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lr ■:
A HISTORICAL AND PHYSICAL SKETCH
OF A

MALIGNANT  EPIDEMICK,
PREVALENT IN MARYLAND,
And some other states, within the last few years-.
WITH A BRIEF NOTICE OF SOME OPINIONS WHICH HAVE BEEN
      PUBLISHED ON ITS NATURE AND TREATMENT.
In rebus medicis consulendum est, ne error recto de tramire
    pellat; et si quid audiendum dicam, libere loquar.


         BALTIMORE:
"PRINTED BY R. W. POMEROY, & I.'IJ.
      .Vo.  12, Light strdrt.
              IS15.
/ 
 
INTRODUCTION.
  THE discussion  of science  is a common
privilege.—When it arrives at truth  it will
elicit respect.—-When it deviates into errour
it  merits exposure.   I cannot solicit indul-
gence, when I refuse submission to restraint.
Nor will I attempt to throw around the pre-
sent essay, the flimsy bulwark of apology  or
professions. I leave the one and the other to
those who are at the same  time courtiers for
patronage, and cowards to  criticism.
   Propriety however demands  the remark,
that the  freedom I  arrogate, and exercise,
should not  be construed  into  unprovoked
assault.  In daring to assert what I am war-
ranted in  believing, I have no where in view
a particular object.* I hold up neither this
man, or that book.
  It might be justly termed presumption to
contend  for victory,  where so  many  have
incurred defeat.—But such is not my object.

         * I allude to the introduction.
       A 
IV
Thrown  by the casualties  which direct the
individual allotment  in human condition, an
adventurer upon the theatre of medicine, that
prolifick  field of good  and evil, I resign to
others "ample  dominion and extended em-
pire," content with cultivating in a "capricious
climate,"  the  "dubious  hope" of the  hus-
bandman and labourer.  That mania for fame
and fortune, which has directed the "deluge
of disorder," upon every newly discovered
and unexplored country, has not only blended
in confusion in the field of medicine, the poi-
son and the balm which nature had separated,
but has  engrafted on  its soil  every outcast
weed which the experience of other regions*
had  proved to  be  useless  or pernicious.
Amidst confusion thus intricate, and danger
thus multiplied, even the humble occupation
of patient labour, and cautious  inquiry, may
claim a degree  of importance.  It will  help
to disentangle the first, and diminish the lat-
ter.   And  may  confer benefit  though it
should not attract applause.
  Mankind have at different times amused
themselves with the speculative inquiry, how
far the medical  profession  was conducive to
general welfare.  Whether society had gain-
ed or suffered by the unlimited toleration of
this  description of its  members.—The evi-
dence of facts and the  inference of reason if
* Sciences. 
V
attended to, would in my apprehension have
long since rendered this subject too serious to
be entertaining, They ought to have aroused
society to the  conviction that the abuse of
that profession, had rendered the fair promi-
ses of physical science illusory.   That  its
primary  object had been defeated, and the
best hope pertaining to the condition of mor-
tality, doomed to  disappointment.  After a
thousand years of bootless expectation, they
ought no longer to be amused  with written
absurdities, and colloquial nonsense.
  It would be fortunate  for  humanity,  and
creditable to the science, if truth would per-
mit a different testimony.  But it will not.

                      "Naturae
        Perturbaturibi totum sic corpus et omnes
        Commutantur Positurae Principiorum."

   Were the faculty to obey its impulse, (like
the Roman lawyers who  we  are  told were
once seized with the. spirit of self-exposure)
they must admit the general  fact, that were
professional incaution to drop for a moment
the mask which hides its ignorance from com-
mon observance, or the. hand of inquiry to
lift  the drapery of artifice  behind  which it
seeks  security,  the philosopher would turn
with disgust from the barren spectacle, and
the philanthropist drop a tear on the expo-
sed  condition of mortality.—For  it  would
then  be discovered that while social indul- 
VI
 gence had held the occupation sacred, and
 restrained curiosity  from  intruding  on its
 work, in  the hope  of  eventual benefit from
 its labours, instead of rearing  with care and
 skill, the splendid  and solid  edifice  of real
 science, its  little  industry had  been worse
 than uselessly  employed in heaping together
 a formless mass of rubbish.  A "rudis indiges-
 taque moles," without beauty, proportion, or
 purpose.
   Age after age,  has  generously collected
 materials for the use of the profession. They
 offer it their facts  and follies.  But it appears
 to have examined, only to confound them.
 And "could an old physician  rise from  his
 grave,  and take a view of modern writings
 and opinions,  the venerable ancient" would
 think  even  his follies  disgraced,  by being
 made to prop more  foolish fabricks.   Every
 depository of absurdities has been plundered
 to procure  materials  for the composition of
. systems, whose attempted illustration has ex-
 hausted the stock  of senseless verbal ambigu-
 ities.   Like the labours of the multitude on
 the  plain of Shinar, they were begun without
 order and ended in confusion.  And like the
 issue of those  labours,  each will one day be
 regarded as nothing more  or better, than
 "une boutique de verbiage"—a mere word
 shop.
   Modern  cultivators  of  physick outstrip
 their predecessors in nothing but rashness. 
vii
They have advanced boldly, though blindly,
into  the  fruitless desert of conjecture.  No
license of fancy is left unclaimed, or unexer-
cised.  No dream of imagination escapes a
record.   "A  supernatural  gloom is  thrown
around  every thing they  touch; and amid
the artificial  darkness and perplexity thus
created, the candid inquirer knows not where
to bestow  his confidence   Their ingenuity
acknowledges no bounds of pru-dence, and
encounters no  obstacle  which it does not
overthrow.   Facts are alleged, or distorted
as best suits the purpose, and laws promulga-
ted for the admiration of man,  which  nature
never made, and cannot obey.—Such is the
supmeness to  investigation,  so great the
proneness  to credulity,  that theories  and
systems, thus founded, and thus supported,
maintain a quiet, or  but feebly disputed em-
pire, amidst  the ruins  of observation and
common sense.*'
   The science has always been disgraced by
whimsical theories.   But in an unenlightened
age they were not without  apology.  That it
should still be the sport and the victim  of
"vague and disjointed reveries,  when a really
philosophical spirit seems  to have pervaded
every other branch of knowledge," is matter
of astonishment.  The  mathematician can
manage successfully his lines and figures;  the
mechanick his rule;  the astronomer his tele-
scope;  the  navigator his  compass.  The 
viii
natural philosopher walks  in  familiar con-
verse with the material world;  or  where he
lacks an acquaintance, the noble science of
chemistry operating by principles and with
results seldom destitute of surety, can secure
him an introduction.  In short every science
save medicine has  become  rational and re-
spectable,  by the  exertions of their cultiva-
tors.   It alone has resisted the diligence of a
thousand  years.   And though  it  has been
wrested "nutricibus anilibus," from the hands
of nurses and old women, and its profession
become dignified  and lucrative,  it  possesses
at this day in  the understanding of but few,
either a definite idea or established principle.
It seems peculiar to physicians to grovel in
darkness; "to erect aspiring structures with-
out regarding the insecurity of the foundation.
Folly is  piled upon  folly, till  the architect
vacillates  among the clouds, ready to sink
under the first blast that overtakes him."
  The writer is indifferent to the application
of his remark on the limitation of professional
understanding.  He hazards nothing on the
score of its intrinsick truth.  Except in the
hands of a few, the  correct principles and or-
dinary practice of medicine have no natural
relation.
  Formerly the motion, quantity and proper-
ties of fluid, engrossed conjecture and experi-
ment. With the sages of the time, the human
body was a congeries of tubes, conduits, and 
ix
reservoirs, whose different capacities were
calculated with as much accuracy as the gra-
dations  of an hygrometer.   Heavier  heads
and hands less dexterous, have since been at
work on more solid matter.   And  for many
years it has been discussed with the antiquated
solemnity of a trial for necromancy, whether
the animal machine, were a clock, a fiddle, a
watch spring, or a go-cart.  Every known
principle  of mechanicks,  and every fancied
property of matter, have been pressed into
service, and dragooned into discipline.   Dis-
tinguished leaders have taken their station at
the head of the adverse battalia; and when the
commanding generals  retire, subalterns, after
trimming and currying their hobbies, vault on
their backs, and figure on parade.
   In the writings  of most professors and
practitioners, and in the current opinions and
common conduct of physicians, the disinter-
ested observer will find the dogmata of medi-
cine and the modes  of practice, "inconsistent
with one another,  with common  sense, and
with themselves.  The different systems and
opinions tripping up the heels of each  other,
and garnished with the semblance of  litera-
ture;  the 'tortuous meanderings of verbal ob-
liquity/  serve  little other purpose than  to
procure for their author or usurper, the vote
of fashion; that he alone is  qualified to take
nature by the hand, and lead her through her
distresses.   For fashion is  as necessary  to 
X
the physician, as to the dentist and dancing
master."
  A profession honourable even in  an age
without science, for  it was then  confined to
the learning, and engaged the best intellects
of the  time, has  dwindled into a petty craft,
shared among adventurers, as different in cha-
racter  as the objects ofenterprize are various
and multiplied.  By those who become book-
makers* without a qualification  from nature
or the schools; by others who are made prac-
titioners of physick after their stupidity had
been found proof against the plainest rules of
the simplest art.   And by a third set (not
least in number,) who too profligate to be in-
dustrious, have cunning enough to prefer the
practice of impostures licensed by custom, to
those which involve a legal penalty.
  Should  it be said that such language is less
temperate than the  subject or occasion re-
quires, there can be but one answer.  I would
not hold a straw against the Indian tomahawk,
nor hope to dam with sugar the mountain tor-
rent.   The profession has many ingenuous
cultivators and upright members.  But  their
very attachment to that profession has shut
out most of those from a participation of its
advantages.   When casual circumstances  do
not  contribute  to  their success, they are

   * If it can afford any gratification, I'will readily
eon sent  to be associated with this fraternity. 
xi
thrown into obscurity with breadless and rag-
ged families, by  cunning intrigue and brazen
faced pretension.
  A.\celebrated  historian has remarked that
wmte in Europe, superstition was  the  hand
maid of religion, the  savages  of America had
associated  magick and medicine.   Could  he
write  again the history of that continent,  he
might leave on  record as a comment  on that
remark, that where the original race could not
now be found, this memorial of its former ex-
istence, might, still be met with.  That the In-
dian in falling  under the sword of his  more
civilized conquerour, had bequeathed him his
credulity.  For  only Indian credulity could
attribute medical knowledge to minds destitute
of all other  science; or create  chapmen for
papers and  boxes  declared to  contain arti-
cles possessing mysterious qualities  and  magi-
cal powers.
   While  society continues, disposed to com-
mit a "Felo de se"  by offering premiums for
folly in lieu of science or sense, human life will
be a fair subject of awkward experiment.
B 
 
