- Climate and Diseases in 1811 «waft 812. 77 pact appearance, refembling plates of horn, which gave the patient a v^'ry fingular appearance. Thefe crufts gradually feparated and peeled off, leaving the fkin beneath found. In others, thefe blifters did not occupy the whole face, but appeared in ir- regular blotches, with jagged margins. I faw no cafe of this kind which appeared dangerous. Others affected had fmall railliary eruptions, which appear- ed in irregular clutters like ring-worms. The year 1811 was warmer than any other year that has occurred fince 1806. The mean tempera- ture is marked in the table 48°,454. From March to the end of the year it was as healthy as common, and no particular difeafe appeared worthy of remark. January, !fU2.—-Though nothing very remark- able appears in dhe table refpefting this month, yet, by examining the Journal, it will be feen that in it the coldeft feven days occurred which have been known fince we have had any correct account of the temperature of this country. On the 16th, in the morning at funrife, the mercury flood 4° below O; and at one, P. M. it flood 5° above 0 : the 17th, at funrife, 6° below O; and in the afternoon, 8* above O: the 18th, at funrife, 8° below 0; P. M. 4° below O: the 19th, at funrife, 15° below O; P. M. 1° below O : the 20th, at funrife, 1° below O; P. M. 4° below 0; the 2lft, A. M. 1° below 0; P. M. 3° belew O: and on the 22d, A. M. 14* below O j P. M. 2° below O. The direction of the wind was two days north, four days north-eaft, and one day north-weft. Once, for a fhort time, it veer- ed into the fouth-eaft, then north, and north-caft, 7* Climate and Diseases in 1811 and 1812. fouth, eaft, north-weft, and finally north-eaft. On the 20th, fome fnow fell, which ended in a rain, or rather in frozen mifl. During this month, there were 17 fair days, 10 fnowy days, 3 cloudy days, and 1 fqually. The wind was north-weft 18 days, north-eaft 7 days, fouth-eaft 2 days, and north 4 days. The range of the thermometer was 60°. The mean temperature of the month was 17°,5. The whole number of days, on which the wind blew from the north, or had a northerly bearing, were 29. During the greater part of which time, it blew an extreme cold and heavy gale. Perhaps the oldeft man living never before experienced fo fevere and long continued froft. The leaves of the pine, hemlock, fir, and other evergreens, were killed by this cold northerly blaft,much more than I ever before recoiled to have feen them, and efpecially in bleak and expofed fituations. A Synoptical View of the Weather and Diseases, from February 1812, to January 1813. |? 8* §?|^SP1SJ§- Leapyear. *-. ■ too»ooi-*4>.toc»ioo3tOtoiooo tv,/-/ /,„„* „r .. . ■^t-'oo tscotoocjcjca^oto-1 otai neat of the days OOOON(OOmOSO»(OK)00_____ ^ Od > J ^^ ^* ^^ b»A h^ *^ 4>4J'aJOoO*vtooooowoO»4v /-./ .» • .. MOMOhOiO^CiUOiMO) *■// <«ff nights 0*tOt04^^0JQOOtotoOJOoo ** ° OOttoooo^CJuootAM^ ooJUean temperature of 4>. pa Me rtfay* * <3 c»'-totoo34ikO>toOJ4>'C3to»-*" 0» C3 O to to 00 - to to u «*. O O* ^^ ; ^ oo______ to o ^ * jia-^ooooo^toitcftto^toto Difference of tempera- te______________________^"to turebetw.days & nts 4^ C3 5> to to 4^ Ca to 4J> O to OS OJ 00 to OJ O to to to 4-0* 00 to to oc g M.t an temperature of the days and nights to C3 CO OS to O to 4> OJ to to to C3 to O 00 to 3 03 ^ Greatest aeg. of heat * cj * to 03 tO O to to to to C3 o to 4* to 4> to to 00 £ Lowest deg. of heat *> CO to 00 to Ol 03 to 03 to 4^ OJ f^ Greatest vari. in 24 h. to to o 00 to C3 to to to Oj to 4» >-* to OJ £ Number of fair days _§_££_^r ££££££ ^ Number 9ffoul days "tooowoooo o 03 to ca ^Number oj snowy days foto^cotogj^to^otOKS ^Number of rainy days % ^caOcto^OtoMCto ^Number of cloudy days C3C~-~OOCOQOO q Number oj squally d. CJ i-IO^^ »-. _i »_. i— _i _i \rnrtll -,,,„<•* i? Ot0to03034vQJ4>-to00C3 q> Olxorlrl W?s* ^- 4^. OJ C3 -too^to^too^ ^North-east to « ^. i-» OOOmcachom'io 0Souttieust 4-k ia h hmsmw»mooci ca South-west H- 03 tO .-toi-*4^tootooto to North to C Ot to04^00>o0too o*-a8t to -* 4>- tOtOC34^totO'-«C3>-* t-K^SOUtfl a CCOOO'-'-tOOOtoOO JTw* 5-5 0 K >"* "» r* rl ~ Diseases wh'u prevailed. *• f* « 5" " S S. SO Weather andDmas* in\^Vl and 1815. A Succinct Account of the Weather and Diseases which occurred in the years 1812 and 1813. February 1812, like January in the fame year, was fubjecfc to very extraordinary variations, as will appear by examining the table. In its mean temperature, and in the difference of temperature between the days and nights in this month, there is nothing uncommon. The mean greateft variation, marked in the table for the month of February, is 359,5 -, but we find this month to have fuffered a variation in the prefent year of 45*. There are likewife 6 days of north-eaft wind, 9 north, 3 fouth- weft, 1 fouth, which alternating with the northerly winds, made the changes more fenfibly felt than they ©therwife would have been. By examining the. Journal we find, that feven extraordinary variations' happened in this month. On the evening of the 5th, the mercury flood at 40° : the 6th in the morning it had fallen to 5° below 0; at three o'clock, P. M. 2<> below 0: on the evening of the 7th, irhad rifen to 34e : on the evening of the 11th, it flood at 28° : in the morning of the 12th, 5° below 0: on the evening of the 15th, it had rifen to 43<*: on the morning of the 16th, it flood at 10°; on the 16th, P. M. the mercury flood at 38°: the 20th, A. M. it had fallen to 3» : the 23d, P. M. it flood at 36*: the 24th, A. M. it had fallen to 4* below O: the 26th, it flood at 31° : the 27th, it had fallen to 12* below 0. The variations will ftand thus, 45, 36, 33, 33, 35, 40, 43 : and the period of moft of thefe great variations is from 12 to 18 hours only. On the 14th we had fnow and rain -, and, if 1 remember Weather and Diseases in 18 12 and 1818. 81 Fight, fog. The range of the thermometer this month was 57B. On the 16th of this month an obfcure cafe of fpotted fever occurred. I bled my patient, and I think to his difadvantage. He recovered, but it was with great difficulty, and very flowly. His cafe had very nigh proved fatal from an exceflive difcharge of mucus into the bronchial cells. Symptoms—The perfon being at work in the woods, about one fourth of a mile from his houfe, was fuddenly attacked by a violent pain in the head, which foon removed to the right fide of the thorax, and there became fta- tionary. Such was the violence of the attack, that his ftrength failed, and he immediately fell to the ground ; but recovering a little, he had fo much ftrength and prefence of mind as to clafp his horfe's neck with his arm, and by this aid he ftaggered home. When I firft faw him, his face and eyes were very much fwollen, and of a faint purplifh red ; his pulfe were full and foft; his breathing was very much oppreffed, with a fevere pain in the fide.— Several other cafes happened about this time. March 1812, as appears by the table, was very remarkable ; its mean temperature was more than one degree below its ufual mean ; but the.differ- ence of temperature between day and night was one degree above. The thermometer rofe 12° higher, and fell 4° lower, making the range of the thermometer 16° greater than the mean range. The greateft variation in 24 hours is 46° ; which is 9°,5 more than the ufual mean greateft variation. L 32 Weather and Diseases in 1812 and 1815. There was likewife an excefs of foul weather, and other unfavorable circumftances, as will appear by the table. On examining the journal, the changes are found as follow: On the 10th of March, the mercury flood at 16°, A. M-; and in the afternoon it rofe to 50": on the 11th, in the afternoon, it ftood at 62° : on the 12th, in the morning, it had fallen as low as 16° : on the 23d, A. M. it ftood at 29°; P. M. it rofe to 59°: the 24th, in the morning, it had fallen to 21°, and rofe to 51° in the afternoon : the 25th, in the morning, it ftood as low as 26° ; and rofe to 57° in the afternoon ; the 26th, in the morning, it had fallen to 25°; in the afternoon it rofe to 60° : the 27th, in the morning, it bad fallen to 37* ; and rofe in the afternoon to 73° : and on the 3lft, in the morn- ing, it ftood at 27* ; in the afternoon it rofe to 58°. It fhould be remarked, that the periods of thefe variations are but little more than 12 hours. The number of the degrees of variation are as fol- low : 34,=46,=30,=38,=30,=31,=35,=36,= 46,=31. On the 12th and 13th, feveral fell fick. I vifited a patient on the 14th ; flie had a fevere pain in her fide, and difficult refpiration, &c. I had my doubts refpecting the nature of her difeafe. Her pulfe were full, flrong, and I think rather foft. I bled her—-gave a cathartic—and directed an epif- paftic to be applied to the pained fide. She recov- ered : but, about five weeks after, being very much expofed, fhe took a violent cold, which re- produced the difeafe, and foon proved fatal.—On Weather and Diseases in 1812 and 1813. 88 the 15th, I vifited a patient with fymptoms fimilar to the above. He had been ill of the difeafe two or three days. At his particular requeft, I let blood ;' but had my doubts as to tbe propriety of the oper- ation. H s cafe terminated fatally, in about four days from the attack, in confequence of an effu- fion of lymph into the cells of the bronchia.—The three cafes abovementioned appeared fimilar to a pleurify ; or at lead fo much fo that I could difcern at that time no important difference. The pulfe, as near as I can recollec~l,were not fo hard,but were as full and ftrong as we ufually find them to be in a real pleurify. The reafons of my doubts refpecVmg the nature of the difeafe, were, the attack was more violent than in a real pleurify ; the head-ache was attended with a peculiar throbbing of the temporal arteries, and was more fevere than ufually happens, in the pleurify; the countenance had more of a leaden eaft; and the face had more of a bloated appearance: but thefe are circumftances that we are liable to overlook. The circumftances which caufed me to hefitate as refpecled the propriety of blood- letting, were the extreme difficulty which attended the recovery of my firft patient—the unufual pro- grefs of the difeafe, viz. the febrile paroxifms were irregular, and uncertain—the patient appeared not very fick at times, but was far from being well— was drowfy—his countenance had a fingular afpeel, and was very much funk. On the 15th of March, we had hail; the wind was fouth: the 16th, rain and fouth : wind the 17th, fnow, the wind fouth-eaft and north-eaft. 8'4 Weather and Diseases in 1812 and 1813. During thefe three days,and two or three days after, the difeafe increafed with great rapidity.lt was now no longer difguifed, but aflumed its characteriftic- fymptoms, viz. extreme cold fhivering, acute pain in the fide or head, but occafionally in the hands or- feet. Sometimes it afte&ed the bowels and back, in the form of colic or dyfuria. In other cafes, the moft acute pain would be felt in the ear, the jaw, • or even in a tooth. The breathing was in moft cafes? I difficult;attended with cough,andoften withabloody \ expectoration. Delirium was a frequent, but not an uniform fymptom. Some were affected with an unmanageable furious delirium, fimiiar to that ■- which attends phrenitis. Others were affefted with low muttering, and comatofe delirium, attended with a difpofition to fleep. Some few, as the dif- eafe declined, became infane ; but the infanity was of fhort duration, and entirely left them on the re- covery of their ftrength.—Difficulty in voiding the urine was almoft a conflant fymptom : the hands and face were generally of a leaden colour, and moderately fwollen: a very flow motion of the blood in the capillaries was very perceptible, by making a flight preffure on thefe parts with the point of the \ finger : effufions of blood or lymph in the rete mu- coium and cellular membrane, as likewife effufions in the fockets of the eyes, (the eye-balls were occa- fionally fuffufed with blood) deep effufions in the . extremities, lying in immediate contact with the pe. riofteum, and occafionally occupying the whole limb, and extending from joint to joint ; effufions of blood and lymph in the cavity of the thorax, in Weather and Diseases in 1812 and 1813. 85 the cells of the* bronchia, and in the brain, &c. Blood was occafionally difcharged with the urine, and in fome cafes from the bowels, refembling dyf- entery. Some one of the above named effufions happened in moft cafes, Raifing blood from the lungs was frequent; in fome inftances it was dif- charged in confiderable quantity; but more frequent- ly it was expectorated with the mucus from the lungs, and was very trifling. A difcharge of blood from the nofe was frequent, and not an unfavorable fymptom ; alfo a milliary eruption, or an eruption of white pimples which had a fpherical appearance, and ftood out confiderably prominent; from the fight, I at firft fuppofed them to contain water, but on examining them I found they were very hard, and unyielding: likewife a rafh, or an eruption fimilar to ring-worms, was very common, and at- tended the mildeft form of this fever. The above difeafe continued to prevail with great violence and mortality until about the 10th of May ; at which time it abated in its violence, and frequency; though occafional cafes happened, fome of which proved fatal, until the middle of July ; after which time I faw no more cafes for the year. The difeafes which prevailed in autumn, were bilious and typhus fevers, and likewife a fpecies of cynanche, which prevailed in a few inftances in the fall, and appeared to bear confiderable relation to the epidemic fever which had prevailed in the winter and fpring preceding. Symptoms—The difeafe firft made its appearance about the middle of Auguft, a few days after a heavy rain from the north-eaft > during which ftorm, So Climate and Diseases in 1812 and 1813. a great fall of the mercury happened, viz. from 91° to 54«, which was a variation of 37Q in 24 hours. The patient, on the firft attack, was feized with fhivering fits, laffitude, a peculiar pale and funken countenance ; yet, in general, both he and his friends confidered his difeafe not dangerous, but merely a common cold, or fomething of that nature, from which he was foon expected to recover : but inftead of a recovery, he gradually funk lower ; the tongue fwelled, and in fome inftances could hardly be re- tained in the mouth. I have been informed, that, in fome cafes, the tongue was thruft out of the mouth between the teeth, the throat and neck were confiderably fwollen, and a tough, vifcid mucus, was almoft continually difcharged, or attempts were made to difcharge it, from the throat and mouth; and a thin white flough covered moft of the throat and mouth. This flough was as white as thl whiteft paper, and as thin as a wafer ;* and, if removed, it would be re-produced in twenty-four or forty-eight hours. In thofe cafes where the dif- eafe terminated fatally, death appeared to be in con* fequence of fuffocation. I heard of a few attacks which were very fudden and violent, the patient's throat, tongue, and neck, fwelling in a few hours in fome inftances, and in others in a day or two, fo as to produce fuffocation. Though the number of fevere cafes of this difeafe were comparatively few, yet there were a vaft many people who had the * This was in general the case ; but in a few instances very deep mortified spots occurred, which, if the patient recovered, left loul ulcers which were difficult to heal. Climate and Diseases in 1812 and 1813. 87 difeafe in a flight degree. It was not fo fevere with children as with adults. The duration of this difeafe was in general about 13 or 14 days; but in fome inftances it terminated fatally at a much later period. Although the epidemic fever, which prevailed in the winter and fpring months, in 1812, within the circle of my pradice and obfervation, like other epidemics, affeaed the whole or moft part of the population of the places where it prevailed ; yet its violence was confined to particular fituations. The firft cafes happened on the northern brow of the mountain called Kearfarge ; it then prevailed in a direction parallel with that range of mountains called the Ragged Mountains,keeping at the diftance of about a mile or more from the foot of faid mountains, and from two to three and a half miles from the fummit of the firft range of thefe moun- tains, on a ridge of land where the wind blew with its full ftrength from the mountains. One remark- able current of wind from the north-weft is formed by pafling through a notch in thefe mountains, and fweeps the whole width of the town of Andover, and then ftrikes the northern brow of a prominence in Salibbury called Rackoon-Hill. Another ftrong current of wind paffes from north-weft through a notch which is cut in this mountain by Black-Water river, fo called, and fweeps an extenfive ridge in Salisbury called Center-Road ; but a part of faid current of wind is driven down the channel of faid Black-Water river, and fweeps its weftern bank, the eaftern declivity of Kearfarge mountain, and the high lands adjacent. rl here is alfo an elevated height 88 Clintate and Diseases in 1812 and 1813. of land, called Beech-Hill, which projects into the focus of this current of wind, all of which is fwept by this ftrong current, except a valley which is at the weflern declivity of faid hill, and is pretty effectually fecured from the wind by fharp ridges, mountains, and woods. The fun likewife has its full operation on moft of the before mentioned places, Kearfarge and this valley excepted. The violence of this difeafe correfponded with the bearing of the wind and fun very exactly ; and its feverity was confined to thofe places where their concurrent operation appeared to be the greateft, except the northerly brow of Kearfarge. December 1812, and January 1813, as will appear by the tables, were one degree colder than the fame months in 1811 and 1812. They were likewife as remarkable for being ftill, and pleafant, as thofe months in the preceding years were for being boifterous. The greateft change which happened in December was 30; which is 6°,25 greater than the mean greateft change for this month. In January 1818, the mercury fell 45* in 12 hours, which is 10°, 25 more than its mean greateft change in 24 hours. A Synoptical View of the Weather and Diseases, from February 1813, to February 1814. ^0?0^^^>>v? Table 9- *?