"Cohors nova incubuit Febrium terris"
  FOR eight years past a disease has prevail-
ed at irregular intervals in  different parts of
our  country, whose novel and  destructive
character has excited much professional  at-
tention and general alarm. The first authentic
account we have  of this mischievous visitant
is from the Boston medical register of May,
1806.  The  physicians of that state though
silent as to  the particular period of its ap-
pearance,  accord in referring generally to
the spring of that year (1806) as the era of
its introduction.   It appears to have  been at
that time confined to particular, and (so far as
we can learn) very limited districts, generally
villages and  small towns.  We have not been
informed whether its agency was subsequently
more diffused; nor whether it prevailed gene-
rally, or but  at intervals  since, or has been al-
together absent.  I  believe however (from
oral communication) that it has occurred oc-
casionally in every year since its introduction.
  The statements which give us  the first no-
tice  of this disease, do not offer us any topo-
graphical  or circumstantial intelligence, on
which we might rest conjecture as to the cause
of its generally local existence.    It appears 
14
to have selected  villages and towns as the
chief theatres of operation.   But we are not
informed whether  those towns occupied  an
elevated or level site; whether near to, or re-
mote from, mountains, rivers, creeks, swamps,
&c.  We are left in equal ignorance as to the
temperature, dryness,  or humidity of the air
during the periods  of its prevalence.
  In 1807 (the  spring I believe, but we are
not  distinctly  informed) the  physicians  of
Connecticut, were called upon to  resist this
formidable assailant.   Its  inroad  upon that
state appears to have been at many and dis-
tant  points, about the same period. Here too
the  towns and  villages, were the principal
sufferers.   The noxious agent seems to have
directed its force where its victims could  be
most readily multiplied.*
  We should infer from the alarm communi-
cated to the Connecticut physicians  by the
symptoms and consequences of the disease,
and  the incertitude they  avowed as  to the
proper weapons to be wielded  against the
invader, that they had acquired but partial
information of its previous existence in  Mas-
sachusetts, of  its character, or correct treat-
ment.   Its  diffusion appears to have  been
more considerable in Connecticut, than it had
been in Massachusetts.   The medical histo-

  *  This does not appear to have been the fact in
relation to cities, or the most populous towns. 
15
ries of the disease,  published in  the former
state were more numerous and explicit, than
those of the latter.  They exhibit an account
of its symptoms, the modes of treatment dicta-
ted by  analogical reasoning, or  adopted on
the evidences of experience: with the compa-
rative success of the different plans  pursued.
Those accounts appear entitled to respect;
for they indicate in the general result,  or af-
ter sufficient  time had been afforded to cor-
rect early misapprehension,  great uniformity
of sentiment  as  to the intrinsick  character,
and proper treatment of the disease. But we
are compelled  to award the medical gentle-
men of this state, a participation of the*cen-
sure, in which we have ventured to  implicate
their brethren of Massachusetts.  They have
omitted all circumstantial detail, and leave us
in darkness as to locality, weather, &c.
  Vermont, New Hampshire, Rhode Island,
and  New York, have each  been visited by
the disease we are describing.   But from the
partial traces of its  existence, in those states,
to be met with on record, we should presume
that it was not generally  prevalent; nor pro-
ductive when  it existed,  of consequences
equally mischievous and alarming, as in Con-
necticut and  Massachusetts, particularly the
former.  To this conclusion New York per-
haps,  should be proposed  as an  objection.
The disease  appeared as early in some parts
of that state, as in  any of the more eastern 
16
ones: and though confined in extent, was se-
vere in degree.
   We find very little said of this disease by
the  physicians of New England,  or New
York, from 1808 until the latter part of 1811,
and spring of  1812.   At this period it revi-
ved with augmented force in the north eastern
section of New York.   The United  States'
troops who were this year detached to occupy
stations on the New  York northern frontier,
suffered severely from  its  ravages.   If the
informal accounts of its  destructive influence
on those troops, can be relied as general evi-
dence, the remote cause of this disease, must
have  spread itself over  an  extensive range
of  country,  and have  possessed proper-
ties in a high degree active  and forcible.   It
had  travelled in the autumn  of  this year
(1812) as far south and west as Albany; and
in all the route from  that place to the lakes,
in a direction north and north-west, its  aspect
became more distinct and sensible as the lakes
were approached.   The inhabitants  of the
level grounds on the North river, above Al-
bany, and of the villages  stretching north up
this  river, called the Mohawk above  Troy,
felt its force in a very  great degree.  Some
of those villages we are told, were  depo-
pulated, by the disease, and the desertion
occasioned by  the  terrour  it  inspired.  In
1813  it prevailed so generally in  and near
Albany as to excite serious deliberation about 
17
the propriety of a temporary removal of the
seat ot government.
   There are no written accounts (which have
fallen  under my notice) of the existence of*
this disease in Pennsylvania.  It is ascertained
however upon satisfactory traditional evidence
to have prevailed in the western section of that
state in 1810,  11, 13, and  14.   It  exhibited
there (from reports)  its common character.
   I have heard no  assertion of the existence
of the  disease in Delaware.   That it has pre-
vailed  there is very probable.
   The state of Maryland felt  its pernicious
presence, for the first time I believe, in the
fall of  1812.  It commenced its work of deso-
lation,  on the eastern shore of the state,  (east
ot the Chesapeake) and was marked there by
consequences the remembrance of which, ages
will not efface. Those who witnessed, will often
talk of them, and traditionary testimony will
present them to posterity.  We should bor-
row but little of figure, in saying of the pas-
sage of the disease through that country, hor-
rour stalked before it, while death and lamen-
tation testified its presence and proclaimed its
progress. This minister of destruction began
to execute  its  merciless commission, on the
western shore of the  state, in the winter of
1813.  In  many parts of this country it has
exacted and  continues to  exact, an ample
tribute.  Tn  some  districts  it  has  wielded 
18
an indiscriminating and almost exterminating
sword.
  This historick sketch has been premised to
facilitate a more connected estimate  of the
disease in separate situations, and at different
periods.  It will be satisfactory, if not useful,
to arrive at all possible certainty, in regard to
the identity of a disease whose novelty of cha-
racter, and unparalleled controul over health
and  life,  has been almost equally sensible,
wherever it appeared, yet whose real nature,
and proper treatment, has been and still is, a
subject of opposite and irreconcilable  senti-
ment among those who hold officially, a claim
to its investigation and conduct.
  This disease (its cause properly) has been
thought  irregularly migratory; penetrating
slowly into different districts, and pursuing no
determinate direction. An eccentrick vagrant,
rather than a systematick traveller. Its gene-
ral  tendency however has been from  north
north-west, to south south-east.*  Perhaps in-

  *If the southern and northern disease be generical-
ly the same, it is of no importance whether the cause
of the first, be identically the  same with that of the
latter, or only a similar one. A cause transferred, or
a cause locally created. 
19
stead of calling this a migratory disease, we
should express a sentiment more correct, be-
cause more consonant with our general know-
ledge of epidemicks, in supposing the cause of
its existence, in plain terms, its generation,*
strictly local.   That it was the result of an
unsearchable contingent condition, of those
places or sections of country where it prevail-
ed. It is not necessary to suppose the causes
of this local condition absolutely confined to
particular  spots  or districts.  The circum-
stances (of season perhaps,) which produce
it, may exist generally, but in the degree ne-
cessary to this particular  consequence, only
in situations most favourable to their opera-
tion. .
   Such an opinion would at least liberate us
from the vague idea, that a cause of disease
elaborated at any given point or place, should
be held in suspension (we  must reject any
possible combination,) in the air, to  be carried
into different and remote districts, in obedience
to the atmospherick currents.  This disease
appeared  first in a  north  and north-east di-
rection.   It appeared in places distant from
each other, at or about the same lime.  What
condition  of  climate or country is there in
 New England, New York, and Pennsylvania,
 which we cannot have at the same season, in
 the same,  or  subsequent years, in  Delaware,
 Maryland, and Virginia? That it was not the
 result of any strictly topographical peculiarity
         c 
20
  in the places where it first appeared, we must
  infer from the fact, that  it was  unknown in
  those places until eight years since. >
    Another consideration opposed to the pre-
  sumption of  its incursion  from  abroad, is,
  that the winds, the  supposed vehicle of its
  transportation,  observe considerable  unifor-
  mity of current in the respective divisions
  of the year.  We ought then to haVe the dis-
  ease accompanying their general course, not
  diverging as  we find it, in every direction.
  Besides, the fall, winter, and spring, winds,*
  of this continent,  blow in  the general from
  the south-west;  in direct  opposition  to the
  course, the disease  must travel to reach us,
  by an atmospherick  current, from tbeunorth-
  east.   Should  it be supposed, in order to
  account for its appearance in opposite  di-
  rections, that an  occasional variation of the
  tide  of air, may transport the cause of dis-
  ease out of  its more  general course, then
  we should expect to  have  its  operation in
  those places, but for a short time, that  the
J noxious agent would soon be  dissipated, and
  the district relieved  from its pressure.  But
  such is not the fact.  When its operation be-
  gins to subdue health in any district, months
  elapse before it ceases to be felt.