«§ ^33]L3 to OMCOCiOCto^lOtOOJtOOO Tnt„J /,„„* ~f th. J„..~ aotcooooo^oiNoo woto-* otai neat of the aays. oo to to to 4y O O — to 4» --tO^CJ niohto to £ go o. £ o " 3 to 2 & o o^a* temperature of the days. 00 4>> (ft to 00 O 4-to to 00 OJ to OJ to to 03 *-to 03 to p to * Of the nights. to 03 OJ to 1—k to O to to 00 to O 5 ^.Difference of temper a-"0 tar* fofw. da\ & nts 4^ ^pj »o *> to 4»- to to 03 00 o> to oo OJ 03 to «o to to 4^- O to to C3 OJ 4> to OS Ox to to 3 to i* to o to to *> OJ O gMcan temperature of the days and nights. ^Greatest net*, of heat. •—•i— ^to4J-toto4^C3tjB>— — T , , , ^ 4>4^o»ooo«— o t* 4> -^ to •-.^to Lowest deg. oj heat. fca a>4>-toc3toc3tot04>.0303OJOJ Greatest vari. in 24A. 7x7 >-k O oo^OOsw^Qii*****___,_____________— £ taMMMH»BwttMKi-H Number of fair days. « O O to to -^ •-* 4> Q^ m m 00 to Oj ____J J -1 4v,— i— i— i_l m ►* mhi Number of foul days. to >-> tO to 4^ O *■* to to Q to to to »<"" vj j___, ^ . •— _ _ ., _. „„ _ . Number of snowy aays oototoo^OOOOOtooj to;"""""" v J"__2__Z_* o> « . '"* ~ *^ ^ ,, -. Number of rainy days. <* v„ . ^ _ ,„ -» ,. ^* Number of clouay days O3tO4^to03tQ4^4*-'-tt*O> c» **<______ y______Z___Z " ~ ~ ~ ^. /-s ^ o ■#«>• of squally days. en q Q03>-*OOOO*-^OOO / 7 7---2_ o> *o »■* ^^i*^^^^^*, North-west. b JTZ-^mj^ ^^q^^^^q North^ast^ J § oo »_ajfcjfc-2-OJSLa.*i>-2> *^^:f!_--- | it c co 4- ~ C3_np__^ 03 o o co #or'A* r* £ o» 03 to 4>- ^_Q. ^ cs ^» J>. C3 ca --—-.-------■ g S^^OOO^ QJ Q O.to tO *»_J±----^Lll-----3 -------------- - West. ?■ cocowocmoomho *£? £> «^ SL >- t£ Diseases which S5 o o. ' a. ? « aa^s prevailed. c i M yo Weather and Diseases in 1813 and 1814. A Succinct Account of the Weather and Diseases to- 1813 and 1814. February 1813 was like January in the fame year, ftill, and pleafant, except a few days, on which the wind blew very ftrong, and was nearly north ; the weather was of courfe intenfely cold. The greateft degree of heat, which happened in this month, was 48L ; the loweft degree of heat 15° below 0. On the 25th, P. M. the thermometer flood at 46-'; en the morning of the 26th it had fallen as low as 15° below O; which was a variation, in about 16 hours, of61Q. There were likewife feveral other great variations, which took place in a fhort time. Fourteen days the wind had a foutherly bearing, which alternated with breezes nearly from the north, which caufed the changes to be more fenfibly felt.— March was not fo pleafant a month, but more flormy, as will appear by the table ; on the 26th of this month, the fnow was four feet deep on a level: no lefs than fix great and fudden changes happened ; as great as 61, 50, 35, 30, &c. There were likewife a fimilar prevalence and alternation of northerly with foutherly winds; we had likewife three great rains in this month, which caufed the vibration of temperature to have a much greater effect.—April, as will appear by the table, was more than ufually mild : but fuch was the depth of the fnow and ice on the lft of April, the weather in general being warm, fuch was the chill occafioned by the melting of the ice and fnow, and the moifture of the ground, that the nights were extremely chilly until about the 20th, when the fnow and ice were entirely diflblved, Weather and Diseases in 1813 and 1814. 91 and the ground confiderably dry;' the weather became more temperate and healthy.—May was temperate, but rather rainy.—June was remarkable for feveral violent changes, and was, for lune, a 1 very fickly month : but the difeafes which prevailed, viz. fpotted fever affecting the limbs, bowels, &c. were much more mtld than thofe of the winter and fpring preceding.—The remaining months of this year, were mild and temperate months, and as healthy as ufual.—January 1814, as will appear by the table, though comparatively moderate, was fubject to confiderable variations of temperature ; and feveral cafes of fever occurred in this month, the fymptoms of which were progreflively verging towards fpotted fever. The winter and fpring of 1812 and 1813, were doubtlefs feafons more fickly and mortal than have been ever known fince the fettlement of this State. In January 1813, cafes of fpotted fever were faid to have occurred in the northerly parts of New-Hamp- fhire and Vermont. About the middle of February, it appeared in an alarming degree in feveral parts of New-Hampfhire. The places which fuffcred moft from the frequency and mortality of this dileafe, were generally low fituations, having a fouthern declivity, or otherwife enjoying the influence of the fun ; and were in general near rivers, ponds, &c. next to thefe loxv fitu.itions, be their defcent in what direction it might. The difeafe was indeed frequent in almoft every imaginable fituation ; but was fo mild, except in the places above mentioned as rarely to need medical affiftance j and in thole few 92 Weather and Diseases in 1813 and 1814. cafes that did, it generally terminated favorably, with the exception of perfons of very intemperate lives, old people, very bad habits, or fuch as had fuffered extraordinary changes of temperature from being very much expofed. In 1812, the lungs were almoft univerfally effected; and death was caufed by fuffocation, &c. In all the cafes which I witneffed in 1813, the lungs were not fo generally affected ; the head appeared to be the part which fuffered moft, and the patients appeared to die in convulfions, apoplexy, palfy, &c. Q2 00 -2 5 ^ ft Fehr. I Mar. April Ma? June Julv Aug. Sept. Octo. Nov. Dec. Jan. Result 874 1277 1665 2215 2323 2493 2148 2028 fW 1200 817 645 19669 .b<3 622 679 1123 1625 1787 1913 1868 15831 1284 901 564 407 14356 $■£ !^ 31 41,1 55,5 71- 4 77,4 80,4 75,7 |67,6 57,5 40 26,3 20,8 22 21, 37, 52, 59, 61, 60, 52, «, 30, 18, I* Q 5 9 19,2 18,0 19,0 17,8 18,7 15,4 14,8 16,1 9,9 8,1 7,7 V) fcv a ^~!£ 26.5(57 31,5|83 1^ 6 4 61,9 68,4 71,0 67,9 30, 1 49,4 35,0 22,9 16,9 46,5 89] 93 92 92 89 92 70 59 40 45 93 3 12v 8* 25 35 41 44 44 31 tJ- | ^ 3 £ 24 9 49| 48 49 35 34 34 35 57 32 31 10*131 21*26 21*157 Si 171 19 18 14 20 22 19 21 28 13 23 21 235 ^ \ Direction of the winds ^l^l^llj^ n| 4; 4 3i o 12 12 17 10 9 12 3 1 10 0 12 0 7 01 7 oUo 9l 01 8 3 17 8 10 0 2 3 7 5 0 4 2 130l20J66 5 41 4 3 2 2 1 1 61 1 0 ■SI 91 0 141 O 13 0 8 15 ^J 1 ^ t* v. 4| 1 0 17 0| 12 24 12 2l! 9 2 5 5 5 3 5 3J 3 0 0 0 1 li 0 1 2 £ |(M l&a IS 0| 6| 3l 5 fyotted Fever. 3 2 ditto. 8 4! 9 11] 2I 0 0 0 t 0 0 3t 9 8 O ditto. 31 O ditto. 3l O ditto. 5 9 ditto. 4| O ditto. 91 0 TyphoidFever 4 2 ditto. 0 21 4 II 3 8k2 158! 9l35ll9|l5l62|50 0 Malig.spot.fcv. 1 Spotted Fever. 5 ditto. 24 * Below O. 04 Weather and Diseases in 1814 and 1815. A Succinct Account of the Weather and Diseases which occurred in the years 1814 and 1815. February was unufually warm for this climate ; the medium temperature of this month ftands marked in the table 26,50; its mean^annual temper- ature is marked in the table 22,1.6; the greateft degree of heat, as will appear by the table, was 57° ; and the lowed, 12° below O; the range of the ther- mometer was 69° ; four rains likewife happened in this month, and one of thefe was immediately followed by a warm thick fog, on the 2d day of February, with the wind in the fouth-weft. On the Sift of January, the mercury ftood 14■• below O : on the lft of February, in the morning, the mercury ftood 1° below 0 ; in the afternoon it ftood as high as 12%$ Table-11. 3. .* ~ -T ~s-3 »- *p* to 4- G>' C> ~* C> ca ifr M M S^f 05C(00 U ffi O 00 CO ^ «) ca *. to w do tn c» j- _j* T^f-an temperature. %» Id -* K> •-* «pajco££££5>MC}o«&» iJ/tran difference oj tem- g 2 b S 5 2 8 25 ". g 'S' J"'^ ^^,y> <*> ^ ""**' ** ._ "f . "* ,tk- ^ i.#» *<\ *•% ^ est £___^ oobo'w to m «» ca heat. -^ -^ Ca Ca ->J -£-to*a „.. i , * ? P ? .^ r^ ? r .u .t° P." -s Mean lowest degree %?. c/t-sj^oto* su<«>^ neat. * **^^ ____». & ^Sot^Uis $#««£* o/ the thermos I ^tgfeis" S5' 5?STgfe <*?•___________p £> ^totoof5»iioK>^» £ Mean greatest variation m •* w> m >-» oo " c> ' *- 10 Ja £m 24, hours b! o< Oi to r m te K? K) co to ,y, p M co S oo u> jt to m f* m jo 6 5*^aM nvmber of fair ., ' "t-* o» w cti oo to o ^ days. CftK?WOr ^t^^trCft to ""yj_____ E*nUorwptoi3topj- p. Mean number of foul V. ' oo w ^" U ~ e* to * " ~ days. Jri m £ £ oo ca f m to to ^ ** North- west. ^ "t-O5to00tP"* ►«> ^ &-Worth east. KS Ci h^ ->; K' Vi >' (9 B W Q( S_____________.___„_______ «* ^ - .. ,- W w m »5 M K- 14 W ,, ,. . ^ » to b.to" - -» o a c» to ia ^outh-east. r. -^ bt Q> C» » W'V ««U_______________________•*• ,_ _ >_. c -j ^to'-o^-to-Wo., 3 to a> J c ~ c-h b * oo ~ ^outh west. •>■•>► Cn K' K> »-■ '> K«t CA ^t K> ■vj______________ CS JO n. to to — ~ - — — K) to M ,. , ^ *o>" oo "v «-> Vo >o to *t •-> >-» zo^ortn. ^ j^ K. to Xii <-. C f^ — ^ W • >— ,. Cj "c cj « ic ' ' m b> »" "1-^ La\t. S. ' ^- k» ' bouth. bi K K Ot JT c O j- - c c c o c o b TA/ lt c ti o •- "— " "m b ^ - b're■4*• OtiUiOMMC«MO««l90 iif.KAN A\:w'AL CALLTI iflO.S # 5- ■n ccoooooocoocoooo 3 <;■< iw ~ o £■ «&"■&. +.+.+. 4* .U ' ------------- & p to oo 3i to oi5 5 '-nmiucoOncsui Annual temperature. »■* Co to fcr _ >., -•) * _ v - - - - - • Diffrencf of temperature be- OCACO^OOC.5 — CA..J. / / • , 4>- -^ 4^ ca oo o> 4v oo >•■ tween the days and nights. CDcOCOcOOOO&tOcO CO" »- mean annum greatest heat. t-. •-. -j." _ M KO ,_; _^ *» 4^ O Ca K> to to v to t-» * * * « * * * * to * w •*-!*- W> w «\J W W ** W ... ■ . . ^ '_*****#** ./% *n annual lowest heat. ^§Sco8i^^i M*an nnmat ran&e °J the thtr' '• jo____________mometer. *>> 0> ^- c ca ca 4^ ca to ' " T" ■„tow^^cjttc»oito A/am an/i. greatest va in 24 fl. "to'>i,J2,*iONS*G60h3 " CO^ci?cac>oo«A^ Mean annual no. of fair days. jy>___________________________________________________________, S&8§ji&l£i2 Mean annual no. ofjoul days. jt>_________________________-_____________________________ J;; W KD M » w » (8 •(> S 2 g g ft g g 3 g ^ rem gwm/a/ wo. c/Vn/ days^ P CO CO c© ►-» -• — tO "^»~' ^*o>j-oo?e(0 Mean annual no. of wet nays. §§SS§5i^§ North-west. H*__________________________________________________. _____ u»ca^*oca«acok)ca jybrfA east. t to to ts to ^o -» to *»■ o wc'-tocoooooto- South-east. "Z. SS.____________________________________----------I 1^ — ^ tA - (J) (Ji IO IO jrtoo — ts*».-viCA«^oo South west. 2, 'to_______i_____________------------~ * K tO to tO ^ NO —'• — „ , T, .,j^.*.»^cotoooc7sooo> North. to *>• — KO K) to to — to _ 5' -st^CACi^tOcOOO^ £,ySf. ^ JO___________________________ c» o> x* 4* ^* t^ to to tj j^cotsoocotacAtoto South Ca ________ *>ooa> - -* ^* w O w /fVsf. Table shewing the mean temperature of several of the United States, and of other Countries. • —= r* eO to y* <» ?> P <* 2 5 "S"g«s b ? 11: 3*3 °K|« Table IS. 2 S o w -Meau annual tempe- •-co » r?tnre-__________ CMCCM •« to to MC — © • — &» fst degree of heat. MMeau annual lowest ♦ gSSej, £ » © *><*;* ^toto^ - degree of heat S3 to, w ceo cTcT^ cftcoco 08«5 oMeaa annual range 5"©ooww w«to ©cnco ~ie»* ^»Qf the thermometer. e£ e» p J^Mean annual greatest " ""**variation in 24 hours. £2 co w ^» S SMeau temperature of "*" "w«>. January. 8 la August. *» — © © © S 5* Mean temperature of ____Vj____oo — V» September. fi j^ w 2 eo tn —Mean temperature of Vacs, October. to © S3 co tS£j§ "Mean temperature o^ fet Bay. The north and north-eaft winds, which were doubtlefs very prevalent at that period, would fweepall that tract of country which lies near the fhore ; and the fouth wind doubtlefs was fufficient- ly ftrong to reach the oppofite fhore. Thefe caufes operating, as we fhould fuppofe they would at that period, might reafonably be expected to have pro- duced very great and fudden changes. That the cutting away the wood of a country fhould confid- a Change in our Climate. 117 erably alter its climate, is a thing fo obvious, that argument feems ufelefs. That it will jnake it fub- ject to greater changes of temperature, appears to be allowed by all ; but that it will have any effect in moderating its climate, is denied by very refpect- able authority. Noah Webfter, Efq. makes the, following obfervations on this fubjed. See the ac- count in the New-York Medical Repofitory, Vol. I. Hex. 3. page 369. " It appears to me extremely unphilofophical to fuppofe any confiderable change in the heat or cold of a particular country. We have no reafon to fup- pofe, that the inclination of the earth's axis to the plane of its orbit has ever been varied, but ftrong evidence to the contrary. If this inclination has always been the fame, it follows, that the quantity of the folar rays falling annually on any particular country muft have always been the fame.—Should thefe c, > ed *H eo o CD s W s u3 > 11 16 9 12 11 20 12 1 4 3 5 2,5 2.25 6,5 13,5 4 11,25 0,25 13 20 10,5 25,5 2,5 5,5 7 4 1* 7 1.5 I 3 9 5 5* 10 8* 14 3 4 15 6* 7* 1 0 0 5 6 7 1 '• ,21* 6* 8* 14 4* 15 4 1 ' 22 11 14 20 3 1 14 16 28 4 tfli. ■ i Salisbiir 3 O (8 8 1 7 15 1 4,5 22 0 12 15 19 6 12 * Below 0. > VA/. tfJO- .1 r,zh ■<4 * .'/ U TO j*. • V sr jfoM ■:■/ v.ji: . -<***-'.-. AIE'TEOUOLOGICAL OHStiiV iTIOXS, made at Eastman's Village, in Salisbury, hv Edward Blodget, Esq and at the Centre IVb cling House in said Salisbury. Tue^Meeting House may he 300 {Vet timber than the Villas ; tue distance ot the Village from the Meeting Hoim: is about 5 miles ; the descent is to- wards the north-east; tlie descent of the laud at the Meeting House is towards the south west. ot — II a .-" S c o- a. t> ? >?l u, A-1 2 9 & po 5? 3 - « .i p= a. 5 B TAB1.F. 15. jolOrn.bef. sunr. r; ~ 2; §gl o'clock,r.M.J ^ ;jlO in.btf. sunr. ri C' 5£1 u»ciock,l\M- -1 i •"" ; ^~<~" 1 Morning, s.' =: ^ wt-?euing. s B* £ uiiVlorning. ^ j* ^ i Evening. S *. 5- *£Variatioain ^PJ labours. ~ ■£. —Variation in j*; ~ •* 12 hours. «.| * Below Oi 134 Remarks on Tables Fourteen and Fifteen. Remarks on Tables 14 and 15. From the preceding tables it appears, that the difference of temperature is very confiderable in fituations which are at no great difta/ice from each other : that the nights are colder in ftill,cold weath- er, in the vallies, than on elevated fituations ; and when the fun has a fair bearing, the days are pro- portionably warmer in the vallies than on hills or mountains ; but in windy weather, and probably in moderate weather, elevated fituations are the cold- eft. The variations of temperature are generally the greateft in vallies ; but this is not invariably the cafe; they are, at times, greateft on the hills ; this appears to be the cafe in windy weather, particular- ly when cold and boifterous winds from the north and north-weft alternate with foutherly winds. TABLE 16. State of the Weather at Augusta and Mallowellin tVaisii, Salisbury in New-Hampshire, and Albany in Nero* Tork, on the 9th of February, 1807, at sunrise. Angus Ther.lHallo. Thc^r.lNalisb. Thrr I Alb. Ther |WeatherAV*Hid. lat 44.36 34*llat.44.16 36»|!at.43.20 2* |lat.42.39 20*| Fair. N.W. State of the Weather at Salisbury in New-Hampshire* itiew-Tork City, and Albany in New-Tork, in 1808 and 1809. Salisbury. Ther 1808. Sep. 19.82 20 56 21 40 22 33 1809.Jan.13.13* 25 7 New-York.Ther lat.40,42 82 Rain. — Albany.Ther. Weather. Winds. Fair. N.W. Cloudy in Sal. Fair. N.W. Frost. — — — Fair. IS — — Fair. 13 February 9 6*JThe coldest 6 12 8*|dayfor the year State of the Weather at Salisbury in New-Hampshire* and at Boston in Massachusetts,forfour days in 1810, — 17* Fair. Fair. N.W. N.W. N.W. Nr* N.W. Salisbury. Lowrst Highest ISlOjan.19.23* 20 IS* 21 1G* 22 11* 18l5jan.3l.21* 19* 12* 10* 10 6* Boston. |Lowest lat-42,23! 4* 5* 6* 2* 14* HighestI Weather. Winds 1 Hazy. N.W. 4 I Fair. N.W. 10 [Fair. N.W. 22 I Fair. N.W. 16*1 On this day Se{"mometer was observed'at 8. A. M.and at 7. P.M. State of the Weather at Salisbury in New-Hampshire, and at Quebec in Lower Canada. Salisbury. iTher.] Quebec. |Th«.at8 o'clock.A.M X815jan.l8.20|lat.46,48] 17 19 22' 20 21 22 23 24 23 27 12 11 6,5 25 10,5 26 71 27 1,5| 28 8* 29 0 30 7* 31 21* 19 28 24 14 15 8 12 8 14 2 10 7 14 A'pathcr. Winds. Fair. Misty. Fair. Fair. ICloudy Snow. I Fair. N.W. Ease N.W. N.W. . East N.W. N.W. ditto.S.fcN.W 'ditto. N.W. jditto. S. W. ' ditto. West. ditto, ditto. ditto, ditto. ditto. N.W. ■r. wm-V-i.-* be,"TC»»inri«* 136 Remarks on Table Sixteen. Reiharks on Table 16. By this table is fhewn, that the greateft ex- tremes of cold are experienced in the deepeft vallies; (fuch as are at fufficient diftance from the fea as not to be affected by it) as is evidenced by the great de- gree of cold experienced on the Kennebec and Hudfon rivers.—Although it appears from the hiftory of our climate, particularly fince 1804, that great and long continued viciflitudes of temperature ultimately affect, in a greater or lefs degree, all or moft part of this continent, of which we have any account: yet this table fhews, that their operation is very' unequal, as refpects the latitude of different places ; and that places, fituated nearly in the fame perallel of latitude, experience very different de- grees of temperature. Qause of Catarrh, Influenza, and Spotted Fever. 137 The Remote Cause of Catarrh, Influenza, and Spotted Fever. " The remote caufes of catarrh," or a cold, as it is called in the Englifti language "is moft common- ly cold applied to the body; the application of cold can, in many cafes, be diftinctly obferved ; and I believe it would always be fo, were men acquaint- ed with, and attentive to, the circumftances which determine cold to act upon the furface of the body." —Cullen. The influenza is faid to be produced by a fpecific contagion, andtoexift independent of the fenfible qualities of the air; yet it will appear, on examining the hiftory of this difeafe, that a long feries of cold, variable, and unufually wet weather, has uniformly preceded the commencement of this difeafe: the ' continuance of fuch changes for a confiderable time, as might be expected, appears to produce a debility of the capillary fyftem, and thereby gives a predif- pofition to the difeafe : in this ftate of the fyftem, a change of temperature, which, in a conftitution not predifpofed, would merely produce a common cold or catarrh, we are very generally informed has been the exciting caufe of the difeafe. Great colds are fometimes called influenza, particularly when a great change of temperature is experienced-, in fuch an event, great numbers of people are affected with the difeafe at nearly the fame time. Dr. Rufh, in his account of the influenza, appears to confider it contagious ; or rather gives us the opinion of other writers to that amount; yet, in the conclufion of S US Cause of Catarrh, Influenza, and Spotted Fetter* the dccoufit,- he makes the following remark: u\ have hinted, in a former Effay, at the diminutives eT certain difeafes. There is a ftate df influenza which is lefs violent and more local than that which has beendefcribed. It generally prevails in the win. ter feafon. It feems to originate from a morbid matter generated in crowded and heated churches* and other affemblies of people. I have feen a cold, or influenza, frequently uhiverfal in Philadelphia* which 1 have diftinftly traced to this fource. It would feem as if the fame fpecies of difeafes refem-. bled pictures ; and that, while fome of them par* took of a deep and vivid nature of mofaic work^ others appeared like the feeble and tranfient impref- fions of water colours." There are fo many facts oppofed to the idea of the contagious nature of influenza, (viz. the circum- ftance of two veffete coming from different countries where the difeafe did not prevail, and the crews of both: being attacked by the difeafe at fea at the fame time ; and likewife families who were remotely fit- uated, and having no communication with any per- fon for a confiderable time, having the difeafe at the fame time with other people; its fudden appear- arice!in remote places, &c.) that it now appears to be pretty generally renounced. Dr. Ricketfon makes the following remark :— "Notwithstanding the general opinion, long entertained, and handed down from one phyficianto another,of the contagious nature of [influenza] it is hoped there are now fuffi- cient obfervations and inconteftable facts to queftion and even to difprove that idea."—The fimilarity of the Identity of Influenza with Spotted Fever. 139 the influenza to fpottec} fever is fo Unking, that had it not been for the accidental appearance of fpots, in fome cafes, the probability is, that the prefent epidemic would ftill have continued to be called by that name. The Identity of Influenza with Spotted Fever. It is true, that the characteriftic fymptoms of in- fluenza, (or contagious catarrh, as it has been called) has not invariably attended the prefent epidemic, viz. a defluxion of rheum from the nofe, throat, lungs, &c. yet a difcharge from thefe parts ha* oc- cafionally occurred, even in very fevere cafes of this difeafe, particularly when the thoracic, vicera,throat, . &c. had been the feat of the difeafe ; neither is a • fimple cold always attended with a difcharge from the nofe, throat, &c. " Suppofe a perfon fainting from the heat of a crowded room, a window is thrown open, with the door, and many are expofed Jo a current of cold air ; yet how various are the dif- orders produced! Should any other part, from previous circumftances, have been rendered more fenfible to its influence, we (hall in confequence have either a fore throat, a diarrhoea, a ftiff iuck, tooth- jache, or rheumatifm, in place of catarrh. 140 Symptoms of Influenza and Spotted Fever compdred. The Symptoms of Influenza and Spotted Fever compared. The following symptoms are common to both diseases. 1. A person laboring under a predisposition to spotted fever, feels extremely sensible to the least change of temperature. A 1. A person, who labors under a predisposition to influenza, feels exceedingly sensible to the least cbange of temperature. 2. The face in some instance* is iwolleu and-florid, and probably it is sometimes of a leaden cast; the bands are sometimes purple; the extremities cold ; lassitude,&c. 3. There are sharp darting pains felt, at times, iu the head. 1. When the exciting cause has been applied, and produced the disease—The patient experiences a chill more or less severe ; pain in the head frequently very se- vere, or in the breast, side, car, jaws, or even a tooth, in the fron- tal sinus, or over one eye, &c! The pulse full and hard, but some- times soft; the temporal arteries throb violently ; the head often very hot, while the extremities are cold. After the cold fit, the heat at the surface is very considerable; the fever has evident remissions, and seldom continues above three or four days ; but the cough and other troublesome symptoms, person in this situation once ob- served to me, that if he dipped bur. the tip of his finger in cold water, he immediately experienc- ed a severe chill, which penetrat- ed his whole body. 2. The face is often rather swollen and purplish ; the extrem- ities colder than natural, and also moderately swollen and purplish ; the pupils of the eyes are some- times dilated, pulse full and soft, and when examined at the wrist, are frequently stronger in one ra- dial artery than in the other.— There is a great torpidity of the system generally, and it requires all the resolution that tbe person is master of to perform his custom. ary business. 3.Sharp darting pains are felt at times in the head;and it sometimes bapi ens,that when from coughing, straining, or otherwise produc- ing a fulness of the blood ves- sels of the brain.whereby the mem- branes of the brain, and brain, be- oome compressed, a soreness is felt in the membranes of the brain, generally on one side of the head only. 1. When the disease has made its attack—The patient often com- plains of extreme and long contin- ued chills, pain, (sometimes very extreme) in the head, over one eye, breast, side, extremities, and even in a tooth ; pulse sometimes full, and slow, but frequently small, quick, and intermitting; but never hard ; the temporal ar- teries beat violently ; the head is often extremely hot, while tbe ex- tremities and most of the body feel cold ; after the cold fit, tbe heat of the body at tbe surface is often very considerable, some- times as great as in any fever with which 1 am acquainted ; the fever Symptoms of the Influenza and Spotted Fez:r. it eotnetiines continue throe or four iveck«. 2. Profuse sweats sometimes ap- poaroverthe whole body, with- out affording any relief. 3. Erysipelatos and miliary eruption^ sometimes attend the influenza. 4. Dr. Rush observed, in his treatise on this disease, in the year 1789,that in most cases which terminated fatally, the patient died of pneumonia uotha. Dr. Rush likewise observes, mat those who suffered by the influenza in 1789, were affected in the breast, but in the year 1790, they were very generally affected by this dis- ease in the head. 5. In influenza, deep seated rheumatic pains, which appear to be in the small vessels, which are in immediate contact with the periosteum, are frequently com- plained of by the patient. 6. In some instances, the whole force of tbe disease falls on the bowels, producing diarrhoea, &c; but in general the bowels are reg- ular, or costive. 7. In 1790, Dr. Rush observes that in a few cases the fever (viz. influenza) terminated in a tedioni and dnngeroos typhus. hav evident remissions : it seldom continues violent more than three or four days, thon~?i effusion »a the hin^s and bronchial cell' o:tni happen as ht« a« ibe filth and spv«-nth day, and the cough, rheu- matic palns,n:id other troublesome symptoms, «ometiinvs continue for several months. 2. Profuse sweats have in a few instances attended the spotted le- ver, particularly in the mouth «f July, 1314. 3. Erysipohlos and miliar;* eruptions occasionally happen i.i spatted fever, and likewise pete- chia and vihices. 4. In 1812, spotted fever gen- erally a fleeted the longs; ami in 1813, the head was lhr> pail which suffered most frequently. 5. Deep seated and excruciat- ing pains in the limbs, swelling of the joints, and effusion of blood, and scrum in immediate contact with the periosteum. G. In some instances this dis- ease affects the bowels, producing dianhma, colic, dysentery, &c. but in general the bowels are reg- ular, or costive. 7. There arc comparatively but few cas's in which the spotted fc ver terminates in a real typhus. Similarity of Symptoms in Influenza and Spotted Fever. It appears by the preceding ftatement, that influenza and fpotted fever correfpond in all the moft important fymptoms ; and there are ftill other fymptoms which are common to both difeafes, viz. 142 Symptoms of the Influenza and Spotted Fever. palfy, dropfy, mania, abfceffes, &c. From the pre- ceding hiftory of thofe omplaints, their prevailing in the fame year, a great mortality in fo.ne inftances attending the influenza, and both diforders being at times very mild, the identity of the two difeafes ap- pears obvious; and from the foregoing hiftory of our climate and difeafes, and likwife for other rea- fons, I am induced to confider catarrh, or a com- mon cold, a difeafe of the fame nature, and depend- ing on the fame caufes, as the abovementioned dif- eafes, differing only in degree.' Although I can difcern no utility in confidering and treating the fpotted fever and influenza as diftindl: difeafes ; yet th?re are an infinite variety of gradations between a fimple cold which merely produces flight inflamma- tion, and the moft deadly ftate of fpotted fever which deftroys all action, and confequently all vitality of the patt. Though thefe very oppolite ftates of the fyftem appear to be produced by the fame caufe, dif- fering only in degree as refpects the intenfity of thofe changes,and the frequency of their occurrence ; as the fame changes of temperature, when applied in a fuitable degree, are invigorating and healthful ;* and as heat and cold, in their appropriate degrees, * Cold is a re'ative term. A degree of heat or cold is agreeable, or disagreeable, according to the previous temperature of the body, or part, to which it is applied : as the same water may be made to feel hot or cold : if you first immerse your bauds in snow, and then in the coldest water, it will feel warm; then if you immerse them in warm water, or warm them by the fire, ,it will feel cold: neither is it the degree of heat, or cold, but a sudden transition from one to the other, which is so injurious to health. Dr. Hush observes, that " a continu- ation of the same kind of weather, whether it be cold or hot, wet or dry, is uniformly healthy."- -There are but few persons who have not been sensible of the acute pain which we experienoe in consequence ■of a sudden-transition from one extreme to the other; as for instance. wb' it our lingers are benumbed with cold, the sudden warming of thfctq produces the most poignant pain.. Symptoms of the Influenza and Spotted Fever. I4S are agreeable ; yet if thefe degrees are but moder- ately increafed, and the tranfition from one degree of temperature to the other is fudden, they becoir.e in a flight degree painful: if ftill further increafed, they produce intenfe pain : and if further aggravat- ed, they caufe death In like manner, if the change! of temperature are increafed beyond a certain rel- ative degree, which will be fometimes more, ard at other times lefs, they produce flight inflamn a« tion ; but if thefe changes are increafed to an ex- treme degree, ceflation of all action, and death, is the confequence. And from the moft moderate or flight ftiade of inflammation to the moft violent, there are an infinite variety of grades : fo the reverfe is equally true, from the higheft degree of inflam- mation down to a complete ceflation of action. From this view of the fubject, there appears to be three ftates of the fyftem,, though produced Ly the different application of the fame caufe, vis. the different degrees of temperature, and the more or lefs fudden tranfition from one degree of tempera- ture to another, as likewife the length of time the fyftem has fuffered by thefe changes; yet the firft and fecond ftates require a confiderable difference in the mode of treatment; and the fecond and laft are oppofite ftates of the fyftem, and confequently in moft refpeds require oppofite treatment : from which circumftance, there is a propriety of confider- inff thofe different ftates of the fyftem feprately, and affigning to each a diftinguifhing term or appel. lation- The generic term catarrh, though of very ancient date, does not appear to be fufliciently fi^ 144 Febris Catarrhalts, or Catarrhal Fever. y nificant, or defcriptive of the nature of this malady : yet I have thought that by the addition of adjectives expreffing the different ftates of this affedion, it might anfwer my purpofe in this Inquiry perhaps better than any name which I might adopt. Febris Catarrhal, or Catarrhal Fever. " It is not till the next day, or perhaps the fec- ond or third day, that the perfon, who has caught dold, begins to complain, and recollects his expo- fure to cold, either partial, as is moft common, or general. This frequent, but curious fact, is fimilar to what happens in the operations of the caufes of other febrile difeafes. From the commencement of their action on the body, fome time muft elapfe before the fyftem in general can be affected by them, fo as to produce the difeafe correfponding to the nature of the caufe. -The fymptomatic fever, in confequence of wounds, amputations, and other chirurgical operations on the body, is feldom con- fiderable until the third day after the operation is performed. This caufe will go on (lowly, acling imperceptibly until the fyftem in general is affected, exciting more or lefs of fever, or that difagreeable fenfation over the body,which generally precedes the acceflion of fevers. The leaft cold produces uneafi- nefs even in warm weather. The membranes of the nofe become firft affected, and there is a drynefs, and afterward defluxion of that part; often the amygdalae, and other glands about the throat, mark the firft ftage of this diforder. There is frequently Febris Catarrhal Sytiocba Major. 145 confiderable fever, efpecially towards night. In a few days the trachea,or wind-pipe, becomes affeded, when the throat appears hufky ; after which, the natural fecretion is increafed and altered, and there is a confiderable difcharge of .thin, fliarp rheu'n, from the glands of the throat, and fauces. The fe- cretion from the upper parts decreafes, and it is now faid to fail upon the breaft, which feels tight. At firft there is only a tickling, uneafy cough ; expec- toration' comes on, which is thin at firft, gradually becomes thicker, and diminifhes in quantity until the patient recovers. Febris Catarrhalis Synocha Major, or the Greater In- flammatory Fever from Cold. Symptoms.The countenance florid,the face occafionally fwollen : the fever commences with more or lefs of a fhivering fit; the pulfe is full, ftrong, tenfe and hard : the heat of the body is confiderably increafed after the firft fhivering fit. The minute blood veff Is in the extremities, under the nails, and in that part of the lips which is not covered with the cutis vera, are of a bright fcarlet red ; if an impreffion be made on thefe parts by the point of the finger, the flefh feels firm, the motion of ihe blood in the capillaries is feen to move very quick, and is of a bright lively red ; the blood, when drawn, is uncommonly florid, has a firm coat which huffs up and fhnds prominent in the centre of the difh ; if there is any local in- flammation attending this fever, all the arteries in T 14(T Febris Gaiarrhalis Synocha Major. the neighborhood of this part throb with a firm and flrong beat j the coats of the arteries feel hard and tenfe, as though confiderable refiftance was made to the flow of the blood in them, i he minute veffets, likewife, feel tenfe and firm, as though confiderabla force was required to move forward their contents; the eyes are rather brighter than in health, and all the fenfes are more acute ; the tongue is rather dry and furred, and is of a red color ; the throat and tonfils are fometimes fwollen and red. The moft ufual forms of this difeafe are pleuri^ pneumonia, phrenitis, and influenza in general belongs to this grade, fynanche, trachealis, ton- fylaris, &c. I think that writers are in general agreed in considering moft of the above difeafes to be commonly produced by cold. Dr. Cullen ob-« ferves, " the remote caufe of pneumonic inflamma- tion is commonly cold applied to the body, ob* ftructing perfpiration, and determining to the lungs* while at the fame time the lungs themfelves are expofed to the action of cold."