    * Especially the first and last....Betchel and Hecke-
  iveldcrs Tables. " 
21
   It has been a common prejudice in Mary-
land and possibly  elsewhere; that  this dis-
ease was generated in the camps and military
posts on our frontier.  That the chain of com-
munication established with those posts from
the interiour, and the return of the  sick and
wounded, &c. was  the medium of its intro-
duction,  into separate and  distant  places.
This errour could have been avoided, had it
been known that the  disease existed  to the
east and northward, three or four years an-
tecedent to the arrival there of the troops.
Independent of this fact,  observation should
have early corrected the delusion  of fancy.
Every practitioner and indeed every individ-
ual who has seen the disease, must have ob-
served its occurrence  in persons previously
excluded from all intercourse  with troops,
and in some who for a long time antecedently
had seen no person  under  the influence  of
that, or any other disease
  This disease has been designated in diffe-
rent places, by various appellations.*  A
discordance  as  to  name, is of little  conse-

  * The remarks on this part of the subject, rest on
the presumption that the diseases thus classed, are
specifically the same,  subject to such modifications
as may constitute a variety. 
22
quence.  The disease, though perhaps strict-
ly of the epidcmick character, has been some-
what modified in'its expressions by circum-
stances  of  place  and season.   Though the
name is  unimportant, the degree and kind of
modification is of more consequence.  If ex-
perience did not  inculcate  this truth, policy
would point out to the faculty its adoption as
a covert from disgrace. For in no other way
can we  escape the imputation  of giovelling
blindness, when society challenges us to har-
monize rationally, our contradictory and quar-
relling opinions.
  The common  appellation of this class of
diseases  in  the  New England states,  was
Spotted  fever, (febris maculatus.)  On the
frontier  generally it was  called indifferently
Spotted  or  lake  fever.   In New York, at
some distance from the borders, it was known
by  the  New England term, Spotted fever.
Maryland and Virginia have rejected  those
names, and instead of one term, we have three
or four, applied as they seem to be indicated
by the prominent features of each case.  With
us the term Typhus serves as a gencrick head
to all the rest, i he specifick distinctions, (al-
together capricious and whimsical,) are ty-
phus pneurnony,  bilious pleurisy, typhus or
malignant sore throat, and  (among the vul-
gar ) head  complaint. Although the particu-
lar  disease  derives its name from some cir-
cumstance which  more especially invites at- 
23
tention, as the disordered condition, or suffer-
ing state of a part or organ; the cases thus
varied are all referred to a  similar  efficient
cause.  The ultimate effect under all the
forms of disease, where the degree or sum of
disorder, and original physical capacity are
about equal, is so strictly analogous in its cir-
cumstances, as to leave no ground of dubita-
tion with respect to the general law of agency.
The active principle  is one; contingent cir-
cumstances, the predisposition of the body,
part, or organ, modifies its operation.
   Various attempts have been made to give
this disease  an appropriate rank in nosologi-
cal arrangement.  For this  purpose all the
diseases  have been reviewed with which it
held a real or supposed analogy.  Cynanche
maligna, scarlatina auginosa; every  form of
typhus, every jail, hospital, putrid, malignant,
and petechical fever  of  our  own country or
of Europe, have  been summoned to  a tribu-
nal, where the degrees of kindred and family
likeness, were to be canvassed and determi-
ned.  All this, I  humbly think, a very useless
parade. The thing has some  relation to them
all; but it would puzzle  a board of  Chinese
physicians, who are conjurors as well as doc-
tors,  to sav from whose loins it sprung;  who
were uncles, brothers,  cousins, &c.   The
very difficulty of giving it a  distinctive cha-
racter,  one peculiarly its own, should  have
discountenanced the attempt. For if it be so 
24
much blended in  its signs with the common
traits of other diseases, as to offer no sure
test  by which it can be known, no infallible
evidence of strictly peculiar character, it can-
not justly claim an  independent nosological
station.   Nosology is  properly the doctrine
of symptoms, not of names; or of names only
so far as they are made to represent certain
definite  and uniform signs, indicative of a de-
terminate disease, or form of disease.   Ex-
perience only, can enable us to establish cor-
rectly the attributes of disease, and in the in-
stance before us, we are without such a guide,
for our  experience is contradictory, and leads
to confusion;  there is  no fixed point of cha-
racter on which we can rest.  The disease in
question, is at most but a compound variety
of a  species;* and to give it such an arrange-
ment in nosology, would not secure the dig-
nity  claimed for it.
       GENERAL CHARACTER.


  The medical  gentlemen of New England
and New York, accord entirely in their ac-

  * I allude only to the absence of specifick analo-
gies which could indicate a proper classification with
any of the diseases enumerated. 
25
count of the symptoms of the disease, descri-
bed by them under the term Spotted fever.
We have, I believe, no history of the disease
from the  former, later than  1809-10.   We
can trace it in  New York in 1811-12-13.
All the late accounts give us, without mate-
rial variation, its original character.   In pro-
ceeding to exhibit the signs of the disease, it
will be unnecessary to encumber the arrange-
ment by a minute detail.  The general ad-
monitory  symptoms, those which mark  the
attack  of disease, and  indicate its character,
together with those attendant on its progress,
will be sufficient for our purpose.  It would
lead us too far to hunt up all its occasional ex-
pressions.  Such of them however, as  are
worthy of notice, will be attended to.
   The first stage of this disease, as of other
pyrexiae, was indicated by languor and chill-
iness. As the sense of coldness increased, the
defect of strength became more sensible, and
generally the animal powers fell very low.
This extreme prostration of strength, was a
constant and prominent characteristick.  The
extremities at this time were very cold, and
had assumed a livid complexion; the face was
dark coloured, the eyes red and humid,  the
head for the most part disordered and pain-
ful, the throat generally sore, but not very
painful; spasm of the muscles, fixed pain and
numbness of the limbs, were common  and
early symptoms; the respiration was anxious 
26
and imperfect, somewhat hurried and very
distressful; accompanied with what is termed
sighing, or frequent irregulai  exertion of the
forces of respiration.
  To those symptoms succeeded nausea, vom-
iting, and  proclivity to syncope, with irregu-
lar flushes of heat, alternating with rigour or
chilliness.   The tongue was in nearly all the
states of this disease, moist, sometimes slightly
brown, or having what is called  the  bilious
coat; occasionally it was pale, and apparently
bloodless, rarely dark or dry. The pulse, as
usual in defective temperature, was small and
weak, not so frequent generally as in the for-
ming stage of common fever; in severe cases
it was remarkably slow and intermittent.
   In the more advanced stage, or that conse-
quential to the above train of symptoms, the
pain  of the  head became extreme, delirium
supervened, sometimes mild, occasionally ma-'
niackal and clamatory.   In many cases coma
occurred  either  aborigine, or consequent to
vigilant delirium of short duration.  In this
stage  of  the disease, the particular  feature
whence it derived its name, the maculae or
 spots,  were generally present.  Sometimes
these  were  distinguished as soon as the pa-
 tient began to complain of indisposition. More
 commonly they appeared with the flushing,
 or irregular sensation of heat above noticed;
 occasionally (though rarely,) they were alto-
 gether absent in every stage of the disease. 
27
 The spots began on the face, neck, and ex-
 tremities.  They were irregular and had  no
 determinate seat, or uniform character. They
 were various in figure,  extent, and  colour.
 Sometimes a bright red efflorescence, or dis-
 tinct points  of a  darker  shade;  sometimes
 again, brown or purple blotches,  or vibices.
 None but the last  (the vibices,) were eleva-
 ted above the  surface, nor did they change
 colour  or recede on pressure.
   The form and colour of the  spots were in
 part an index to the  degree of  danger.
 Where they were  dark  and diffused, having
 the true petechial character, the disease was
 formidable,  and the event  often unhappy.
 Where patients recovered from the low state
 of which this form of eruption  (or more pro-
 perly extravation,) was expressive, sloughing
 of the  skin where the spots were  most dark,
" and consequent ulceration of the  part, were
 common.
   The above  train of symptoms were gene-
 rally present for the first four  or five hours.
 If all attempts at relief were unfortunate, they
 advanced without sensible change except in
 decree.  The  loss of temperature  then  be-
 came more sensible to the attendants.  The
 pain of the head,  or delirium,  increased.  If
 the latter was present, the patient was  dis-
 posed  to frequent and vehement exclamation.
 The restlessness.,  or mobility  became great,
          D 
28
with attempts to disencumber the body of all
covering, or to rise from bed.
   In this state the respiration  was anxious,
but not  always  hurried.   The face became
darker, the ips blackish and cracked, the ar-
ticulation indistinct, voice harsh and rough.
The parts about the eye  exhibited a brown
or brownish red areola, the eye itself was in-
expressive; indicating insensibility to objects,
rather than the observant phrenetick vivacity.
The coldness of the surface remarkable in all
the stages  of the  disease, kept pace  in its
increase, with the progression of the other
symptoms.   Additional covering imposed on
the body, or the application of elementary
heat, effected little or no change in this par-
ticular.   The surface appeared equally indis-
posed to the  reception of calorick  from the
internal parts of the  body, or  from foreign
sources.  It  fell off regularly though slowly*
in temperature,  and the defect became so
great  as to give  the body  the cadaverous
feel, some time before the signs of life were
extinct.  The pulse corresponded  with the
decline  of  the other faculties.  Feeble and
irregular, from the first,  it  became gradually-
more weak and intermittent. The concluding
scene was marked by slow,  sighing respira-
tion.  It was commonly  short.
   Such is the history of the severe and fatal
cases of the spotted fever  of New  England
and New York, as offered us by the record 
29
evidence of the time and places,  when, and
where it occurred. Its duration when the ter-
mination was fatal, was from twenty four to
forty eight hours.  Sometimes the body was
subdued more gradually, and the disease pro-
tracted to one, two, or three weeks.   But in
those cases the symptoms though similar, were
not all present at the same time, and the dis-
ease had  assumed an irregularly remittent
character.
   When nature or art opposed to the assault
of this terrible adversary, a successful resis-
tance, the first indication of improved condi-
tion, was a substitution of general warmth to
the previous coldness  of the surface, the
eruption (if it existed,) became of a brighter
colour;  the respiration  though still anxious,
was improved;  the countenance was more
natural; the eyes livelier, yet still red; the
head continued painful, but the understanding
was correct. The pains of the limbs, and mus-
cular spasms ceased; the numbness and ge-
neral rigsdity were removed, and the body
became quiet and easy in its  sensations.
   But the recovery was not always immedi-
ate, or  complete.  The consequences of the
impressing  force, were  still  evident  in the
extreme languor and  feebleness.  A mild
fever of the ordinary typhus character, fre-
quently required attention  for a fewr days,
sometimes  for weeks. 
30
  The occasional  symptoms, or more pro-
perly the occasional consequences,  of the
different  states of the disease, were syncope,
temporary blindness, partial tetanus, paraly-
sis of the limbs,  strangury,  colick, cholera,
and hemorrhages.
  The pathognomonick symptoms were sup-
posed to  be severe head ache, coma, or deli-
rium, sore throat, weak  irregular pulse, and
sudden and great prostration of strength.
             TREATMENT.

  After experiment had evinced the errours
of unpractised  pathology, the treatment of
this disease was  every where reduced to
nearly a common  standard.  The presump^
tive evidences of inflammatory character, in-
dicated at first view a necessity for the en-
forcement  of the evacuant plan.   It  was
generally adopted  and almost  uniformly un-
fortunate.  The  body  fell into remediless
ruin under every  mode of free  depletion.
Individual experience, and the interchange of
sentiment, very early  conducted the medical
gentlemen engaged in  its  treatment,  to the
opposite extreme.   All evacuants were laid
aside, and the very first "demonstrations" of 
31
the disease were met with cordials and stimu-
lants graduated in quantity and force, to the
existing or menaced emergency.  It was soon
discovered that those were the proper instru-
ments of defence, and they were subsequently
used with" a  freedom  and boldness scarcely
paralleled in the history of medical manage-
ment.
  The primary objects kept in  view in what
was thought  the  correct  treatment of the
spotted fever, were  to restore the natural
warmth, and excite perspiration.   In consul-
ting these intentions, a multiplicity of articles
and applications were brought into service;
those were such as prejudice or fancy direct-
ed.  Time reduced the number of each, and
eventually confidence rested entirely upon el-
ementary heat variously applied, and the most
powerful diffusible stimuli.
   The first medicine exhibited was generally
laudanum, twenty five or forty drops in wine
or toddy, and repeated when thought necessa-
ry; heated bricks were then applied to various
parts of the  body, and  frequently changed.
The wane or toddy were repeated every half
hour; and with either or both were combined,
camphor, opium, aether and undiluted brandy;
blisters were applied on or near the pained
parts, and every possible effort made to pro-
voke sweat, by thick  covering and the appli-
cation of elementary  heat.
\ 
32
   We are told that in some cases, in addition
 to the application of various articles charged
 with foreign heat, two or three hundred drops
 of laudanum, two or three quarts of brandy,
 and one or two quarts of wine, were adminis-
 tered to  the same  patient in  twenty four
 hours.  Those of course, must have been
 cases of extreme torpor and debility.
  Many kinds of hot vegetable  drinks were
 used to accelerate the sweating state. Among
 others the snake-root-tea, held much reputa-
 tion.  Another favorite tea was made by boil-
 ing twigs  of the hemlock tree.  Blocks of
 this wood, boiled and wrapped  with cloths,
 were  thought a convenient and useful vehicle
 of elementary heat. They were laid on each
 side,  and  at  the extremities of the patients.
 Those blocks became celebrated among  the
 vulgar for specifick virtues, and in a little time
 supplanted every  other heat-conveying  ap-
 paratus.
  The articles supposed to be more especial-
 ly appropriate to particular symptoms, were
 as follows:
  For the head ache, coma, and delirium,
 blisters  on the head and neck; internally,
 opium, aether  and brandy, and heated sub-
 stances to the feet and legs.   For the vomit-
ing  (a frequent and distressing symptom,)
opium and camphor in the solid form, and hot
 applications to the gastrick region. For pain in 
33
the intestines, or colick, blisters on the abdo-
men, fomentation of the same, with injections
of yest  and brandy.  For the strangury, the
warm bath.  In  paralysis,  local  stimulants
and irritants.
  The unmixed stimulant plan was however
not always pursued.   Some of the  medical
gentlemen say they met with cases in which a
considerable modification   of the common
practice was necessary. The disease came on
in those cases with distinct chill, quickly suc-
ceeded by pain in the head and limbs, quick,
full pulse, heat, thirst, heavy  eyes, foul tongue
nausea,  and bilious vomiting.  A dark  red
efflorescence appeared  with  the fever, or
more commonly petechias and vibices.
  In such cases, the first medicine given (after
the chilliness had  abated)  was a cathartick,
generally calomel and jalap, in sufficient quan-
tity to act freely.  At the same time,  the feet
were immersed in warm water; blisters appli-
ed to the extremities and diluent,  or  (as they
are called,) sudorifick drinks, given freely.
This treatment is said  to have been success-
ful where the above symptoms were present:

      Remarks on the preceding notice.

  Both justice and decorum  must confine the
commentator within narrow limits, who  ha-
zards an opinion on the proper conduct of a 
34
disease with which he is acquainted by report
only.  However  fairly  its general features
may be laid before  him,  he must rest his
judgment upon facts supposed, rather than
known, upon a thing imagined rather than
perceived.  The subject before us implicates
in a peculiar manner, difficulties of this nature.
Leaving the general facts as stated, in  undis-
puted possession of their ground, the question
lies between the relative capacity of the body,
and force of foreign impression.  Each must
vary in different cases; and  we can neither
feel the pulse, nor ask a question. For those
reasons, and to avoid repetition of argument,
I would prefer embracing the inquiry under
the general head of remarks contemplated in
another place, on a similar treatment of a dis-
ease which is (I believe,) intrinsically the same
and with whose particular character  I am
better acquainted.   I wish then to  embrace
this  disease however, with all the limitation
which the variety of form, indicated by their
comparative history, will warrant.
   Before closing this history of the spotted
fever, it Avill be proper to notice, that from its
frequent  occurrence, novel  character,  and
alarming consequences, an idea was at first
entertained  that  it was diffusible by  conta-
gion.  The testimony  however,  of all the
medical gentlemen who became familiar with
the  disease  is opposed to this opinion, and 
35
experience  appears to have dissipated very
soon,  the errour  of general apprehension.
There exist as far as I can discover no rea-
sons for the presumption that it was under
any circumstances communicable by conta-
 fion.   It was often of solitary origin, and the
 abits of intercourse, do not appear to have
facilitated its propagation.
      The Typhus Fever of Maryland.


  Whether the various forms  of disease
which practitioners  of medicine in this  state
have comprehended nominally under the
above general term, derive  their existence
from the same cause, as the one we have no-
ticed in the preceding pages, cannot be de
termined  positively.   If it were admitted
that the cause (whatever it may be,) were the
same, equal difficulty would be  interposed
in deciding what modification  its operation
would  undergo, from the state of  weather
in the two or three intermediate years, and
from possible variety of climate. I am myself
of  opinion  that a  disease  similar  in kind,
to that alluded to, but varied somewhat  in its
circumstances, has  been of common occur-
rence in many parts of this state for the last
           E 
36
 three  years.  But as the efficient  cause of
 either is altogether problematical,  the  only
 ground of sentiment is the relation  of facts.
 And in forming an estimate by their evidence,
 each man's, personal observation, will be his
 rule of judgment. A decision would  certainly
 involve no important practical consequence,
 without it could  lead us to the nature of the-
 cause,  and point out the proper remedy.  We
 can  make  no discovery which will disclose
 the former, and the latter cannot be invaria-
 in any disease of general character.
   The  name  maculated  or  spotted fever
 seems to have been applied to a class of dis-
 ease, having this common  but not invariable
 distinctive feature.   It  was more significant
 than any other which could have been adop-
 ted.   For, though there  were  some cases
 without the spotted trait, there were other
 evidences of analogy sufficient to establish the
 similarity of essential character, and a large
 majority of cases were  thus marked.   We
 cannot plead equal consistency  in the appli-
 cation of the term typhus fever.  In  common
 use it is vague and arbitrary;  and means in
 the general, a disease  (without fixed charac-
 ter,) attended with  symptoms  of unusual
weakness, or without the presence of inflam-
matory condition.  I  shall confine it chiefly
 to that form of disease, better known in many
parts of Maryland, by the term "prevailing
 epidemick," by medical gentlemen frequently 
37
called  "typhus pneumony,"  and commonly
by the vulgar, "bilious pleurisy."
  The spotted fever of the eastern and  nor-
thern states, differed from our epidemick:
first—In the  common existence of macula
and petechial discoloiations;  particularly, in
the time of their appearance.   I have seen or
heard of those spots in but few  cases of dis-
ease here, and in those they were late in ap-
pearing; generally in the ultimate stages of
life.   I presume that in the former disease
(spotted fever,)  they indicate rather the vio-
lence, than any peculiar nature of the malady.
  In the frequency  of"  sore throat."  This
was called a discriminative feature of the nor-
thern epidemick. We meet with it occasion-
ally, but it is not common.  (In some districts
of Virginia, where a disease  having  all  the
other features of our epidemick prevails, this
evil is complained of in almost every case.)
   In the frequency of coma,  as also delirium
and  mania,  I have seen  no case of complete
coma.  Head ache and errour of intellect are
common in our epidemick,  entire delirium
less  so, and the maniacal state infrequent. In
extreme defect  of general temperature,  and
duration of that defect. We have chill in the
forming state of disease, with cold extremities
rather than extreme loss of general tempera-
 ture; and the patient ceases to complain of
 coldness (or the sensation of coldness,) one or
two hours after the attack  of disease.  In the 
38
redness and humidity of the eye.  I have seen
both occasionally, but generally the eye is
not sensibly altered from the natural  state.
In paralysis and muscular rigidity. We often
meet with spasms, and disordered sensations
referred  to the limbs; rarely with paralysis,
or great  inaptitude to flexion and extension
of the limbs.  (I have seen two cases of par-
tial paralysis.) In the tetanick state: it has not
occurred (I believe,) in this state. In the ge-
neral smallness, and debility of pulse.   We
find it in our epidemick generally frequent,
and (after the chill,) often full.   •
  There are many occasional symptoms which
the spotted and (with us J typhus fever hold
in common, viz: great anxiety of  respiration,
defect of animal energy, strangury, for rather
dysuryj vomiting, hemorrhage, &c.
   Our epidemick on the other hand exhibits
characters, or marks of disease,  which were
altogether  absent in the  northern or spotted
fever.  I  have seen no mention made in  any
history  of that  fever, of  a strictly pul-
monick affection. The anxiety of respiration
was universal,  but there was in  no  case  an
evidence of organick injury of the lungs. The
accounts are  totally  silent in regard to pain,
of the thoracick viscera, cough, and expectora-
tion. In the typhus pneumony of this country,
pain of the side, and breast, increased expecto-
ration of mucus, and cough, are rarely absent.
Those symptoms are so uniform (varying in 
                    39

degree J as to have given the designation here
used.  The pain though generally moderate,
is sometimes inexpressibly acute; and in those
cases we  have very soon  organick lesion,
marked by ichorous or bloody expectoration.
A bright red flush of one or both cheeks, si-
milar to the hectick of terminating phthisis, is
also common in our epidemick.   A more full
account of the disease  will be found in the
history to which we proceed.

            Typhus Pneitmony.