--" Winter and fpring, efpecially the latter, are the feafons in which pneu- monia appears ; it is generally the more frequent, the colder, the moifter, and more changeable the weather is. Huxham fays, he has feen the fame epidemic in low, warm fituations, near the fea, prove only a catarrhal fever, and in more expofed, cold fituations, a true pneumonia."—" In the obferva- tions of the army phyfician, however, we find pneumonia proceeding from the extremes of weath- er, whether warm or cold, Dr. Donnald Monro obferves, that the foldiers were attacked with Febris Catarrhalis Maxima. 147 pleurifies at all feafons of the year, when they were expofed to the intemperance of the air, whether it was very cold, very warm* very dry, or very moift. Sir J..,,hr. Pringle makes fimilar obfervations. The exciting caufes of pneumonia, the fudden or partial application of cold, is the chief."—See A. Phillips Wilfoa's Treatife on Febrile Difeafes. febris Catarrhalis Maxima, or Fever from Cold, called Spotted Fever, &c. In confequence of long continued and great changes of temperature, whereby the minute veffels, J)oth on the internal and external furface, are in an extreme ftate of debility, the heart, and large vef- fels likewife, partake of this debility, and the pulfe is foft, quick, and intermittent; but, in fome in- stances, it is full, apparently ftrong and flow, or frequent, but never hard, and at times intermits, Or even flops at the wrift. The pain at times will appear in almoft every part of the body, but ufually tt is moft acute in the head, or cheft. The fever commences with fhivering fits, which are often very fevere ; a low and comatofe delirium, with a dif- pofition to fleep ; but in a few cafes the delirium is raving and unmanageable ; but in a large propor- tion of cafes the patient appears perfectly fane; in many cafes there is more or lefs of a palfy of one fide; the pupil of one eye is dilated more than the Other, and the fight often impaired ; the mouth in fome cafes is drawn to one fide, &c; a flight de- gree ofnumbnefs, in one or both arms, &o; the 148 Febris Catarrhalis 'Maxima. eyes bright, but inexpreffive ;* the face, lips, and extremities, moderately fwollen, cold, and purple ; in many cafes, the circulation of the blood in the capillary veffels exceeding flow ; f hemorrhage from the nofe, throat and lungs, and occafionally from the bowels in the form of dyfentery, and from the urinary paffages, &c. ; the blood thus difcharged is ufually cf a dark color ; rheumatic pain, and fwell- ing of the joints and limbs ; effufion of blood and lymph, which in general lies deep on the periofteum, and often extends from the knee or ancle joint to the hip, irrounding the bone and periofteum, and occupyirg the whole limb ; internal effufions in the lungs and liver, in the brain and its membranes, &c producing : alfy, fuffocation, &c. ; effufion on the fu^face of tae large bones of the head and trunk. The pain in many cafes is extreme, in others it is moderate ; in fome cafes the patient lies ftupid, and appears in a great degree to be infenfible to pain ; ftrang ry is a common occurrence ; the tongue is moft uiually moift, except when the pyrexia is con- fiderable, it is dry at the tip ; in moft cafes it is cov- ered with a white, thick coat ; but when bile is * In some forms of this disease, particularly in those cases which are attended with a superficial sloughing of the mouth, throat, &e. the eyes are dull, and the countenance remarkably sunk, in the last stage of this complaint, the eyes are in general dull, and suffused with blood. f There is a want of that tension and resistance in the minute ves- sels which characterize synocha or active inflammation. There is a remarkable loss of tone, or relaxation of the fibre, which is perceptible both by the pulse, and fc el at the surface.—The countenance and ex- tremities have in most cases a dusky, lifeless aspect. The strength of the patient is generally greatly reduced; though in a few instan- ces, he has sufficient to sit up, and even to walk, but a few minutes before death, The Remote Cause of the Spotted t\ ver. 149 confiderable at the ftomach and bowels, it will be of a brown or yellouifh hue ; the fkin is in fuch cafes yellowifh; the breathing is often laborious, and attended with frequent fighing : there is in many cafes cough, and pain in the fide, as in pleurify, attended with a bloody expectoration ; the heat of the head is often great, while the extremities are colder than natural; the temporal and carotid arte- ries in fuch cafes pulfate violently ; the throat in moft cafes is in a flight degree fore ; the tongue and throat in fome inftances fwell to an alarming degree, even fo as to produce fuffocation ; the lips, mouth, nofe, and fauces, are, in fome cafes, affected with a fuperficial floughing and ulceration, which often extends to the lungs and ftomach ;* eryfipelatos and miliary eruptions, likewife effufions of co- agulable lymph, immediately under the cuticle or fcarf fkini t and in fome inftances petechia? and vibices, appear. c The Remote Cause of the Spotted Fever. Dr. Cullen confiders cold as one of the princi, pal remote caufes of fever. See the account, Firft Lines of the Practice of Phyfic, Vol. I. pige 73. Dr. Rufh makes the following remark: « Cold-. This is univerfally acknowledged to be a predifpof- in* caufe'of fever. That it debilitates, I mfar, 1. From the languor which is obferved in the inhab- TTTdescription of these eruptions is given in page 76; a> they occurred in the spring of 1811. I JO The Remote Cause of the Spotted Fever, itants of cold countries, and from the weaknefi which is felt in labor or exercife in cold weather. fi. From the effeasof experiments, which prove that Cold air and cold water leflen the force and frequen- cy of the pulfe." Medical Inquiries, Vol. III. page 6. Other caufes, doubtlefs, have a fhare in giving a predifpofition to this difeafe ; among the principal have been reckoned food of bad quality, thin cloth- ing, and fcanty diet j doubtlefs thefe may be con- fidered as concurring caufes. Intemperance in eat- ing and drinking,* or whatever caufes debilitate or produce unequal excitement, may be confidered at leaft asacceflory; but from the hiftory of this difeafe, and its concomitants, it appears that the viciflitudes of temperature are the great and pre.' dominating caufe. * Persons, who are diseased by the intemperate use of spiritons li- quors, have the same capillary debility, purple bands, face, &c. and Abated countenance, which indicate a predisposition to spotted fever. PART SECOND. AN INQUIRY INTO THE NATURE OF THE 1 THE hiftory of a Angular and very mortal difeafe, which made its appearance in Medfield* Maflachufetts, in the month of March, 1806, com- municated by Drs. L. Danielfon and E. Mann, and publiflied in the Medical and Agricultural Regifler. __The fimilarity of fymptoms in nine cafes which proved fatal, all between the 8th and 31ft of March, have been fo great as to render the particular detail of each unneceffary ; we fhall therefore only ^ive a concife hiftory of the mode of attack, and progrefs of the fymptoms generally. • w Without any apparent predifpofition, the patient is fuddenly taken with violent pain in the head and ftomach, fucceeded by cold chills, and followed with naufea and puking; matter difcharged from the ftomach of no unufual or morbid appearance ; rei- piration fhort and laborious ; tongue a htUe white Towards the root, and moift ; velocity of the blood- increafed, with a very fenfible diminution of mo- mentum in the radial, while in the .arotid arteries it was much augmented ; the eyes had a ™ld. vaiant ftare, without much, if any, appearance of inflam- mation ; the heat of the fkin foon became much 152 Estrucis from Danielson's and Mann's Essay. increafed, yet the fkin is not remarkably dry: thefe fymptoms are accompanied by a peculiar fearfulnefs, as if in danger of falling from the bed, or the nurfe's arms, and continuing from fix to nine hours, when coma (fuppreflion of fenfe and voluntary motion) commences, with increafing debility, extremities become cold ; livid fpots refembling petechia?, pur- ple fpots which appear in the laft ftages of certain fevers, appear under the fkin, on the face, neck3 and extremities ; pulfe fmall, irregular, and un- equal ; fpafms occur at intervals, which increafe in violence and frequency, in proportion as the force of the circulation decreafes : at this time, the eyes appear glaffy, and the fize of the pulfe varies fud- denly, from almoft wholly obliterating the iris,down to the fize of a. millet feed, and then agaiii as fud- denly dilating. Thefe fymptoms feem to mark the fecond period of the difeafe, and continue from three to five hours. —The third and laft ftage is diftinguifhed by a total lofs of pulfation at the wrifts; livid appearances be- come more general; fpafms more violent; coma more profound ; death ! Examination by diffection was had, on five bodies of patients dying of the above defcribed malady. The firft examination was made on a boy, ten years old, feven hours after death, whofe cafe was itrongly marked, terminating in about twenty-two hours. On removing the cranium, and dividing the dura mater, there was difcharged, by eftimation, half an ounce of a ferous fluid. The dura and pia mater, in feveral places, adhered together, and both to the iubftance of the brain. The veins of the brain were uncommonly turgid, with a fluid fimilar to that which was difcharged from between its mem- branes ; and the fubftance of the brain itfelf remark- ably foft, offering fcarcely any refiftance to the finger, when thruft into it : the cerebellum alfo was found in the fame ftate* The ftomach contained Extracts from Danielson's and Mann's Essay. Us about fix ounces of a dark fluid, refembling coffee Sounds ; and its villous coat was nearly in a ftate of diffolution. The lungs were rather darker than Uiual; otherwife, all the vifcera were in a found itate —The fecond examination was made twelve hours after death, on the body of a girl of five years old,of the fame family,and fick at the fame time,and whofe cafe was alfo ftrongly marked. Between the dura and pia mater was effufed a fluid refembling pus, both on the cerebrum and cerebellum, the veins of the brain turgid with blood, and the hemifpheres adhered together with confiderable ftrength ; thefe were the only morbid appearances within the cra- nium. The appearance of the ftomach differed in nothing from that of the preceding cafe, only that the villous coat was not fo tender, the abdominal and thoracic vifcera were apparently healthy. In the other cafes that were examined, nothing peculiarly morbid was difcovered in any part of the fyftem, excepting the veins and finufesof the brain were found remarkably turgid with a very dark colored blood.—See the account in the Medical Repofitory, Vol, III. Hex. 3. page 41. May 2, 1810, vifited Mrs.----, aged about 35 years. She complained of pain in her limbs, a numbnefs in her left arm, laffitude, and a throb- bing fenfation in her head; in attempting to dreft herlelf, flie fell, and remained fenfelefs about two hours ; her fkin cold, and a cadaverous countenance, very low pulfe, and difficult refpiration ; foon after the hot ftage commenced (which was about two and an half hours from the commencement of her dif- order) her fenfes were partially reflored, and many radiated fpots appeared on the fkin; frequent puking of dark colored matter mixed with blood ; her putfe low and intermitting; delirium ; the fpots on her ikin increafed In fize, and dark appearances re- fembling a bruife ; the fymptoms did not alter ^except in violence) until the 4th of May, when fhe U 154 Extracts from &artletfs and Wilson's Dis section. died. Permiffion being obtained to examine the body after death, the following were the appear- ances on diflection. Plate !• Fig. 1, fhews the hairy fcalp, feparated from the bone, and turned back over the occiput and bregmatis.-^-Fig. 2, reprefents the lower feftion of the fkull, feparated by the faw ; the upper part being removed, the brain, covered with its membranes, is brought into view.—Fig. 3, longitudinal finus.— Fig. 6, great lateral finus.—Fig. 5, fourth finus — Fig. 4, tentorium.—Fig. 7 and 8, fhew the appear- ance of ruptures in the extreme branches of the ar- teries or veins, or rather in the junction of the ar- teries with the veins.—Fig. 9, reprefents the brain divefted of its membranes.—Fig. 10, fhews an ex- travafation of lymph on the furface of the brain — Fig. 12, a portion of the brain that was diforganized, and was torn away, adhering to the membrane, leav- ing the impreflion of parallel threads, with other parallel threads crofling the firft at right angles, as in the figure. The membrane had adhered to the brain, or rather to the membrane of the brain, and in feparating the two membranes from each other, the more firm or fibrous part of the lower membrane remained entire ; while the cellular part was removed, adhering to the upper membrane, or pia mater. There was a loofenefs of texture, or dif- organization, through the whole fubftance of the brain ; yet this diforganization did not appear to be in confequence of any putrefactive procefs, but was very fimilar to what happens in frozen fiYfh when fuddenly thawed. The veffels of the brain appeared to have fuffered in a fimilar m; nner with thofe of the membranes; there was a general diffufion of bloody ferum through the whole fubftance of the brain ; the veins were diftended much above their ufual fize ; the ventricles contained no more lymph than their ufual quantity : the longitudinal firuf w as but moderately diftended with blood -, the lateral Extracts from Stuart's Dissection. 157 finufes were confiderably fo, which probably was occafioned in part by the pofition of her head.— Might not the fudden and frequent vibrations of heat and coid, in the years 1807 and 1808, which appeared to produce the influenzt,(or great catarrh) together with wet feafons, and extreme and fudden changes of weather, which happened in 1809, and the beginning of 1810, have produced the fpotted fever? Extracts from Stuart's Dissection. (See the account in the Med. Repository, Vol. III. Hex. 3. p. 23.) [The following cafe happened in Albany : it ap- pears to have occurred in 1811.3—A native of New-Haven, which place he left iix weeks fince, aged 22 years, of a robuft, mufcular habit, com- plained, at 11 o'clock, A. M. the 28th of March, of an oppreuion (or load) at his ftomach ; at 12 o'clock, however, having a good appetite, he ate a hearty dinner, and continued apparently as well as ufual, the flight oppreuion above mentioned ex- cepted, until 6 o'clock, P. M. when he had a fevere chill, which was fucceeded by ficknefs at the ftomach, and great oppreuion at the fcrobiculus cordis ; at ]0 o'clock he puked his dinner, and was fhortly after feized with violent pain in the head, back, and extremities. Thefe fymptoms continued much the fame until 6 o'clock, A. M. the 29th ; at which time his extremities were cold, and feveral claret colored fpots were difcovered on them ; at 9 his extremities were cold, and the difcolorauon above mentioned, extended almoft to the trunk ; had no nulfe in either the radial, temporal, or facial arte- ries ; his eyes fuffufed, countenance heavy, lips livid tongue dry and of a brown color, pain in the K balk, and extremities, ficknefs at ftomach, 159 Extracts from Stuart's Dissection. and oppreflion much as had been during the night ; within the laft hour, a troublefome diar- rhcea, infatiable thirft, great anxiety anddiftrefs, (which he was unable to defcribe) had come on, and rendered his fituation really diftrefiing and hopelefs; at 10, all the fymptoms were increafing rapidly, pulfe in the carotids 38 in a minute, and feeble ; the faculties of the mind appeared to be unimpaired ; the claret colored fpots had commenced on his ears and face ; at 3, P. M. he had loft his reafon,eye-fight, and power of deglution; refpiration hurried and difficult ; fince 1 o'clock he had been very reftlefs, pulfe in the carotid 160 in a minute, and feeble ; extremities xold and ftiff; heat of the trunk natural, difcoloration becoming general, eyes much fuffufed, and eye-lids clofed ; at a quarter before 6 o'clock he expired. At 7 o'clock .the ex- ^ tremities, which at 3 were ftif and cold, were flex- ""jWeyarid to the touch appeared to be feveral degrees above the natural heat of the body in health. Permiflion being obtained, I examined the body at 9 o'clock on the SOtm The claret color on the furface appeared to have been produced by a flight effufion of blood into the cellular fubftance. The omentum was of a pink color, the blood veffels of the mefentery and the vena portarum were diftend- ed with blood, the fpleen was about four times its ufual fize : on cutting into it, a great quantity of grumous blood of