  The first occurrence of this disease in Mary
land (as before observed,) was on the eastern
shore of the state in the fall  of 1812.  It pas-
sed in that and the subsequent year,  through
great part of that country;  in the spring of
1813, it appeared in the upper part of the
western shore of the state.   In  the winter of
1813-14, it was very general on this shore,
having appeared  in many places  south  and
west  At this time Virginia as well as Mary-
land became the theatre of its operations.
Both are  still the devoted dwelling-place of
this fell destroyer.
  We are instructed by general report, and
recently, in a more authentick  and  ample 
40
manner, by publick communication  from a
gentleman,* officially an observer of the dis-
ease, that the symptoms of the epidemick, or
typhus pneumony, (so called,) as it appeared
on the eastern shore of Maryland, were fre-
quently intimately allied in their obvious cir-
cumstances, to those of ordinary pneumonia
or pleurisy.  The disease came on with chill,
irregular in its duration in different cases, fol-
lowed  as usual by increased heat, and more
or less fever.  The head was pained, gene-
rally more so than in common pulmonary dis-
ease, the face flushed, with pain of the breast
or side upon inspiration,  sometimes  mode-
rate, occasionally severe, with a sense of full-
ness, or stricture in the chest, some cough,
and disordered or anxious respiration.  The
pulse was commonly rather full, not frequent,
or tense.
   A more close examination of its symptoms
 (induced  by its frequent  occurrence  and
great fatality,) led, we are told, to the opin-
ion,  that there was something essentially dif-
ferent in the real nature of this disease, from
 ordinary pleurisy or pneumony.  The head
 was found more painful and the flushing of
 the cheek much greater, than in common pul-
 monary inflammation.   The extreme anxiety
 and disorder of respiration was remarkable,

   * An essay on the epidemick of Talbot and Queen
 Ann counties in 1813-li. 
41
 more especialy as the pain of the side  or
 breast was frequently too  inconsiderable  to
 explain that effect.  There was little or not
 much cough, sometimes none. The loss of ani
 mal heat was preternaturally great. The sur
 face generally was lower in temperature than
 is usual in fever with  thoracick inflammation.
 The extremities  particularly,  continued  to
 be very cold to the touch, after the patient had
 ceased to express any sensation of cold. Great
 internal heat too was complained of, while the
 extremities and surface, especially the former,
 were very much below the common standard
 of fever.  The pulse  likewise,  was less fre-
 quent and feverous than is usual in pulmonary
 or pleuritick  disease; sometimes it was pre-
 ternaturally slow, it  was  rarely,  or never
 tense, occasionally it was weak and intermit-
 tent even in the early period of disease and
 while the face was very red, and the breathing
 apparently that of a person  under great ex-
 citement.
  The gentleman refered to, informs us that
 those  circumstances  gave occasion with him
 after mature consideration,  to an  abandon-
 ment of the evacuant plan.   He had enforced
 it at first, but soon found it not only inefficient
 for  relief, but positively hurtful  and perni
 cious.  Reflection he  says  upon the symp-
toms and probable nature of the disease, which
he now believed to be altogether novel,  con-
 ducted him to conclusions  as  to  its cause. 
42
which, while they threw down all the reason-
ing bottomed on former experience in disea-
ses apparently similar, revolutionized entirely
the indications and modes of cure, in the one
before him.  The cause about which he says
he "had made up his mind," was fitted in his
opinion to throw the body into disease from
loss of temperature, in consequence of  a  de-
fect of a certain principle in the air, on whose
presence in due quantity, animal  heat  de-
pends.  The defect of the vital or calorifick
principle in the air,  was occasioned by a
"something" extricated, or ejected from  be-
low, by earthquakes.   The efficient cause of
disease, was the deprivation of the principle
on whose existence the generation of animal
heat depended.  The defect of that heat was
the disease itself.
  On this idea of defective temperature, is
suspended the whole theory and treatment of
this formidable  epidemick.  All the indica-
tions of cure hold  this one point in regard.
They all  contemplate a restoration of lost
corporeal heat.   Bleeding, vomiting, and pur-
ging, however  guarded and moderate were
not  only abandoned,  but are proscribed, as
preposterous and pernicious, in any and every
stage and state of the disease. Whether there
was torpor or fever, strength  or weakness;
whether there was much or  little heat, thirst
and pain; a small and slow pulse, or a quick
and full one, but one indication, appears to 
43
have existed, but one mode of treatment to
have been proper.   The supposed loss of vi-
tal heat must be restored, and all  previously
acquired knowledge must be given up, all in-
ductive reasoning, all analogical inference must
be abandoned, or rendered subservient to that
purpose.  The  physician's senses must be
locked up; the  patients sensations,  and the
evidence of presumed facts, discredited.  Heat
only, appears to have  been wanted, and that
must be supplied at all hazards, or an "effu-
sion of serum  under  the schneiderian mem-
brane"* would take place, and the patient in-
fallibly perish.
   The next and only remaining object of im-
portance, we are  told,  in the same work,
was to bring on a  "warm breathing sweat."
For the first and latter purpose, the remedies
we are directed to use, are laudanum freely,
thick covering in bed, hot bricks to the extre-
mities, and v/hen pain was complained of, hot
teas of every kind,  snake root infusion, strong
drinks, as spirits, brandy, &c. frequently re-
peated, et multas  esusmodi res generis alias.


   * The schneiderian membrane lines the nasal ca-
nal, or cavities of the nose.  But  has never been
found (or any so named,) in  any other part of the
body.
F 
44
  The preceding history of the epidemick on
the eastern shore of Maryland, corresponds ge-
nerally, I think, with the more common char-
acter of the same or a similar disease on the wes-
tern shore. I say generally, for (judging from
personal experience,) such are the symptoms
of the disease in a majority  of  cases in  this
country.  We have modifications and varie-
ties  (as no  doubt is the fact  there,) of the
disease, some of which I propose noticing be-
fore concluding this essay, when I shall offer
opinions  on  the general treatment  of  the
disease, adopted rather from close  attention
to its character in a moderate number of cases,
than from very extensive practice;  and pro-
posed as opinions,  not proclaimed as laws.
In this place I  shall attend  to the  asserted
causes of the disease, and the  propriety of
the treatment urged upon us, as  exhibited in
the antecedent narrative.  I  include  gene-
rally, as mentioned in  another place,  the
history and treatment of the spotted fever,
with which  our epidemick is supposed by
many to hold considerable propinquity as to
cause and nature.  The author  of the work
last noticed is  of this  opinion; and  I confess
myself disposed to  believe  that they are not
without analogy in the chief circumstances of
production. 
45
Mtiology of spotted fever, and the epidemick
            typhus pneumony.

  The spotted fever of New England, &c.
was  supposed to have its origin from a long
continued prevalence of a cold, damp atmos-
phere, which produced  the disease  by rob-
bing the body of too much animal heat.  To
this"l object that cold, (medically speaking,)
never  produced a disease.   It  may render
the body liable  to the operation of a cause
of  disease  previously   existing, or subse-
quently  occurring, but it can go no farther
than  to create  the predisposition.   Besides
the body cannot incur  any material loss of
natural temperature, (under common circunv
stances,) except in consequence of a previ-
ously diseased condition  incapacitating it for
the generation of animal  heat in the ordinary
quantity.  The diseased condition  must  be
antecedent to the loss of necessary vital heat.
The  Esquimaux*  and  the  Icelander, live
without any disease from defect of tempera-
ture, in  a climate where brandy  will congeal
in the  open air for six or seven months in
the year.  The body retains  its  natural heat
too  in  the  "frozen air" of  Labrador and
Spitzbergen.

   * The Esquimaux never has any other fire in his
hut than a lighted lamp made of the seal oil. 
46
  Cold may occasion liability to a particular
species of diseased condition.  Inflammation
will result from a degree  of cold which shall
create a lost relation of  physical power  in
parts.  But even here cold is not necessarily
the agent of mischief, without it kill a part.
The inflamed condition results from  subse-
quent errour in the treatment of the part, or
the state  of the body.   It  is  possible, and
with proper management may always happen,
that the  body may be restored to perfect
health without the intervention of any disease,
even after it has been reduced by cold to a
state of apparent  inanimation.  As we  see
in asphyxia from that cause.   When  the
body gives us the loss of temperature and at
the same  time the evidences  of disease, the
cause of disease (except it  be simple inflam-
mation,)  has been operating so as to produce
the  defect  of heat, through the medium of
diminished health.
   A cold, damp atmosphere would probably
rob the body of its heat  more rapidly than a
cold, dry air,  and by  carrying off too much
natural stimulus in this  way,may interrupt the
function  of the capillaries, and diminish cu-
taneous perspiration.   But whether such im-
pediment of  this  function  would have  any-
 agency in producing such a disease as the one
 we are considering, I am not sufficiently fond
 of conjecture to examine. I am disposed to
 believe it alone would  not. 
47
  Travellers who appear entitled to credence,
mention the common occurrence of an epide-
mick in the northern parts of the European
continent, whose character (as detailed by
them,) is very analogous to that of our late
American  epidemick.   The French army of
invasion  suffered  by it in penetrating into
missia in the fall of 1812.  It is said to pre-
vail for six or eight weeks of periodical warm,
moist weather, immediately antecedent to the
change to severe cold.

               Earthquakes.

   The epidemick of Maryland has been re-
cently attributed to "a defect of vital air" in
the  atmosphere, effected by a " something"
evolved  by earthquakes. What the "some-
thing" extricated is, we are not informed; and
of the existence of any thing  thus extricated,
and possessing properties destructive of at-
mospherick oxygenation, we have  no  other
argument than fanciful assumption.
   It is unnecessary to review the  history of
volcanick  countries, or those  where earth-
quakes have been frequent.  Epidemick dis-
eases  are  occasional in such countries,  but
there are no facts to prove that in them, earth-
quakes and epidemicks  have any  necessary
connexion; or if there were, that the latter
are a consequence of a "something" extrica-
ted from the earth, "fitted to rob the air of its 
48
oxygen." Other causes less obscure and ima-
ginary than this  infernal devourer of vital
air, and dependent on local changes thus pro-
duced, might be made to account for the loss
of health after earthquakes.
  It is certainly possible  that some air  either
actively or negatively unfriendly to health and
life, may exist within the earth, and that this
non-respirable gas might issue from a  viola-
tion  of the earth's integrity by earthquakes.
But that effect rarely happens, and when it
does  take  place,  if such gas were  really
discharged,  its operation must be transient,
in consequence of its speedy dissipation; nor
can it rationally be  supposed that any such
gas could decompound the atmosphere.
  Earthquakes have been felt in our country
in a slight degree at different times.
  They were perceived in  different places
on this continent  in  1732-44-55, and 96:  as
also once or twice since 1800.   But we have
never heard of malignant epidemicks succee
ding to those shocks.
  We have had epidemicks of almost  every
character at irregular intervals in America.
  In '93 and '94, epidemicks of very destruc-
tive character  prevailed in  Pennsylvania,
Maryland and Virginia. No mention is  made
of preceding earthquakes.
  The southern states have suffered severely
from occasional epidemicks, ever since  their 
49
colonization. Yet we find no record of proba-
ble connexion with earthquakes.
   The celebrated naturalist of Pennsylvania
(Mr. Bartram,) records in his correspondence
with a London friend, in 1748 "this winter a
kind of pleurisy is followed by certain death.
But the yellow fever, the dumb ague, and the
pleurisy, joined, are the chief actors in this
tragick scene."
   He writes again in 1749, "the sickness and
mortality in our country are very great; it is
a kind of pleuritick fever, mixed with yellow
fever,  or which some call Hungarian fever,
with black  vomitings. Few recover of this
disease."
   The presumptive similarity of this disease
to our epidemick is too obvious to need speci-
fication. It is worthy attention  as a ground of
opinion that our present disease is not  alto-
gether a stranger, though its visits have  been
rare.
   The occurrence of this epidemick was re-
ferred by the  reporter to  common natural
causes,  somewhat modified. No mention is
made of attendant or antecedent earthquakes.
Had any occurred they would  not have esca-
ped  consideration  by this proverbially acute
observer.
   The spotted fever of New England,  with
which the  author of the  earthquake theory
thinks our epidemick nearly allied, was never
imagined the  consequence of any terrestrial 
50
convulsion. No such thing has been any where
hinted at.  Nor do we hear of earthquakes in
that country at the time of its appearance.
  I  repeat, that any noxious gas extricated
by earthquakes must  be limited  in  its exis-
tence, and scope of operation. The epidemick
referred to that remote cause, has  been felt
in many and distant  districts of country.  If
all the air of our continent is becoming non-
respirable Providence must surely have  for-
gotten us.

  Defective oxygenation of the atmosphere.

  This is considered the  consequence pro-
duced by the subtile infernal agent supposed
to be born as we have just noticed, of terres-
trial throes, or earthquakes. It is held also the
immediate* cause of our epidemick, by occa-

  *  I use the term immediate  cause, to  signify the
incipient diseased condition.  The language is philo-
sophically incorrect, but  it explains  best the text  I
quote.  Some might  prefer the term proximate, as
according to the doctrine I contradict, the defect of
oxygen, is the "ipse morbus^9  the disease itself.  But
I reject all proximate causes, and, because they are
the  disease itself. If the remote cause produce ne-
cessarily, an effect, constituting disease, (no matter
through what medium,) that effect is the first dis-
eased impression, and  cannot  be dissociated from the
impressing agent.  It has become the efficient cause.
To  suppose any intervention between a cause and its
consequence, is  not only a solecism in language, but 
51
sionmg an absence or want of the due quanti-
ty of animal heat.
   A defect of vital air  has never existed in
the atmosphere.  If it did exist, it would not
produce disease.  If it could produce disease,
that disease would not  consist in loss of tem-
perature.
   I strike openly at the whole theory, in all
its positions.  With what success, I am not to
determine.   The proposition is  mine, the
right of property in opinion, another's.
   The constitution of the atmosphere cannot
be changed; though it may become the  vehi-
cle of qualities not its own.
   The same great "First Cause"  which has
appointed to all  creation, the condition  of its
being; which has erected an impassable bar-
rier between the classes and characters of ex-
istence, from the lowest order of affinities to
the  most  perfect  state  of  life;  which has
stamped immutability on the general species,*
&c. of the vegetable, insect, and more anima-
ted condition, has no doubt impressed equally
its law of incapacity for  radical change, on
that part of its plan to which has been assign-

an absurdity in philosophy.  Two different  causes,
cannot  produce the same effect.   If a cause is ade-
quate to the production of a disease, none other can
be necessary: if it is not, it cannot be called a  cause.

   * The opinion of Monboddo, Rosecrutius, Ilelve-
tius, and Darwin, to the contrary notwithstanding.
          G 
52
ed a controul over its general scheme, sensi-
bly great to human experience, and altogether
unlimited in human understanding.  Those of
its purposes  with  which we are acquainted,
we know to be important; all of them we can-
not compass.  But whatever they are  in their
integrity, for six thousand years, they  have
been steadily accomplished. Effects have fol-
lowed with an  order unbroken, while this
great source  of capacity must have remained
exhaustless and unchangeable.  It exists only
by its qualities; and the indispensable neces-
sity for its existence, gives to those qualities a
fixity, not  to be uprooted  by accident  or
chance.
   To pourtray from fancy the general conse-
quences of their possible subversion, is  not
the business of such a work as this.  Mine is
an humbler task;  and the little light* I  pos-
sess,  too precious to be risked among  the
"chill damps of  hidden  possibilities."   I  be-
lieve from experience, and it is sufficient for
me, natura nunquam deserit prolem.
  The investigation, resulting from man's in-
terest, in  his own  security against  occult
agents, to  whose  influence, experience had
convinced  him,  he was exposed,  has led to

  * This is a very honest declaration. My knowledge
of chemistry  in particular, is inconsiderable.  The dif-
ficulty of finding support in a profession too often the
grave of research, shuts out  many of us from that la-
boratory of truth. 
53
many important discoveries.  He has detec-
ted the friendly or mischievous qualities  of
nearly all the forms of matter by which he
was surrounded. Their mechanical, chemical,
nutritive, and even poisonous properties have
been ascertained, and rendered tributary  to
his wants.  Airs of various kinds have under-
gone a similar scrutiny; and few if any have
retained a mystery.   None of them have re-
ceived  more frequently  the attention of the
chemist and philosopher than thefluidin which
we are constantly enveloped: and though fo-
reign qualities are known to mingle  with  it,
unfriendly to  health, experiment has never
disclosed a change in its essential constitution
which could warrant suspicion as to its fitness
for all the important purposes of animation.
   That constitution depends upon principles
which  prohibit a change  of character. No
natural cause can ever be presented to it, suf-
ficiently forcible to break up and suspend  its
general law of affinities. And when partial de-
composition takes place in small portions of
air, no force effecting such a  change could
preserve a distinct existence for the new com-
pound,  in  the  common  circulating  mass.
 Those' new combinations of limited extent,
 may be effected; but they must  be cut  off
 from the common volume,  and effectually  se-
 cluded from the operation of its general law,
 if they are to be perserved for more than a
 moment after creation. 
54
   Definite quantities of atmospherick air may
also undergo  decomposition by the  abstrac-
tion of one of the principles of its constitution.
The air in  a room sufficiently close in its
structure to insulate it completely, may be so
far altered in this respect by the combustion
of a taper, or the respiration of one or more
animals, that the taper  will expire (its flame,)
and the animal fall into syncope. The oxygen, •
or vital  principle is consumed.   But if a door
be immediately opened, a lighted taper then
introduced will burn well, and the animal re-
vive.
  An air too,  (or gas,) different from atmos-
pherick air, and unfriendly to life, may exist
in the distinct or separate sjtate.  But to do
so,  it must occupy by  its gravity  situations
which protect it from diffusion or agitation
by currents of air.  If thus exposed, it under-
goes a change of condition which  renders it
innocuous.
  It is not a little singular if defect of oxygen
ever existed in the atmosphere and could oc-
casion epidemicks, that such defect and cause
have not been discovered  before; and  that
chemists of every country should have fallen
into a curious consistency in an errour, which
says the existence of such defect, is vision-
ary and impossible. It  has so happened  that
in examining atmospherick air at the distance
of thousand of leagues  from  each other,  they
have all found the same  quantity of oxygen 
55
   or vital air always present in the atmospher-
   ick fluid.   The atmosphere has been measur-
   ed in France,  England,  Scotland, America
   and  elsewhere.   It has  been measured in
   countries convulsed and agitated by volcanos
   and earthquakes* and in those where  "earth
   keeps her firm fixture,"*f* and rarely or never
   trembles,  on  mountains,  and in  vallies.   In
   spring and summer, autumn  and  winter; and
   as yet in no place or country,  at no time  or
   season,  has the atmosphere been  found  to
   contain  more  or less of its constituent  parts
   in the one  hundred, than seventy six nitro-
   gen, twenty four oxygen  or  vital air.

     *  The doctrine  of a "something"  evolved by
   earthquakes,  taking the plaee of oxygen in  the air,
   is talked of with as much confidence, as if it were
   really not to be laughed at.  If it were true, and the
   opinion be also correct, that it travels from district to
   district, in very cold weather,  we might adopt a cun-
   ning plan of managing this serial demon. If it were
   subject to the  general laws of heat, cold  would
   bring it into a smaller compass, or condensed state.
   In this condition of increased gravity it  would occupy
   the space next the earth, and when we found out its
   habitation (by its effects,) we  might confine  it to the
   spot, by building up round its dwelling, a close, high
  fence, first inviting all the inhabitants to leave the in-
   fected district.