a foetid fmell oozed out of it, the ftomach was empty, the gall bladder full of yellow bile. Nothing farther was difcovered in the abdo- men differing from a healthy ftate ; the lungs were of a healthy appearance ; the heart, and large veffels connected with it, particularly the aorta, were diftended with blood ; the coronary veffels were as minutely injected as I have ever feen them in the beft preparations. On removing the fkull-cap, the dura mater adhered very firmly to it; the blood veffels of the dura mater and brain were diftended with blood 5 on making an incifion i»to any part Extracts from Stuart's Dissection. \5i) of the brain, the cut furface was inftantly covered with blood, which oozed from its veffels ; the right lateral ventricle contained about a table fpoonful offerum. This was, unqueftionably, a genuine cafe of what has been termed in Connecticut "the Spotted Fever," where, I believe, it has generally been confidered ag a difeafe of debility, and treated as fuch. But how debility fhould take place fo fuddenly, and to fo great a degree, and yet the patient fhould recover almoft as fuddenly, (which has been the cafe in a few inftances) was a myttery, which neither myfel£ nor any medical gentleman with whom I had converfed on the fubject; were able to explain. With a view, if poffible, to throw fome light on the nature of this difeafe, 1 was induced to undertake the diffection before ftated ; and from what was difcovered, I think myfelf warranted in making the following conclufions, viz. Let the caufe be what it may, I think the effea is to produce a torpor of the glands, lymphatic and fanguiferoyj veffels, fituated in the extremities and furface of the body, which, inivio- lent cafes, is fhortly followed by a total lofs of action in thefe veffels. The effect of this is to force all the blood from thefe parts into the large veffels fituat- ed in the abdomen, and thorax, and brain, produc- ing^ them a ftate, termed by the French writers engorgement, and conftituting what, I think, may be properly called a difeafe of oppreuion, not of deS This opinion is fupported by the early lofs of the circulation and difcoloration in the ex- lols or toei urc aion of thft tremities, and by tne now *nu « STE*°Z5£& »y <>« rfual quan y of blood conftamiy crowding upon it. im Description and Dissection. A Description and Dissection. Mrs--------was feized with the ufual fymp- toms of fpotted fever, April 27, 1812, viz. fevere, cold fhivers, pain in the breaft and head, difficulty of breathing, great anxiety at the pit of the ftomach, pulfe full and foft: on the third day, the difficulty of breathing was greatly increafed, attended with rat- tling and coughing; great exertions were made to raife the mucus from the lungs, but with little effect; the matter expectorated was vifcid, and adhered to the throat and mouth, fo that it was extremely dif- ficult to difengage it from thefe parts ; the pulfe become irregular and intermitting; the face and lips fwollen, and of a purplifh eaft ; the eyes fixed and ftaring : on the fourth day from the attack, fhe died by fuffocation. Leave being obtained to examine the body after death, the following were the appearances on diffection. Plate II. A View of the Internal Face of the Sternum, covered with the cellular Membrane. Fig. 1, reprefents the fternum, the pleura being removed. Fig. 2, the cartilages of the ribs. Fig. 3, reprefents veficles of air in the cellular membrane, adhering to the fternum. Fig. 4, fhews extravafations of lymph in the cel- lular membrane, of a yellowifh appearance. In the pleura, lining the pofterior and lateral part of the thorax, where the lungs did not adhere. The arteries and veins appeared to have been rup- tured in their moft minute branches, or immediate- ly at their junction with each other, and produced extravafations of blood, of a very dark color; as is feen in the reprefentations of the veffels of the heart, lungs, &c. View of the Lungs and Pericardium. 165 Plat* III. A Front View of the Langs and Pericardium. Fig. 1. Trachea, or wind-pipe. Fig. 2. Aorta. Fig. 5. The pericardium. Fig. 9. A view of* the internal furface of the pe- ricardium, the blood veffels of which have fuffered in a fimilar manner with thofe of the lungs and pleura; but the fpots of extraVafated blood were much larger in the pericardium, than in the pleura or lungs, as feen in the figure. The pericardium contained nearly half a pint of yellowifh ferum. The lower edge of the lungs was of a bright fcarlet red, and fwam in water ; w hile a portion of the organ, cut about two inches above, was remarkably heavy, and funk in the fame liquid. The air cells were completely filled with a yellow fh lymph, which was as fluid as water, except at the lower edge of the lungs, which contained air. This viicus was of a dark red color, and adhered, throughout its whole furface, to the pleura and diaphngm,faving the pofterior furface, where there was a large collection of lymph. 166 Vhfs> of tbe tieatu Plate IV. A Front Vtew of the' Heart. The heart, the aurioles and veffels of which are diftended to an enormous fize, with blood almoft black, and fpots, as in the aforementioned repre- sentations ; and an extravafation of lymph and blood, of ayellowifh color, at its apex* Plate V. A View of tbe Convex Side of the Liver. The liver appeared of a dark red color, with large irregular fpots difperfed throughout its whole furrace. Thefe fpots were nearly of the natural color of the liver, and appeared founder than any other part of it. The diaphragm alfo appeared of a dark red color, and adhered to the lungs throughout its whole extent. The fpleen had a fimilar appearance with that of the liver. A Representation of the Lungs of Mr. Stevens, who died of the prevailing fever, April 17, 1813, aged about 17 years, of a robust, athletic habit: He died by suffo- cation on the eighth day of the disease. Fig. 4. The right lobe of the lungs.* Fig. 5. The left lobe of the lungs.f Fig. 6. A blood veffel of the lungs, its branches not well defined, but very much fpread, and jagged by a previous extravafation of blood in its branches. Fig. 7. The veftiges of fpots, which are moflly abforbed. * See the plate of the lunge, facing page 165. f The blood vessels of the lungs are '':a.rn proportionally lars>«r than natural, the better to shew their morbid state. ^ o o Dissection of the Lungs. 3 69 Fig. 8. Veficles of air in the fmall plica of the lungs. r Fig 9. A minute effufion of blood, of a dark Cnmfon color, occupied all that portion of both lobes of the lungs, which is comprehended above the great fiffure ; thefe portions were of a brick color, ahci fo completely diftended with blood, as to prevent their being, to any confiderable degree, inflated with air ; their gravity was nearly equal to that of water ; on cutting into any part of them, they appeared, as it were, one mafs of blood, mixed With air. Fig. 10. A blood veffel, with fpots from eX- travafated blood, the fides of thefe veffels, and Fig. 12, are diftinct, and well defined. Fig. 11. Large extravafations of blood of a black color. Fig. 12. The lower portion of the right lobe of the lungs, which were tolerably found. A B. That portion of the left lobe of the lungs, likewife, wnich is comprehended between A and B, was nearly natural ; thefe two laft mentioned por- tions were the only parts of this vifcus which were capable of being inflated in the laft hours of the patient. There appeared, on examining the brain, the veftiges of an extravafation in the blood veffels of the dura and pia mater, fimilar to what is reprelent- ed in the drawing of the blood veffel, Fig. 6 and 7 ; there were, likewife, feveral fmall depofitions of lymph on the furface of the brain. From the above appearances, and the fymptoms which attended the firft ftage of the difeafe in this cafe, it feems highly probable, that in the firft attack there was a con- fiderable extravafation of blood from the extreme branches of the veffels of the membranes of the brain, which now appeared to have been nearly abforbed. In the firft ft age he was comatofe ; and, as I was informed, emetics had little or no operation, W |70 The Curative Process apparent though given in large dofes. On the fifth day, as I underftood by the attending phyfician, his breath- ing became extremely laborious. It required bis utmoft effort to dilate the thorax, fo as to admit ait fufficient to fupport life ; it was found, at this peri- od, that cathartics gave him great relief ; which was probably in confequence of diminifhing the bulk and tenfion of the abdomen, and thereby giv- ing the diaphragm more fpace. It appeared, from the fymptoms of the difeafe,. and the appearances on difie-aion, that the patient might have furvived the affection of the brain ; but this affection of the brain was probably the caufe of the infenfibility of the ftomach to the operation of emetics, in the commencement of the difeafe; and thereby the moft efficacious medicine in this difeafe, with which we are acquainted, was rendered in- active. From the fymptoms on the third day, the time when I faw the patient, and the information which the attending phyfician gave me, there was every appearance of the brain having fuffered more in the firft attack than the lungs. A confiderable portion of the lungs, as well as the brain, had the appearance of having, in a degree, recovered from the firft attack ; but from fome unfortunate acci- dent, perhaps from the want of proper agitation being given to the capillaries of the lungs, which probably an emetic might have effected, and excited them to greater action, the torpor continued in thefe veffels, until they were fo gorged with blood as to produce fuffocation ; and in the violent efforts which the patient made to infpire, the cells of the bronchia were ruptured, which muft have greatly increafed the difficulty of infpiration. Vegetables are organized bodies, fimilar to ani- mals, but their organization is more fimple. They fikewife poffefs contractibility and irritability, or an energy inherent in them, by which their fluids are circulated, in feveral refpects, fimilar to thofe of Fi . VVOld,i not'be unneAtooa, that I conceive thechanzes of tempe- rature to be the onlv cause which is capable of producing this disease; oter causes doubtless do occasionally aggravate the dneiKi and .., certain cSumstances, may even produce a simil.u state o. the vyst^in ft has been observed by several very rcspeetaWe physic au«. that ?am^Pdcorn scanty provisions, &c. might be th* preoispo>.ng cause damaged core,, seamy p . prevailed in years of great °\X 1 wel'l af ea cUy, and when the fruits of the earth were m plenty as wen as "/ . ' It m-iv likewise be o .served, that many families have V'^^t sof life. So this disorder cannot. want of the necessane o. comfort ol hie. ^ ^^ with propriety, be called the poors pl^- - varietie8 than the vicissitudes of tempeuture ra 'Poou ^ ^ of inflammation, yet it appears "'8^ PJ>b* ^ this is by far tho poring causes of inflammatory ep.demie d.»ea e s 7 ^^ Za common; and whatever P^j^ ^e yet. trom the bKoiy Sft^S^^- 8SS ^^udJof temperature u, the great predominating cause. 18£ brain and on its furface ; effufion in the cellular. texture and bronchial cells of the lungs ; effufion in various parts of the cellular membrane, in the tunica conjunctiva of the eyes,&c; effufion of blood and ferum in the inteftinal canal and vefica urinaria, producing colic, dyfentery, ftrangury, &c; erup- tions on the fkin, in the form of ring worms ; miliary eruptions and large irregular blifters, firm and unyielding to the touch, filled with coagulable lymph, boils, vibices, petechise, and ecchymofis. The three laft never fuppurate ; but if the patient recovers, they flough off, leaving a foul ulcer with ragged edges, which jifcharges an ichorous matter, and heals with difficulty. In thofe fubjects, which I have examined after death, there were fimilar eruptions, affecting the internal membranes,to thofe which appeared on the external membrane or fur- face of the body. The capillary fyftem may be debilitated to a very confiderable degree, and no fever happens, if the heart and large arteries are equally or nearly equally debilitated. The face and extremities may be pur- ple, and even a little fwollen ; but fo long as the equilibrium is fupported, or very nearly fo, although the circulation may be very languid, and the patient weak and very much reduced, yet, as no derange- ment has taken place in the fanguiferous fyftem, no fever happens. But when, from any caufe, the capillary fyftem is debilitated to a confiderable degree beyond what the heart and larger arteries are, the blood will be propelled into the capillaries fafter than they will be capable of tranfmitting it into the veins ; of courfe a congeftion of blood in thefe veffels, and their diftention thereby, muft be the confequence. The circulation of the blood being impeded from the torpor of the capillary fyftem, or the extreme branches of the arterial or venal fyftem, or both, while the large veins return the blood to the heart, (as there is a partial obftruction, in the minute veffels, to the circulation of the blood 188 trom the heart, and larger arteries to the larger veins) there will of courfe be a congeftion of blood in the heart and large arteries, which will in moft cafes excite them to an increafed action ; and if the con- geftion in the capillaries is not removed by the in- creafed action of the heart and arteries, a further fwelling of the capillaries muft Follow, which will increafe in the fame proportion as the action of the heart and larger arteries exceeds the action of the capillaries ; or if the capillaries do not tranfmit the blood to the veins fo faft as it is propelled into them by the heart and larger arteries, they muft of courfe continue to be diftended, till their action is excited, (by the pain arifing from their diftention) and the equilibrium reftored, or yield to the diftending force and rupture of their coats; and effufion of blood, &c. happen, or a complete ceflation of action, and mortification.* * " In short, inflammation seems to consist in the debility of the capillaries, followed by an increased action of the larger vessels, ami is terminated as soon as the capillaries are so Car excited, and lhe larger arteries so far weakened by their excessive action, that the force of the capillaries is in due proportion to the vis a tergo. Ibis doctrine we shall find s'ipported by direct experiment, and at once capable of accounting for all the phenomena and causes of •nj*nj- ination."—See A. Phillips Wilson's Theory of Inflammation, \ oJ. 11. Treatise on Febrile Diseases, p. 22. uw:i;i» That inflammation is very generally produced by previous debility nfthe capillaty system, and the consequent i'"™*^"*0" J". "J larger vessels, appear, to me to be a fact, not only proved by drr,t experiment, but is what we see in wo-'n^ir0^11"0? J:!^. ohw may plainly observe all the phenomena of inflam™tlOTt° ^« p™! Tn succession. And though I conceive the above toe^J-J^ ticnlar* tube correct, yet in active iuflamma«»« *« ^j) W« to be an increased actiun of tbe capillary system. And11^com e i possible, that inflammation may exist, and even be> increa ed after he Capillaries are excited to Increased action, w£ ^^i^thS U~ s^erior to the action of the "ger ve.scR B ,t£ ^ „ ,„ consistent, we must suppose at least, that there ,soni prf the free circulation of the blood m h«;al,,^t B „,- tl)P hlood part: and may not this impediment to the free c, c"* "« * m J, the minute vessels arise from «'«r .nereased b t JJ-^J ie, havo well as from a diminution of tUcirwtio"? That «h i^ ^ ^ an action of their own, independent of the ai ti.w ff >r, larger arteries, ^ observable from tbeiractiortb.mg excite ^ y^ ^ tious of the mind through the .ufluence< «'*e »ef^tl tue veins, as blushing, &C. Intheveryjuncnoi. of the arteries PART THIRD. CATARRHUS: OR, Slight Inflammation from Cold* ATTENDED WITH BUT LITTLE OR NO FEVER. -----^•.♦^^.♦■•» UNDER this variety of fimple inflammation, we fhall comprehend flight rheums in the head, Creaks in the neck, moderate inflammation of the eyes, flight colds, rheumatic pains, &c. As the internal furface of the nofe, fauces, &c. are continually fwept by a current of air, it is very natural to fup- pofe that thefe parts would moft frequently fuffer from the changes of temperature, as likewife the eyes from their expofed fituation, though great provifion is made in this organ to prevent a dimi- nution of temperature. Symptoms.—Seepage 144. The beft method to avoid flight colds, appears to be, to accuflom ourfelves to the moderate changes of temperature, avoid taking much heating or ftim- ulating drinks or medicine ; exercife in the open air, &c. Slight changes of temperature invigorate and ftrengthen the conftitution. the circulation of the blood must depend almost entirely on the mus- cular contraction of the minute vessels, it is reasonable to suppose, th.it their power of contraction is proportionally greater in this part thin in any other. And may not their contraction in some instances be so considerable as very much to diminish their diameters at this part, and thereby cause a partial obstruction to the free circulation of the blood ? The most elfectual mode of treating inflammation really appears to favor the idea of an increased action of the capil- laries ; and -iudeed, we find inflammation to be directly produced by exciting the action of the capillaries, as happeus in superficial burns, &c, and miv oiteu be readily remove! by the judicious application. of cold water, or any other application of a similar nature. 