     f I of  course mean relation of  parts;  not globular
•   fixity. 
56
  It is certainly unnecessary to travel farther
in pursuit of proof, that a  defect of oxygen
in the  atmosphere fitted to produce  general
disease, cannot exist.  My second objection
was, that if it could exist to  a sensible degree,
it would not produce physical disease.
  Before  that effect could  have time to take
place,  death or recovery must happen.
  A certain sum  of vital air is absolutely ne-
cessary to animal health and life.   If a sub-
traction be made  from that sum, (and it may
be reduced in confined places,) till the pow-
ers of the body, in other  words,  its  life, be-
gins to fall  off, will  those powers  or that life
be restored,  without the lost sum of vital air
be regained? No man can say they will; or he
asserts that vital air is not  necessary to life.
Again, if  when the  body was strong, the di-
minution of oxygen affected it, and took off
sensibly from its  powers, will not the effect
of that diminution be greater when it is weak?
And how long will it live under those  cir-
cumstances? Most assuredly not long enough
to fall into what we understand  by disease.
Defect of vital air is the negation of a princi-
ple, without which, life cannot go on: and
without life there  can be  no  disease.   The
interval between incipient  failure of physical
faculty, and positive death, is  too short and
has too few marks  of diseased condition, to
be distinguished by that  name.   It  is more 
57
properly classed under the head of fatal ac-
cidents.
  If a man were placed in carbonick acid gas,
or any other non-respii able air, or submersed
in water, or had a rope drawn tight about his
neck, we know that death will ensue; and
that a very limited  period  only is  necessary
for its occurrence.  Nothing more ensues ne-
cessarily to those causes, than defect of vital
air.   But if we extricate him from the air or
water, or cut  the rope early enough, to per-
mit the restoration of live,  he  will not upon
recovering, exhibit  a case of typhus pneumo-
ny, or any other disease.   Experience says
the recovery is as complete, as the failure of
power, was  sudden.
  The third objection, viz: That if defective
oxygen could produce disease, that disease
would not consist  essentially in diminished
animal temperature, has been  already  estab-
lished, (or presumed to be so,) in the first
paragraphs, under the head "aetiology." My
reasons are there proposed, why cold cannot
produce such an effect, or why the absence of
heat simply, though it may kill the body, will
not create physical disease.
  I shall  add  but little to the  remarks made
on this subject in the place refered to.
  It has  been presumed that the general or
atmospherick  defect of oxygen, brings the
body to a point of diminished temperature,
bordering on disease.  That cold from with- 
58
out, or other causes reducing the temperature
still lower, readily throw it into actual disease-
But the disease occurs when  cold cannot be
acting as a remote or immediate cause.   It
attacks persons who are well clothed, who
have not  been previously exposed, and who
immediately antecedent to  the attack, were
unconscious of any defect of temperature.  It
frequently makes its assault also, upon per-
sons in bed  and asleep; of course comfortably
warm.  If it be said  here  that  cold  before
going to  bed  has  accumulated  excitability,
(often made the plaything of medical  folly,)
on winch  the detained heat  of the body after
being in  bed, acts, producing disease, then
the first evidence of that disease, should be
increased excitement, not chill  or ague.   If
coldness in the incipient state of disease, be
the evidence of defective atmospherick oxy-
gen, nearly all  febrile diseases  result from
that defect.   For nearly all have the precur-
sory chill.   And this  being granted,  human
condition  exhibits a melancholy picture; hu-
man life is indeed  "suspended on a slender
thread."
  In denying the  direct agency of cold  in
producing disease, I have also asserted, if it
could produce  disease when  occurring from
defective  oxygen,  the application of heat*

  *I question whether a very  cold  body can gain
much in temperature, from the chemical property of
elementary heat, a dead animal body  is certainly a 
59
alone, would not produce recovery.   To ob-
tain the clearest perception of the operation
of agents, it is  perhaps best to regard the
body in its most simple state of life.   On this
account I have in one or two places, directed
a view to the state of suspended animation.
  A small diminution of animal temperature,
will not occasion defect or suspension of vital
and animal functions. A considerable loss of
temperature will have this effect.  Some heat
(we can establish no  positive quantum,) is
necessary to health  and life.  But though a
sum of temperature  (majus aut minus,) is ne-
cessary to both, the continuance of either does
not depend on  the  presence of heat  alone.
Vital air, and respiration are indispensable to
life.   Foreign heat cannot give  the first;  nor
can it produce the other except under certain
circumstances.   These are a capacity in the
body to be  acted on by  heat as a stimulus,
 so as to exhibit in consequence the operations
 of life.   If a body be in the state of suspen-
 ded animation, (with this capacity remaining,)

 bad conductor of heat.  In the living body also in the
 state of  chill, we find it difficult, (if it be possible m
 fact,) to communicate warmth from  abroad.   When
 we thus succeed in  warming  the  body, it is probably
 by stimulant impression on the living principle,   lhc
 body too in many diseases is very cold on the surface,
 when great internal heat is complained of.  The vital
 actions being weakened, the body appears to possess
 little capacity as matter of conducting heat.
              H 
60
heat applied under such  circumstances, may
excite (by  its  stimulant  property,)  the  lan-
guid vitality, to a renewal of the vital motions
and first respiration. The action of the heart*
is next aroused: and the dissevered chain of
vital and animal functions, thus gradually and
fully reestablished.
  It is thus I would explain the experiments
of the French  philosophers who have seen
suspended life  (from submersion,) come into
renewed operation under the action of the sun
alone.   The heat diffused (no matter how,)
by that great source of  calorick, impresses
(or stimulates,) the remaining vital capacity
into a renewal of the vital actions.   The  first
effect, namely,  partial respiration, brings the
body under the controul of its natural  and
essential stimulus; the blood's oxydated condi-
tion.
  When however science and humanity  ap-
peal to experience, they  are taught that  the
stimulus  or heat alone,  is frequently ineffi-
cient for the reproduction of the vital and ani-
mal functions.   The life of the body beino-
very much reduced  we shall in vain solicit its
operation by foreign heat however elevated
in degree; or long continued.  We must sup-
ply directly a defect resulting from suspen-
ded respiration, viz: imperfect oxydation of
the blood, or the total negation of that condi-

    * By the stimulus of newly oxydated blood. 
61
tion.  For this purpose pure or vital air must
be thrown into  the lungs,  for though they
contain air, it is  unfit for the purposes of life.
mechanical or artificial respiration must for a
time take the place of the lost natural func-
tion.  Nobody I imagine has  supposed that
mere inflation of the lungs could produce re-
newed vital actions, or that to attain the bene-
fit anticipated  from artificial  respiration,  a
heated* condition of the air we inject, was
necessary.   No rational man has  attempted
to revive what is called a drowned  body,
which had been taken out of cold  water, by
subjecting it to submersion in water made
hot.   Neither could a body  thus fallen in its
vital condition, be reanimated in a disoxyge-
nated atmosphere, however raised in tempera-
ture.   The  unfortunate  victims of Asiatick
barbarity could not have wanted elementary
heat, in the black hole of Calcutta.  Nor does
the wandering Arab  of the desert,  find the
Sirocco least pernicious, when its temperature
is highest.-f

  „# It should  be of pleasant temperature.

   \ I do not suppose the air of the desert non-vital
from "defect of oxygen."  I rather imagine that ex-
cessive heat long continued, exhausts (as a stimulus,)
the capacity, or principle, of life in the body. 
62
General  remarks  on stimulant  forces,  and
        their application to practice.

  We are often reminded that "he who under-
takes to instruct, should first take care that he
does not require teaching." I am satisfied that
I fall fully within the  scope  of this maxim.
In my notice of the following  subject,  it is
probable I shall  be found rather the  curious
traveller than the skillful surveyor who mea-
sures his steps by the principles of  geome-
try.  But I think we  should not hold the pro-
fession as a sinecure, nor wear  the title* of
office, without attempting a discharge of its
duties.   Errours in  sentiment  may  be for-
given, but bare  contradiction is  justly offen-
sive.
   Apart from testimony which I feel a pro-
per disposition to respect, I should conclude
that there are few conditions of the animal
system, which demand the sum of stimulant
operation, indicated  to have been necessary
in the diseases exhibited in the narrative part
of this  essay.  When the body  has  been
thrown suddenly into the state  of asphyxia,
by cold or  other causes, the  remaining sus-
ceptibility of  the vital system to impression,
is sometimes so partial, as to require the most
powerful  exciting causes to  arouse  an evi-

      * Unde doetoris titulje nisi ut doceant? 
63
dence of life, or a renewal of that vital ex-
ertion, on which the recommencement of the
animal functions depend.   But when this  is
effected, when the  vital principle affords us
an  evidence  of its  sensibility to stimulus, wc
cannot safely urge upon it an augmented im-
pressing force: we shall probably gain more
by  apportioning the stimulus to the capacity
for bearing impression.   A man taken out  of
frost, destitute of animation, might require a
powerful stimulus (volatiles, for instance, ap-
pl ed to  the most excitable instruments  of
sensation; or general  friction.*)   But if the
application were successful in  arousing par-
tial signs of life, should we not by exhibiting
a more  powerfully stimulant agent,  exhaust
the capacity or principle, and extinguish the

  * I know that the common practice is to rub such
persons  with snow, &c. and that such application is
said to be a low degree of stimulus.  But certainly
the simple application of snow in the open air, could
not stimulate  or restore him.  It possesses  no quality
which could  have  that effect.  For  (I presume,) it
could not there be higher in temperature, than the  air
in which he had suffered. It is the warmer air of the
room to which he  is removed, or the friction, that
stimulates.   Snow applied to a part endangered  by
cold,  may be useful in preventing  mischief to that
part, by taking off some of the blood's heat in its pas-
sage to the part, after the  system has been excited
by a warm air, and thus prevent its stimulus from ex-
hausting the reduced  life of the part.  But not  by
 stimulating such part. 
64
 life we had rekindled? If we lay such a body
 in which life was just awaking, (if the term be
 admissible,) before a large fire, will life con-
 tinue? Facts often exhibited in the case, but
 more particularly by experiments on animals
 in the torpor of hybernation, say it will not.
 The falling into death here, must result from
 exhaustion, and that exhaustion  be depen-
 dant of necessity on stimulus, as we are aware
 that fire,  (or  heat,)  possesses  no specifick
 morbid quality; that it only stimulates. After
 a  few glasses  of  brandy,  the  muscles  lose
 their vigour, and the man begins to totter, or
 reel as he walks; if a few more be taken, they
 become powerless, and he falls. While lying
 in this state of torpor, if we raise him up and
 pour down his throat  half a pint or a pint
 more,  if the stomach do not reject it, will it
 reinvigorate him, will he get up  and  walk? or
 become less sensible, fall off in temperature,
 and perish. On the  same principle, infants,
 and children a  few years old,  will be made
 drunk and deprived of life, more readily than
 grown persons.  I  may possibly be charged
 with errour in this particular, on the authority
 of the Brunonian  doctrine; which says  that
 children are more  affected by stimulus than
 others, because they have more excitability.
 But that doctrine says also excitability is life
 or the principle of life, and as life, or the
principle of life, is power or the capacity for
 exertion;  if the doctrine were  correct, chil- 
65
dren  would have more strength and energy
than adults. When from any cause, food and
drink have been withheld from an individual
until the body has fallen very low  in vigour,
if a moderately full  meal,  or  a quantity of
brandy, which he could drink without incon-
venience  in  health,  be taken  suddenly, he
sinks  almost immediately into convulsions, or
stupor and coldness, from which he recovers
no more.  The demand  for energy was too
great for the capacity of the vital  system; it
could not supply the organ, and the function
of that organ was suppressed or  overwhel-
med.*
  The term torpor, or morbid inirritability,
has been used sometimes in contradistinction
to debility.  And on the peculiar condition to
which the term is appropriated, has been res-
ted the  propriety of free stimulation.   The
distinction is certainly just in part.   Morbid
causes inflicting violence on the vital functions,
whether from excess of cold, gaseous,  mine-
ral, or vegetable poisons, in short,  any  cause
producing suddenly,  or by their protracted


  * Such a person, as also the man recovering from
suspended animation, would bear  a greater sum of
stimulant force, after the animal actions  had been go-
ing on for some time under the operation of a less, and
had increased the actual quantum of life. 
66
operation, a defect of animation,* may induce
torpor.
  We cannot always detect the causes which
create a difference of susceptibility to impres-
sion.  We know that it is different in different
diseases; and in the same disease in different
persons, when in  both cases  the  sum of ac-
tual  physical infirmity is apparently equal.
We know also  the sensibility  to  impression,
varies in the same person, in the same disease
in its  different  states    These are important
considerations in  all diseases of reduced vital
energy.   But  whatever the  cause or degree
of original insusceptibility, when the lost ca-
pacity for impression has been restored; when
either by  foreign  aid, or the  unassisted pow-
ers of the body, the vital system has regained
a sensibility to- ordinary stimulus, the state of
sensitive debility  succeeds to previous torpor,
and in proportion to the degree of that debi-
lity,  will be the aptitude to impression,  and
incapacity to bear an active impressing force.
We see this fact  every day in ordinary chill.
We find the same body presenting  two very
different states in the lapse of one hour.  A
stimulus which could not be felt when it  was
cofd, will give  us a direct  and powerful op-
eration  when the natural heat is reestablished.