185 Method of Treatment. ^ I would recommend to leave this complaint en- tirely to nature, except where the patient .s of a delicate or phthifical habit. In fuch cafes, I would recommend from half a grain to a grain of emetic tartar, or a dofe of radix feneka, to be taken at bed- time, fo as to produce flight naufea, and a gentle diaphorefis; if the cough is troublefome, a fmall pill of opium may be taken at night.—Perfons who are of a phthifical habit fhould avoid changes of tem- perature, even if they are but flight, with the great- eft care, and wear flannel next their fkin from De- cember to June. Febris Catarrhalis Major, or active Inflammation from Cold, attended with more or less Fever, arising in gen- eral from a local affection of some particular part, as inflammation of the brain, lungs, or side, eyes, &c. or • some phlegmonic affection, as boils, abscesses, &c. viz. Phrenitis, Pleuritis, Peripneumonia, Ophthalmia, and Phlegmon, &c. Symptoms—Before the commencement of the fe- brile fymptoms, the part is fuppofed to be colder than natural; the circulation in the capillaries very Ian mid ; the firft fymptom of inflammation, it con- fiderable, is a fhivering fit more or lefs fevere ; a throbbing, and an increafed pulfatory motion is often fenfibly felt in the neighborhood of the part in which the* inflammation is about to commence. The part foon fwells more or lefs, the heat increases, drably in reafed, and the fenfation ver, *cute ^ at this Urne we make an ^P^ff'Xer° The c u- „t .!,<. rart with the point of the finger. 1 ne circu increafed. The part feels firm, and hard, P 186 in general is full, ftrong, and always hard. In fome inftances, particularly in inflammatory affections of the brain, lungs, &c. the face is moderately fwollen, and of a lively red : the extremities appear rather florid, and the blood in the capillaries, as is feen in the lips, and under the nails, &c. appears of a bright, lively red. Even active inflammation is liable to attack perfons in very oppofite ftates of health, viz. thofe of a full and plethoric habit, and fuch as are demaciated and weak. A predifpofition to inflammation is moft common- ly produced by great changes of temperature. A partial application of cold is moft commonly the ex- citing caufe. To avoid inflammatory affections, we fhould live temperately, and particularly as refpects drink and diet. Great changes of temperature fhould be avoided with the greateft care. Perfons who work in water, or who are otherwife expofed to great viciflitudes of temperature, are very liable to abfcefles and other inflammatory affections. The tranfition fhould always be gradual from one extreme to the other. Pleurify, peripneumonia, &c. prevail moft commonly in the fpring when great vicifli- tudes of temperature are frequent. Perfons fubjecr, to thefe complaints fhould be peculiarly careful in this feafon of the year, and at all times when great changes are frequent, not to fit in a current of air, or in the cold, after being heated by exercife, or in fweaty or wet clothes. There is often a confiderable affection of a part from a debilitated action of the capillaries, for a con- fiderable time prior to the acceffion of active inflam- mation. The part is rather colder than natural, and oftea flightly fwollen. If nothing further hap- pens to aggravate the complaint, the part may grad- ually recover its loft tone, and all go well; but if during this period, the perfon happens to take a vi- olent cold, or from any other caufe a febrile action is excited in the fyftem, the whole force of the difeafe will fall on this debilitated part, as here will 187 be the leaft refiftance to the circulation ; thefe veffels will be the firft to give way to the diftending force of the heart, and larger arteries ; a large proportion ot blood, of courfe, will be forced into the debilit ;'- ed part : and as there will be more blood, and of courfe more oxygen in this, than any other fimilar part, its temperature will be increafed : and if the excitability is not far exhaufted, its aftion will be increafed ; and if the action of the heart and larger arteries is in due proportion with the action of the capillaries of the debilitated part, in moft cafes the local inflammation will be removed ; but in fome inftances, from the action of the capillaries being unequal, or exceflive near their junction with the veins, or immediately at their function, or from fome other caufe, an impediment arifes to the free circulation of the blood in the extreme branches of the arterial or venal fyftem,and a confequent effufion, or diftention of the veffels, &c. muft follow. Active inflammation may terminate either by refolution, fuppuration, or gangrene.—The moft common and the moft defirable mode of termi- nation is by refolution. This may be expected to take place when the fymptoms have been moder- ate, and the action of the heart and larger arteries inconfiderable, When the adion of the heart and larger arteries, and likewife the minute veffels of the inflamed part, has been confiderable, and this increafed action long continued, an effufion of blood and ferum is often depofited in the cellular mem- brane, which, after undergoing a certain change, forms pus : when this happens, the inflammation is faid to have terminated in fuppuration. \\ hen the action of the heart and arteries is exceiliye and of long continuance, and the capillaries greatly dittend- ed, die parts, from long and great diftentior,, kle their tone • the circulation becomes firic languid, ndthe" emirdy flops; the part «™f"££% or dies : but the molt frequent and worft foim ot Y 188 mortification is, when the heart and large arteries, after long and violent action, fuddenly flag ; the capillaries of the inflamed part fuddenly being c'e- prived of their accuftomed ftimulus, their action entirely ceafes, and a more dangerous and extenfive mortification may be expected. Treatment—To effect refolution, and thereby pro- duce a folution of the difeafe, is to reftore the equi- librium between the heart and larger arteries, and the capillary fyftem. When the action of the heart and larger arteries is in excefs,we would reftore the equilibrium by reducing the action of the heart and larger arteries by phlebotomy, cathartics, &c. If the action of the minute veffels of the inflamed part is in excefs, topical bloodletting, cold application, &c. a folution of facharum faturni, or even cold water or vinegar, or cloths immerfed in water or the above folutions, are much more powerful in allaying the increafed action of thefe veffels, than merely wet- ting the part. Where the action of the capillaries appears to be deficient, apply blifters—In deep feat- ed inflammations of the thorax, throat, and large joints, blifters uniformly appear to be ufeful—To promote fuppuration, warm applications—In gan- grene or mortification, if the action of the heart and larger arteries is impaired, wine, bark, &c# are to be given internally, and ftimulating ai;d tonic applications to the verge of the mortified part, in all cafes. In fynocha, or inflammatory fever, unattended with local inflammation, the fame general princi- ples will apply. When the furface is exceffively hot, the patient will experience great relief by hav- ing the furface of the body generally wafhed with cold water or vinegar. 189 Febris Catarrhalis Maxima, or Passive Inflammation from Cold in most cases attended with Fever more or less severe, commonly called Spotted Fever, &c. This fever, in a majority of cafes, is attended with fome local inflammation ; as inflammation of the brain, throat, fide, lungs, bowels, extremities, &c; various eruptions on the fkin, as eryfipelas, miliary and broad blotches fimilar to blifters, vi- bices, petechias, ecchymofis, &c* Symptoms—Before the commencement of the fe- brile attack, the temperature of the patient is fup- pofedto be confiderably reduced ; the circulation in the capillaries is exceeding languid; in general there is a great torpor, which affects the fyftem ; all the motions of the body are performed with great lan- * guor. It requires all the refolution, fortitude, &c. which the patient can command (in moft cafes).even to walk or perform the moft trifling bufinefs; this, in moft cafes, is not from any weaknefs of the mufcles or limbs ; but proceeds from fome affection Of the nerves, or a want of refolution. There is a great torpor and drowfinefs, in moft cafes, which precede the firft attack of this difeafe. The above fymptoms may be confidered as only denoting a ftrong predifpofition to the difeafe. The fever makes its attack with fhivering fits, in moft cafes, extremely fevere, and of long continuance ; but in fome inftances this fymptom is not fo remarkable ; yeTin all cafes there is a confiderable diminution of temperature which precedes the firft attack. Pain, moTe or lefs fevere, in the fide, head, or extremities h Sen the firft complaint which the patient make,; "n moft cafes the eye. have a bright glaffy appear- that part of the system wind-, s '^,^,1 of by the patkut; yet. generally suffers most, and is first con pia mil j evcntual|jr suffer if the debility is S"*t aud <*iQ™VG* yUier P ' 11)0 ance; but in fome they are dull, and in all cafes they are inexpreffive ; the countenance in unfavora- ble cafes has an unufual deathifh afpect; the circula- tion of the blood in the capillary veffels, as feen in the extremities, under the nails, and in the lips, is exceedingly flow and languid, except during the greateft febrile paroxifms and heat: there is in gen- eral a confiderable numbnefs of one fide, or fome one of the extremities; they are likewife colder than in moft fevers. The extremities in moft cafes, during the cold ftage, have a livid and almoft lifelefs appearance. The pulfe in fome cafes is full and ap- parently ftrong, but never hard ; likewife in fome inftances it is flower than natural, in others it is very quick, weak, and fmall; in fome cafes it is not perceptible at the wrift for feveral minutes; in moft cafes it is very irregular, and often intermits. " The breathing is often laborious. Diftrefs about the praecordia ; alfo univerfal agony of the whole fyftem. The tongue is generally covered with a white coat; but in fome bilious cafes it is of a brownifh hue ; fometimes it has been obferved to have a bloodlefs appearance," which has been confidered as a very unfavorable fymptom. In fome cafes the tongue appears very natural. To avoid thofe caufes which produce this difeafe, and thereby efcape its attack, or to obviate the effect wh^n the attack is actually made, is a fubject fo im- menfely important, that it requires our moft ferious confideration. But fuch is the condition of human life, that it is not for us at all times to forefee the dangers to which we are expofed : neither is it in our power always to avoid them, when they are forefeen. The great changes to which this quarter of the globe we inhabit is liable, I have endeavor- ed to fubftantiate in the preceding pages. So great and extraordinary have been the changes of tempe- rature of late, that not even the hardieft conftitu- tion, or thofe of the moft robuft habits, have been able to endure thofe changes which we have fuffer- 101 ed, without receiving material injury.. Nor indeed does it appear, that the favage life, in this refpect, pofleffes any advantage over that ot civilization. From hiftory it appears, that th-y have fuffered even more feverely, as might be expected, fince they have not the comfortable lodging, &c. which a people in a ftate of civilization have ; neither is it likely, that they would pay that attention to pro- vide againft thofe great changes of temperature, which civilized nations do, had they the means. If the above ftatements are allowed to be correct, it is certainly an object for every perfon, who regards his health, carefully to avoid great changes of tem- perature, by all the means in his power. It is the great extremes only which require our attention. We fhould avoid being expofed to their violence as far as circumftances will admit ; and when we are obliged to encounter them, we fhould adapt our drefs to the weather, the particulars of which, every perfon's good fenfe and. experience ought to inform him how to manage.* We may frequently put on and off great coats, and other outer gar- ments ; but our under garments, fuch as flanner, &c. which we wear next the fkin, ought not to be left off, until the fummer or warm feafon is ellab- ^general it is the cafe,priorto the> attack.of this fever Yfee the fymptoms of predifpofition,page 189) Aafffie^yer being for a confiderable-time -^pears by Table 13, ^X^*^^ zc^ rj^££^«« ■* - —u,,try noliced in the Tabic. jrarmeuts of different lengths, and in- « The Chinese wear ^0* &™*™ £ y Ul the frcqUeirt and crease or diminish the nnmbcr oTt '*£; acc° ™' »have nry few „•,., sndden chants of their wea^ '^Tl of iVm.sylvai.ia. who.have diseases among them. Thn* iiiliab.Jant. «I ^ „,„.„„ 0, „lir acauircd the art of conto.muiS to tac c ang acnto (, fir. Rush's Medical Innain^ ol. I. P- 192 expofed to confiderable change of temperature, feels a deep chill, which penetrates his whole body, but is moft fenfibly felt in the breaft, or above the pit of the ftomach. He attempts to warm himfelf by the fire, if he has this convenience ; and though he may warm the outer furface with great difficulty, yet he feels a chill within. His breathing becomes a little affected ; by and by his breathing becomes more difficult ; and although he may breathe near- ly as eafy as ufual, yet he receives not that advan- tage from it, which we ufually do;' but experiences a degree of fuffocation, or at leaft the fenfation is fimilar to that of a flight degree of fuffocation from bad air in a crowded room, &c. He is likewife affecteU by an unufual ftupor, which is fo great, that in fome inftances it appears to be almoft as much as his life is worth to move. He feels con- fcious that his fituation is far from being fafe ; but fuch is his extreme torpor, that he would hardly ftir to fave his life : and in thofe'circumftances it is my belief, that many have lofiV their lives, while with a little attention, had their circumftances have been known, they might probably have been re- covered. The breathing becomes more difficult, the pulfe flower, and the patient ftill more torpid. A fulnefs is felt near the heart, great diftrefs at the ftomach, and an engorgement of the great blood-veffels and finufes of the brain; great ftupor : it is at this time that the pulfe, in fome "inftances, is not perceptible at the wrift. It fome- times happens, that apoplexy clofes the fcene, and the patient dies fuddenly. If the difeafe does not immediately prove fatal, the accumulation of blood about the heart at laft excites it to action, and the patient is roufed by a fever-fit more or lefs violent; and pain more or lefs fevere in the fide, head, or extremities, is often the firft complaint that the patient makes. If the action of the heart and larger arteries is confiderable, and the torpor of the capillaries great, they are diftend- 193 ed until they yield to the diftendine force and * haemorrhage of blood, *, will happen to^ha ^ where the capillaries are in the greateft ftate of de- bility, as from the veffels of the nofe, throat, lungs, bead, in the extremities near the furface of the bones, &c. But fhould the patient, during the com- mencement of the ftupor, havehis feet put in warm water, and warm clothes or heat otherwife applied to the furface of the body, and have his extremities rubbed in fome warm ftimulating application, as fpirit of turpentine and brandy, or red pepper and brandy, &c.; and warm ftimulating applications ap- plied to his hands and feet, as cataplafms ofmuftard feed, &c.; and at the fame time make ufe of the moft ftimulating, warm herb teas that can be procur- ed, as peppermint, fnakeroot, &c. ; or effence of peppermint,&c.; or even warm water given in con- fiderable quantity; it is very probable that he might efcape having the difeafe: yet it will be a confider- able time before the patient will fully recover : during which time, he fhould guard againft any confiderable change of temperature with the greateft care, and ufe moderate exercife ; and that exercife which calls the greateft number of mufcles into ac- tion* is to be preferred, fuch as walking, &c.; of all kinds of exercife, riding on horfeback, or in a fleigh" or carriage, is the worft : he fhould ufe a ftimulating, but moderate diet, feafoned well with fait, pepper, &c* and drink temperately of cickr or wine: To eat or drink to excefs will produce fever^ and in fome inftances apoplexy, &c. even in thofc who are not predifpofed. TThT^habitantsof rery coldi-ounfrta use «^££™^ antarhcle. both of diet and d n«k; «Ju. those enjnt. k. ^ but moderately cool, annual food is eaten much more iKuintries. • j—-O^^P' 104 Treatment of the Epidemic Catarrhal Fever, commonly called Spotted Fever, &c. This difeafe appears to differ from active inflam- mation, from the predifpofing caufe being more powerful, and of longer continuance. The differ- ence between active and paffive inflammation appears to confift in the following circumftances :* in active inflammation, the debility is confined almoft entirely to the capillary fyftem, while the heart and larger arteries are but little or not at all debilitated, of courfe the cure confifts very confiderably in reducing the action of the heart and larger veffels : but in paflive inflammation, the heart and larger arteries are materially debilitated, even in the flighter forms of the difeafe, as appears from the pulfe being irreg- ular and intermitting. In active inflammation, the capillaries are foon roufed to an increafed degree of ac^ tion, as appears from the heat and rednefs of the part, the apparent increafed velocity of the blood in thefe veffels, and above all, from their refiftance to the impulfe of the blood from the heart and larger ar- teries ; j hence the pulfe are hard and tenfe, which * The three species of boils, page 175, mark two opposite states of inflammation, viz. active and passive. The first deuotes active in- flammation ; and when it occurs, it is a favorable omen, and is a sure sign that the action of the capillaries is considerable. The second de- notes the most favorable grade of passive inflammation; and .to this species belong erysipelatos and miliary eruptions, and likewise the effusions ofcoagulable lymph, in the form of broad blisters, &.c. The third species likewise occurs in passive inflammation uiily, and indi- cates a great debility of tbe capillaries, which verge towards complete mortification ; if the swelling lies fiat, and its heat and sensibility decrease, and is soft, flabby and purple, we have great reason to dread the event: but it its beat and sensatiou increase, and it ac- quires a brighter color, becomes prominent, and suppurates,it is a sure token that the capillaries are recovering from the extreme debility 'which attended them. To this species belong petechia:, ecchymo- sis, and vibices. t There is a period in the commencement of active inflammation, when Jhe capillaries yield to the impulse of the blood from the larger arteries, ana of course they are distended ; but their action appears soon to be excited, which may be equal proportionally or superior to the action of the large vessels; if this action is equal, i.e. alike in every part of the small vessels, the swelling will be removed; but if the action of those vessels is unequal, viz. if their action is most powerful 195 appears to me could not be the cafe, if the capil- laries yielded to the force of the heart and larger arteries.! If the above principles are correct, the cure in paffive inflammation will confift in exciting the ac- tion of the capillaries, and in fome inftances the ac- tion of the heart and larger arteries; but as the debility of the heart and arteries is in confequence of the debility of the capillaries, and as no fever can happen unlefs the equilibrium between the capillaries, heart, and larger arteries, is difturbed, the excefs of action will always be that of the heart and larger arteries ; and this excefs of action, al- though it may be below the healthy ftandard, may, notwithftanding, prove to be too ftrong for the capillaries, in this their extreme ftate of debility: hence ruptures of the capillary veffels, and haemorr- hage, is a very common occurrence in this difeafe ; and death, in a great majority of cafes, (when it happens in this difeafe) appears to be produced from this caufe ; of courfe, in this difeafe, as in active inflammation, to reftore the equilibrium of the capillaries, the heart, and larger arteries, is an important part of the cure. But there are cafes in which the action of the heart and larger arteries at their junction with the veins, their diameters at ™* V*«""\£ course be more contracted than in any ot er parr, and o. £- - flow of tbe blood through them re aided I. Ibese ^ ,^Marte_ mo* powerful tneir actmn ,s .t *« actkm of the heart «d ^^ ^ ries is proportionally srcng, *f^f ..fl^e a^-ribld state of active distention must be expected; yet. thei aboveU ^ the inflammation, the d.schargc of b» ana naotrtj ^ .^^ part, as from the ^W^^Z^^ q«»«* we """"l! tumor by cupping, &c. w 1 ich iro us ve , n artenes. will suppose could have n» eflejt ™*L^™m?5ms "nmediately often give immediate relief, all the teDnu j y er I the ceas nf The same often follows the extraction ot a tnoiu ^ PS*i?mitigatedI by some external JPP J^ of told, the part be directly diminished by the powcrmi fi Tame effect often follows. swl_uiferolls system, may be compared f Tension, as it respects the sa 6""*'™*JU thc COi,teuts ol the rnth^ension of the chords of a^^ sidcs ^ lhe t.allsM sanguiferous system and the contraction which modify its tone. 196 Is fo exceedingly low, that it will not admit of the leaft reduction ; for which reafon we fhall confider thofe different forms of the difeafe feparately. Cases in which the action of the heart and larger arteries* though debilitated, yet admit of a further reduction, with the prospect of thereby restoring the equilibrium ; and the aanger of congestion, distention, rupture, and effusion from the capillaries, thereby prevented. If the pulfe is not very low or intermitting, or the countenance very much funk, if the powers of life in general are not exceedingly reduced, we may in moft cafes conclude that, at the commencement of the hot fit, the action of the heart and larger arteries will admit of a fmall reduction ; and as this point of time is of vaft importance, we fhould be prepared to reduce their action at the commence- ment of the febrile exacerbation, or hot fit. But fhould the propriety of reducing the action of the heart and larger arteries, from any caufe, appear doubtful, we had better wait till the commence- ment of the hot ftage, (in fome cafes the hot ftage is not very evident,) or at leaft till thefe doubts are removed ; at which time, we may be fulfilling the firft indication, viz. to excite the action of the capil- laries, and even the heart and larger arteries, if their action is exceedingly reduced. The action of the heart and larger arteries may be excited by ftrong cordials, as fpirit of lavender, vitriolic aether, fpirit of wine, &c. The two laft fhould be diluted, and given in confiderable quantity. The internal capillaries, (viz. the internal furface,the ftomach, bowels, &c.) by ftimulating drink, fuch as herb teas, peppermint, Virginia fnakeroot, com- mon fnakeroot, effence of peppermint, fpirit of lavender, &c.; and a blifter may be applied to the pit of the ftomach. The action of the external cap- 107 illanes may be excited, or their adion increafed by external heat, by the application of warm cloths, by fteam from hot bricks, blocks, &c. which have been immexfed in water in which the boughs of fir or pine have been boiled,by blifters and rubefacients, as fp. terebinth and brandy, capficum or red pepper and brandy, cantharides and brandy, by fric- tion with the hand or brufh. The exctflive action of the heart and larger arteries may be reduced by phlebotomy, cathartics and emetics ; yet in a ftate of the fyftem fo delicate as that which attends fpot- ted fever, when life and death appear to depend on different degrees of the fame action, and thefe de- grees not very remote, I think the two firft rem- edies are very dangerous, becaufe the action of the heart and arteries is already below the healthy ftandard ; and any further permanent reduction of their action will be a ferious difadvantage,* if it is to any confidence degree ; and fhort of this, no con- fiderable effect will be produced : both venefection and cathartics permanently reduce the action of the heart and arteries, which does not appear to be the fcafe with emetics.t .. r Emetics appear to poffefs the peculiar quality of exciting the adion of the capillaries, and at the fame time they reduce the adion of the heart and larger arteries. Of all medicines that I have given 10 this grade of the difeafe, emetics appear to be the moft valuable. If given in the cold ftage, they excite the laion of the Capillaries ; ^J^***^ -T^mnscular fibre cannot distend j^^ffflf 'SS. powerful depleting means must cause a soft pulse to and a weak pulse to be still weaker. ,i)ch case, 1S f Gentle cathartics such ^^Jw^W*. But all po- caihartics are indicated are adm s»•"• ^/^ £c. llWI uniform ^rS:;;tmg^,aAic,Snch.G,a«bC, ty appeared to bare a verv bad effect. 198 larger arteries, which may be expected to follow the cold ftagew If given in the hot ftage, they flip- prefs haemorrhage of the lungs, &c. they reduce the violent or exceffive action of the heart and larger arteries, and thereby moderate the violent pain of the head and other parts. From the facility with which the heart and larger arteries throw the blood to the head, a violent action of the veffels of this part is excited,* (both of the capillaries and larger veffels) attended with great heat of the part, and extreme pain in fuch cafes ; if we omit to remove this extraordinary action but for a fhort time, the death of the patient will almoft always be the con- fequence. To moderate the pain of the head, emetics, as before obferved, by moderating the action of the heart and large arteries, have a valu- able effect. But to allay the great heat and violent action of the capillaries, we have powerful means, viz. cold applications ; take four or five thickneffes of linen or cotton cloths, fufficiently large to cover the whole forehead, and reach from ear to ear ; thefe fhould be wet in cold vinegar or water, and applied cold to the forehead, the hair being care% fully ftroked back.f If the head is very hot, (fteam * i have often observed, that to oppose the gravity of the blood to the increased aetion of the heart, by elevating the head, or even for the patient to sit erect, (when he had strength) has a very consider- able effect in moderating the impetus of the blood towards the head ; and consequently relieves the pain in this part; it likewise favors respiration, and the circulation of the blood through the lungs. Dr. Blanchard, of Pembroke, informed me, that he found it con- siderably to moderate the febrile paroxism, by taking his patients out of bed, during the hot; fit; but when they sit up, just before the com- menceinent ol the hot fit, it was constantly found to aggravate the next paroxism from the chill which they took, If is not improbable that both of the above circumstances have a considerable effect. f It will be remembered, that the hair is a bad conductor of heat, and that it is difficult to wet the head through the hair, even if it is short; and to shave the head during,a severe paroxism of fever would be difficult; besides, we should lose too much time. For the above reasons, I think the forehead to be by far the must suitable part to ap- ply the cold applications ; for which reason, I would seldom or never apply a blister to tbis part; and if I found a blister on the forehead in a severe paroxism of head-ache, I should recommend to remove it, to make the more powerful applications of cold and wet cloths; saccharum Batumi dissolved in the wa,tcr orviuej;ar Wj|j ma^e us operation more .powerful. 199 will foon rife from the cloth like fmoke) the cloth mould be removed, and another applied in its room as often as once in two or three minutes ; if the cloths are applied fufficiently often, and if the water is fufficiently cold, they will feldom fail, in a fhort time, of moderating the heat ot the part, and con- fequently the J>ain and increafed action. Treatment of that grade of Spotted Fever, in which the action of the heart and larger arteries is so low as not to admit of further reduction. Symptoms—The pulfe is in general fmall and quick, but in fome inftances flow and intermitting, but never ftrong. The extremities, in the cold ftage, are generally purple ; a cadaverous counte- nance, and great proftration of ftrength. In this grade of the difeafe, emetics are not admiffible ; if given even to the greateft extent, they never operate well, and in moft cafes have no operation ; but appear to fink the patient ftill lower. In this form of the difeafe, the adion of the heart and arteries fhould be excited by the moft ftimulating cordials* and medicines internally ; ex- ternally, heat and rubefacients fhould be applied, as defcribedin the preceding grade of the difeafe: a blifter to the nape of the neck; and if there is great diftrefs at the pit of the ftomach, or puking, apply a blifter and warm applications to that part, while the moft warm and ftimulating cprdials and meth- anes fhould be given internally. It will often hapj oen that after the ufe of thefe remedies, for a inort £ 'he heart and arteries will be excited to con- Sd^SkiSo : if this fhould appear exceffive or if it ihouldnot, yet for ^e^^^^an aftion of the capillaries, and the agitation wu TnTch cases it has usually been my method to give the cordial. or stimulants in moderate doses, frequently repeated. sop emetic gives the fyftem generally, its operation is valuable, in every form of the difeafe in which it can with fafety be adminiftered. Should it now appear that the powers of life are fufficiently reftored to admit of the operation of an emetic, one may be given ; but it fhould be very gentle, fuch as radix ipecacuanha, r. feneka, &c. and fhould be given in fmall dofes, frequently repeated, and affifted with warm water, camomile tea, &c. For children, warm water, feneka, and olive oil, with a Very fmall quantity of radix ipecacuanha. If the emetic fhould not readily operate, a fmall dofe of opium and camphor, or brandy, will often excite the action of the ftomach, and caufe the emetic to operate. Phlebotomy, cathartics, and all depleting medicines, if carried to any confiderable extent, fo as material- ly to reduce the action of the heart and arteries, as might naturally be expected, have uniformly had a very unhappy effect, in all genuine cafes of this dif- eafe. Salt of nitre, Glauber's fait, and all other powerful internal refrigerating medicines, have uni- formly, as far as I have had knowledge of their op- eration, appeared to have the moft baleful effect, when given in any confiderable quantity in this diieafe. It is poffible, that during the hot fit, which in fome cafes of this fev r is extreme, wafhing the breaft, &c. but not the extremities, with,good vinegar which is moderately cool, might bejjfljfree- able and ufeful, if ufed with prudence ancrKution. From the nature of this difeafe, the importance of ftimulants, both internal and external, is_fcridenf, particularly heat externally applied in thdWrd ftage ; and likewife diaphoretics in the cold feafon of the year, when we have reafon to fuppofe that the cutar neous evacuation has long been in a confiderable degree fuppreffed. In fuch cafes, diaphoretics appear highly beneficial in the commencement of the difeafe, but fhould not be forced by violent means, for any confiderable time; nor fhould the fweating be pro- 201 fufe, but for a fhort time, nor fuddenly fuppreffpd; a moifture of the fkin, or a gentle diaphorefis fhould be continued for feveral days. We fhould likewife take fpecial care to fee that the fweating is properly conducted ; and enjoin it on the nurfe, not* to fcald or burn the patient, an accident which unfortunate- ly has fometimes happened. We muft regulate the temperature of the applications by our own fenfe of heat and cold. The patient is often fo numb, as not to complain, though burnt or fcalt in fome inftances to a fhocking degree. Of all medicines, emetics appear to be the rruft generally efficacious ; but it will be underftood, that they fhould never be prefcribed in important cafes until we have examined the ftate of the fyftem in the moft careful manner, and have good reafon to conclude that the action of the heart and arteries, and of the fyftem in general, is fufficiently ftrong to fupport their operation. As much of thegood effects of emetics depend on their being judiciouf.y prefcribed and given, it will in moft cafes be a de- firable object for the phyfician to tarry and re^ui .tc their operation. As the whole population of a place where this difeafe is prevalent, are fuppofed to have a predifpofition thereto, we readily perceive why all other difeafes which may happen during the preva- lence of this predifpofition, put on the form of the epidemic: this predifpofition gradually diminifhes during the fummer months, and often is fcarcely perceptible in the fall, and firft winter month -but fince the firft prevalence of the difeafe, the fyftem ha, never fo far recovered its tone as to acquire the phlogeftic diathefis, or that degree:of tone whichib favorable to active inflammation, (except in a few folitarv cafesO and when the fummer and fall months are fubiect ogre* vibrations of temperature, as in 814 the difelfe has prevailed throurh.xhe whole year; but has always been much mildei in the —' , ,. / . -,-nftnrl tvnbi.'O which is the most oi'ouite a:»i mint u ^ 202 warm feafon, though the changes were nearly as great as in the cold feafon : from which it appears, that the changes of temperature are proportionally dangerous as they deviate from the temperature of the blood; e. g. a change of 40° above or below 49° is borne with lefs injury to the conftitution, than a change of the fame number of degrees would be above 60° or below 20°.* As this difeafe affects different parts of the body, as the head, breaft, bowels, extremities, &c. it affumes different appearances, and requires different treatment ; for which reafon we fhall confider each of the varieties of this difeafe feparately. Violent affections of the head may generally be known, by pain and heat in the part, throbbing of the temporal arteries, &c.f Treatment.—A blifter to the nape of the neck, an emetic, and cold applications to the forehead. After the fecond or third day, when the violent action of the heart and larger arteries may be acquainted. The symptoms are a combination of the symptoms of our former autumnal typhus, (or nervous fever) with those of spotted fever. * " Linnaeus, in a paper in the Amsnitates Academias, expresses his astonishment at the impunity with which the heated Laplander rubs himself with snow, or even rolls in the snow, and drinks the cold snow water."—Philosophy of Medicine, Vol. III. page 104. f The same causes which produce a torpor on the surface of the body, often occasion a greater torpor of the capillaries of the lungs. The circulation of the blood, from the right ventricle of the heart, being impeded by the debility of the capillaries of the lungs, a con- gestion of blood in the right ventricle must be the consequence ; and likewise a congestion in the larger veins: the effect of this engorge- ment in the large veins near the heart, will operate most powerfully on the brain,' as the firm bones which incase this part will not admit of its being distended; while the blood from the left ventricle of the heart (from the shortness and greater proportional capacity of the ar- teries which ascend to the head) will be thrown with greater facility on the brain, than on any other part: hence the violent pulsation of the arteries of the head, the increased capillary action, aud the vio- lent pain and great heat of this part. But when the vessels of the lungs are in an extreme state of debility, they often yield to the distending force, and effusion of blood in the cellular texture of the lungs follows in consequence : when this happens, or haemorrhage into the bronchial cells, &c. the head, as far as 1 have observed, is uniformly relieved. 203 expected in moft cafes to have fubfided, blifters may often be advantageoufly applied to the temples, or behind the ears, or on the forehead. In a few ca'fes the head is colder .than natural, the face pale, the countenance funk, and the puke weak and quick. Treatment.—Warm camphorated fpirit applied to the forehead and temples, a blifter to the nape of the neck ; internally, wine and aromatic ftimulating medicines. Affections of the Throat.—Of all the parts of the body, the neck is fubject to the greateft variety of drefs : fometimes it is clothed exceffively warm, fo as to caufe it to fweat profufely ; at other times it is very much expofed, or left quite naked. The parts about the mouth, the fauces, and throat, being con- tinually fwept by a current of air, we fhould nartui- ally fuppofe that thefe parts, of all others, would moft frequently fuffer from the changes of tempera- ture ; which is the cafe ; of courfe, affections of the throat, &c. from the feveral varieties of inflamma- tion, are very numerous. But we fhall confine our obfervations to fuch affections of the throat,as appear to be different forms of the prevailing epidemic; and even of thefe there are feveral varieties. In the moft dangerous variety of this difeafe, the aaion of the heart and larger arteries is in excefs ; the attack is often fudden ; the face is fwollen more or lefs, is of a dull, pale, or flight purple eaft.;■ the ey- s are fometimes fwollen and fuffufed with blood ; * e neck and throat fwell exceffively; the tongue fwefls, and is thruft out of the mouth between the teeth ; the breathing is more or lefs difficult; the patient ^^r attempts to expectorate a tough^opy mucus. This difeafe often proves fatal in a fhort time fometimes in a few hours ; but m other m- Lncesf "ot tin the thnd fourth oreveri the ^h day. This variety of the complaint moft ^uen^ happens in the fall, after great rains, or other very A a 204 confiderable changes of temperature. I have not had fufficient experience to give my opinion decid- edly, refpecting the treatment of this variety of the complaint:; but, from what I have feen, I would recommend an emetic to be given as foon as poffible; and would repeat it, or rather I would recommend repeated emetics given fo as to excite a permanent ficknefs, and confiderable and repeated puking i apply a blifter to the nape of the neck, and two oth- ers, one to each angle of the jaw ; and endeavor to procure a free fweat; and give internally red pep- per, fait, and flour, aa. to be mixed with twenty parts of warm water, and given to the quantity of from thirty to fixty drops to an adult, once in ten or twenty minutes, to be given conftantly from the firft attack, without regard to the emetic ; exter- nally, to the furface of the throat, red pepper and brandy, fp. terebinth and brandy, &c. In the mild- er cafes of this complaint, an emetic, a blifter to the nape of the neck, red pepper, &c. given inter- nally, and applied externally with brandy. In the other grades of this affection, when the pulfe is weak, quick and fmall, the countenance funk, and the eyes dull, pain in the head, neck, throat, &c. the neck and throat do not appear fwollen, as in the va- riety of this complaint firft mentioned; but a Hough- ing and ulceration of the mouth and throat, more or lefs deep and extenfive. Moft or all of the vari- eties of this complaint will admit of a gentle emetic being given at the commencement of the complaint; a blifter fhould be applied to the nape of the neck, and red pepper internally and externally, as in the variety of this complaint firft mentioned ; to which may be added the bark of the root of red willow, given to the quantity of a table fpoonful of the de- eoction once in four hours ; and ufed likewife as'a gargle. In fome cafes, the Houghing extends quite to the ftomach, and more frequently to the lungs, ears, nofe, &c. In fuch cafes, great atten- tion is requifite, or the patient will fink under 205 the difeafe ; very fmall portions of calomel, opium, and camphor, aa. may be given fix or eight times a day. When the febrile action is inconfiderable, cor- tex peru maybe given, beginning with very fmall dofes, and gradually increafing them ; red port wine, wine whey, &c.; the mouth and throat fhould be wafhed witha weak folution of vitriol, cearuleum. Lac ammoniaci may be given internally, to the quantity of from forty to fixty drops, every two hours ; and a decoction of radix feneka fhould be frequently given, fo as to produce a flight naufea, Affections of the Lungs, &c. When attended with weak, quick, and fmall pulfe, it is ufually the fequel of the laft mentioned complaint, and requires a fimilar treatment. A blifter on the upper part of the fternum will be proper, and the laft mentioned rubefacients to the furface of the thorax. The moft ufual form of pulmonic affection in this difeafe, is when the action of the heart and larger arteries is in excefs. It will readily be perceived, that when great atmofpheric changes happen, the lungs, from their neceffary expofure in the inhala- tion of the air, muft be peculiarly liable to fuffer; hence the bad effect which a variable climate has on difeafed lungs. Affections of the lungs and cheft are often very alarming. The difeafe is known by more or lefs pain in the fide, cheft, or a deep feated, dull pain, paffing through to the back, difficulty of breathing, and occafionally haemorrhage from the lungs and expertoration of bloody mucus, attended with more or ?efs cough; the pulfe is often confid- erably full, and appears to be ftrong but foft When this difeafe terminates fatally death ufuaUy haooens on the fifth, fixth, or feventh day. ine WrJmay generally be foretold by a pecuhar rattlimr which moft commonly may be Perce^^ the rattling commences, thepatiem i«? 206 ufually compofed, and free from pain ; his friends often confider him better; but a rattling in the lungs commences from a fecondary effufion of lymph in the bronchial cells, which occafionally happens at this time : the patient often makes great exertion to raife the matter from the lungs, and at firft often fucceeds ; but the matter generally in- creafes much fafler than it can beraifed ; befides, it is in moft cafes exceedingly tough and vifcid, fo that it adheres to the mouth and throat in a finguiar manner; the patient's breathing becomes more diffi- cult, and he dies apparently by fuffocation. Treatment.—An emetic mould be given as foon as poffible, if there is haemorrhage from the lungs. Emetics, in all cafes in which I have given them, or heard of their being given, have uniformly appear- ed to check it : warm applications, fuch as warm cloths, or warm blocks or bricks covered with cloths, fhould be applied to the pained part ; a free fweat fhould be procured if poffifcle, and continuecjl for two or three hours; after which, a moderate fweat fhould be fupported for a confiderable time, and the fkin kept moift throughout the difeafe: blifters fhould be applied fuccefiively, fothat moft of the breaft, by the feventh day, may be one common blifter. If from the violence of the difeafe, or habit of the patient, the danger of fuffocation is great, an emetic fhould be given as often as every day, or every other day, fo as to produce confiderable puking ; but the emetics, after the firft, fhould be of the moft gentle kind, fuch as radix ipecac, feneka, &c. ; and naufeating dofesof antimonials, or ipecac. ftiould be conftantly given. If the expectoration from the lungs is confiderable, it fhould be aflifted by radix feneka, or fcilla ; the fteam of vinegar, from a tunnel put over a mug filled with hqf vine- gar, and the fpout put between the teeth, fo that the fteam may be conveyed to the lungs. This difeafe, in fome inftances, terminates by an effufion of blood and lymph in the cellular fubftance 207 of the lungs; and if the effufion is not fo great as to entirely interrupt refpiration, the patient often mgers a long time ; and the blood or lymph, if not timely abforbed, produces abfceffes, vomica; &c. and occafionally dropfy in the cheft, pericardium, &c. When ettufion happens to any confiderable degree in the cellular texture, or in the bronchial cells of the lungs, the patient's breathing immediately be- comes very difficult and laborious ; he ufually opens the mouth wide, efpecially when in fleep ; the noftrils are confiderably inflated ; he has a ftrangu- lated countenance, and it requires his utmoft effort to get his breath; the breathing is performed much quicker than ufual, and the action of the mufcles of refpiration are remarkably increafed ; the pulfe is in general irregular, and the heart palpitates. Treatment.—The moft defirable event would be to Jaave theeffufion abforbed as expeditioufly as poffible ; for which purpofe very gentle emetics may frequent- ly be given ; but in fome cafes the patient is fo far exhaufted, that emetics, though given in large dofes, will not operate : if moderate dofes of emetics fail to operate,we would conjoin with the emetic calomel, in fmall dofes from 2 to 3 grains, to be given three times a day; and apply blifters to the fternum and fides, or rather we would blifter the whole breaft in fucceflion ; and apply but one, or at moft two, at a time : likewife, naufeating dofes of emetics, fuch as radix ipecac, feneka. and lac ammoniaci. If the difeafe proves obftinate, and does not yield to the above treatment after it has been continued for a con- fiderable time, we would propofe the following medi- cine, viz. extract of ftramonium, opium, and cam- phor, ha. to be given in a pill or powder, in imal. dofes, of 4 grains, three "mesa day, or in fuch quantities as moderately to affect the fyftem. Port wine and cordials fhould be given at the fame time with the above medicine, if the fever is but mod- erate, which is generally the cafe, in fuch quantities as the circumftances of the cafe may require . if the £08 patient is hectic, give cortex peru, and if not, cha- lybeates, If the effufion fhould unfortunately ter- minate in a vomica, the matter being readily expectorated, the patient may recover ; if it ter- minates in an abfcefs, and becomes prominent, and points towards the furface, it may be advifable to difcharge the matter externally by an opening,when a fluctuation can be diftinctiy perceived. There is an inexpreflible anxiety, which ufually attends this affection from its commencement; to relieve which, opiates are very valuable ; but great caution is requifite in the ufe of them, in the com- mencement of this complaint, as the partial obftruc- tion to the circulation of the blood through the lungs caufes a congeftion of blood in the veffels of the head, which confiderable dofes of opium would perhaps aggravate. Notwithftanding the very formidable appearance of this affection, yet if we perfevere, and pay chat ftrict and prompt attention to our patient which his diftrefs fo imperioufly demands, I think we may not unfrequently have the fatisfaction to fee him recover From the pathology of this difeafe it appears,that the heart and larger veffels for a time fuftain the whole weight of the circulation. The heart likewife is the part which is firft excited to increafed action ; and to propel the ftagnated blood through the torpid capillaries, in fome inftances requires an action fo extraordinary in thefe parts, that it is not improba- ble the great veffels and auricles of the heart in fome inftances are ruptured, or fuffer irreparable injury from their extreme diftention. Congeftion in, and confequent increafed action of, the heart and larger veffels, will probably be attended with a full and ftrong, but irregular pulfe, palpitation of the heart, a fenfe of fulnefs and oppreffion at the heart, difficult refpiration, great anxiety, &c. Treatment.—Immerfe the hands and feet in warm water ; and, as foon as poflible, apply the warm bath ; or rather envelope the patient in blankets 209 wrung out of warm water, in which fome ftimu- lating herbs have been boiled, or the bough, of nr or pine; and let no time be loft in giving an emetic. Cafes occafionally occur, in which the patient gradually finks.* This ftate of the difeafe is aptly expreffed,.by faying, that the pulfe runs down, as does a watch or clock. Such cafes are attended with but little or no fever ; the heart fails of being excited, and the patient gradually finks. Symptoms—The pulfe is weak and quick, the countenance funk and pale, the eyes dull and funk in their orbits, the furface is generally very cool, and often fpotted with large leaden colored fpots; the patient generally retains his fenfes till the laft. Treatment—Warm ftimulating cordials, given in fmall quantity at a time, and frequently repeated ;f warm ftimulating applications to the furface, blifters, and rubifacients. * As the warm season advances, I have in general observ- ed that stimulating by warm applications, as steam Jrom hot blocks, bricks, &c. becomes less necessary; and in casts where the action of the heart is greatly impaired, attended with a small weak pulse, faintness, and sinking. I should at all seasons prefer warm, dry applications, as flannel, oIju- kets, &c. In all cases, the patient's feelings should be con- sulted. When the patient is extremely cold ana shivering, heat is hip-hly agreeable andusful; but when he is excrs- lively hot, or very faint, a great degree of heat may not only be disagreeable, but very injurious. + From the nature of this disease, particularly in such cases as are attended with an apparent diminution £ e™P - roture, purple extremities, fcr*c. and ***«*»»?"*'"£ of oxygen gas, (viz. pure dephlogisticated ""'^Ucf PobaLtyhas often occurred ^^\^^%rS this air might be peculiarly beneficial; but from * ssarv to leave out part of the decimals and words, which occasion- ed several errors. Page 37, Table 2. Result, in mean temperature of the days, and of the nights, and their difference : for 53,2—36,8; read 57,2—36,0. Page 41, Table 3. Result>: for 52 8 —41 9—11,3: raw/52,5 —40.9—11.6.----Diseases Jor February : for cynocha, read cynanche ; for cholic, read cholera. Page66, Table 5. Result: for 31.4—19.1: read35 5—15,1. Diseases should be two figures higher than their oppcsites. Page 71, Table 6. Result: for 52,3—41,3—11,6 : read 52,4—41,2—11,2. Page 75, Table 7. Diseases for February : far hydortha, rau/hydaithrus. Page 93, Table 10. The blanks should be filed by 53.8— 39,3— 14,5.----Direction of the winds in fuly, should be 2 days south, and 5 days west; ana the Result, 47—20. __Diseases in September, for typhoid fever, read typhoid spotted fever. Page 101,' Table 12. Mean annual greatest variation in 24 hours: for 41,6 : read 45 5-----Direction oj the winds : for 182,1—32,1—23,8—45,2—24 7—27.2—37 5—4 7 : read 181,25-32.25-24,0-32.75-25,125-27,5-37,625-4,75 Page 132, Table 14. Feb. 3, (Salisbury warmest J for 4, read 2. ,. , Page 1.5, Table 15. Village 5 warmest, on the 19th March, should be a blank. Page 8, line 13, for phlemmiic, read phlegmonic. 22, last sentence, on scarlatina anginosa, should be sepa- rated by " 32 I'vie 21. for October 8, read October 9. 38 line 4, for mean variation, read mean greatest va- ruition—Line 1 in note, for 26th of Feb. read 14th. 43, line 3, jor mition, read sniiior. 59, line 22, Jor causes, read causus. 67, hue 7, Jor wheo, read where. 98, line 5, jor November was, read November is. US, ls read erysipelatous. 186 hue 10, Jor demaciated, read emaciated. 198, line 8, in the note Jar paroxism, r«td paroxysm. MeJL, Hist. WZ. W7Wu J9ir pi--i£:^'i;::y.:-": ^-^: . W$tiX:^X>X^%vhtii ;y;; ,«,'■;• •,'/.«: ;:>j. *!»•-::■•« " is*1 XfrXl^y-