  * On  the authority of the best lexieograhers I use
animation as  synonymous with sensibility,  or the pos-
session of active life. 
67
If the stimulus be continued in this state, some
organ will fall into suffering, under the gene-
ral  action;  or that  action urged to  excess,
and protracted by  frequent  repetition, will
exhaust the principle by which itis supported,
and the body sink into extreme feebleness, or
death;  we have shewn that these effects may
be  produced by prolonged excitement from
free stimulation, even where no antecedent
torpor, had increased the hazard of  such a
consequence; as in drunkenness, &c.
  It is possible too, and ought not to be for-
gotten, that we may be very much imposed
upon  by the apparent  state of the body,
when it has been thrown by  any cause, into
the torpid and chilly condition.  Its powers,
may be so  far subdued by that cause, as to
be unable to give us afterwards, the evidences
of complete reaction. From the positive waste
of  vital energy by the cause which  had sub-
dued it, the body is in a mixed state, between
fever and torpor.  It has recovered so far as
to accomplish imperfect reaction, but the loss
of vital energy  has been too great to permit
its  complete reestablishment.   Hence  we
have  occasional flushings, of heat,  anxiety
from disordered sensations, local pain, weak,
irregular  pulse, &c.  If such were not  the
fact, if this were really the state of defective
animation, or unsusceptibility to impression,
alias  torpor,  we should  not have the com-
plaint of heat, anxiety and distress, pain, &c.
           i 
68
for the torpor of defective capacity to be im-
pressed  would give us defective or  absent
sensation, as we find in the stupor of typhus
gravior,  where the mind is unobservant of
every thing, and  the body  insensible to the
brandy, blisters, &c. with which it is liberally
plied. If the pathology of thecase above stated
be correct,  powerful  diffusible  stimuli by
giving occasion to a greatly increased exertion
of the slender stock of vital  energy,  must
exhaust  it;  and the action  dependant on its
existence, cease to be performed.
   I have admitted that in some states of dis-
ease an extraordinary sum of stimulus was ne-
cessary to produce a moderate sum of stimu-
lant operation.  Writers inform us that in
certain states of fever, large  quantities of wine
have been  exhibited  in a short interval of
time. We find this a common practice in that
state of typhus of which I have just spoken,
the stupor, &c. of typhus gravior.  But even
here experience has limited us to a  kind of
stimulant less fitted to provoke excessive or
irregular action, than any  other (of the  same
class,) with which we are acquainted.   Good
wine is supposed to afford  the system an ali-
mentary material, and while it stimulates gives
the capacity to bear stimulus.  The best Bri-
tish writers who are advocates for the use of
wine and malt liquors in this form of fever;
tell us that their patients did not derive equal
benefit from distilled spirits  and other diffusi-
i 
69
ble stimuli.  Wine was found a grateful  cor-
dial when the more powerful agents, as opium,
sether, brandy, &c. would defeat the contem-
plated object, by arousing an excitement tem-
porary and weakening, because  demanding
an exertion of the acting powers,  which  they
were unable to continue.  Such is the effect
even of wine when  exhibited in large doses
and carried beyond the amount necessary to
accomplish a determinate sum of action   The
writers who are authority for its  liberal  use
in the atonick  states of fever, inform us that
they were compelled to retrench the quantity
after a given degree of excitement had  been
produced.  If the same quantity  were exhi-
bited after this was effected,  they found the
intellect  disturbed, and the body falling off
in power in consequence of too great demand
on the vital energy, and the waste of animal
faculty from disordered arterial action.
   It is of very great importance  too, to re-
member, that  there is always found a material
discordance in the effect  of stimulus in the
simple  state of atonick disease, and the ato-
nick  condition when complicated with  local
organick affection.   If any important organ
or sensible part is in a state of particular dis-
array or suffering, an exciting cause will give
occasion to an effect much greater than when
such local condition is absent. If inflammation
of the brain, throat, lungs, or bowels, coexist
with thelow gradation of fever, or atonick states 
70
of the general body, however greatly it may
require support; at least one half of the stimu-
lus it would bear were no such  affection pre-
sent, is taken out of our hands.   The affected
part  is incapable of bearing their operation,
it  would give the alarm upon their  introduc-
tion,  and the body sympathise in its aggrava-
ted disorder.   For it must obey its  principal
law, that of sensation.
 .  We are  told that local affections are some-
times relieved by partial or general  stimulus.
This  may   be explained  in conformity with
our  general position.   That  weakened parts
are most sensible.
   Those (local) affections are known to exist;
by pain in the part, which may be the conse-
quence, either of inflammation, or an incom-
petency (without inflammation,) to perform
the natural actions, thus incurring disordered
sensation.   As in parts weakened  by cold,
fatigue, or physical disorder of function.
   In either of those conditions (inflammation
or incompetency,) a local stimulus, as  a blis-

   * Blisters, (on the side for instance, in pain of the
chest,) have been supposed to act in one of two ways.
To give relief either by counter irritation, or by  the
discharge they  provoke. A counter irritation could
occur only where the part affected, and that to which
the blister plaster was attached, were supplied with
blood by branches of the same series of vessels.  In
such cases by reducing the resistance (or tone,) of the
 vessels of the part to which it was applied, the blood 
71
 ter,* or any thing immediately stimulant, may
 give relief by exciting more especially the ac-
 tion of the part.   If it be inflammation, the
 vessels of the inflamed part may be roused to
 a contraction (or action,) sufficient to expel
 the  superabundant blood  which constituted
 the inflamed condition, and thus produce re-
 lief.   This could not happen  if the general
 action  which had  caused  the infarction  of
 the part, was equally roused by the stimulus.
 But as inflamed parts are  more sensible than
 the rest of the body, a stimulus which would
 act  upon them, would not produce general
 excitement.
   On the same principle, an internal stimulus
 of moderate force, would by producing more
 impression on the inflamed part, than on the
 system generally, excite its vessels to a con-
 traction or action, by which they would effect
 a discharge of the excess of blood from which
 they were suffering.

 finding an easy passage into them, (by their dilatation)
 part  of the impetus might be taken off from the ori-
 ginal inflammation.   But only where there was this
 vascular connexion, which does  not exist in the case
 supposed. As to relief by the discharge. A quantity
 of blood greater than that of the serum effused  under
 the operation of the  blister plaster, may be taken
 away by cupping, without relieving the pain of the
 pleura or lungs. Besides the pain is commonly reliev-
 ed as soon as thefies begin to act, and before any  ef-
fusion of serum has taken place. 
72
   In weakened parts also, (without inflamma-
 tion,) where there was  pain  from defect of
 natural action, being more sensible to impres-
 sion in consequence of their weakness, a lo-
 cal stimulus of force, proportionate to their
 sum  of life, or capacity for bearing impres-
 sion, would restore the quantum of action
 which constituted their healthy state; and  ne-   j
 cessarily effect a relief from pain.   An inter-   >
 nal stimulus would, under similar circumstan-  I
 ces, give us the same result.  The  part would  /
 acquire from the stimulus, more activity than /
 any other equal part, and thus ascend to  an /
 equilibrium with all the rest,  in  action and/
 sensation.                                 '
   But on the other hand, if the local  stimu-
 lant, in the  case of inflammation, was so pow-
 erful as to excite a considerable general ac-
 tion,  the part would lose by  its  operation.
 For the cause by which it had first suffered,
 the action of the heart and arteries, being  di-
 rected against it with increased force, the  lo-
 cal mischief must be augmented.   The same
 consequence,  but in a greater degree, would
 result from an internal stimulus.  Though the
 vessels of the part might empty themselves
 on the first impression of the stimulus, (which
they would  feel  most sensibly,) yet the in-
creased general action would be immediately
exerted on  them, reproducing the  same con-
dition. The part being weak, if the stimulus
were continued, the mischief must  be greatly 
73
extended; and  if the part were also delicate
in structure,  and exposed to  the general
force, as in the lungs, effusion to a very hurt-
ful degree, or organick lesion, and if the stim-
ulus  were urged still farther, even gangrene,
must ensue.
  By the same rule, if a stimulus greater than
simply weakened parts required, were applied
to them, either their living principle would be
wasted so as to weaken them farther, or ex-
hausted, so that they would die.  Or a gene-
ral increase of action being roused by the ir-
ritation of that  stimulus, or the operation of
an internal one  disproportionate to their ca-
pacity for resistance, (or life,)  the part must
be thrown into inflammation or sphacelus.
  Though I have proposed objections to the
unmixed stimulant plan in the varied states of
any  general disease, I am prepared  to ac-
knowledge that the  testimony of a sick-bed
will in particular cases, contradict the deduc-
tions of abstract reasoning I think however,
we shall always proceed most safely, by fol-
lowing the  paths of nature.  She  often re-
quires our aid in repulsing disease, but we
must assist her on her own principles.  The
most important one, is physical capacity to
bear exertion.   I believe that cordials (stimu-
lant  ones if necessary,) are better props of a
falling body, than diffusible stimuli which ex
cite  actions they afford no power of continu-
ing.   For they possess no properties which 
74
the body can appropriate to the purposes of
support.  On the evidences before us I rea-
dily admit they may have  been  sometimes
useful.  I must  be permitted to think also,
that they have often done harm.   A physi-
cian who has collected with considerable in-
dustry,  the  records of successful  stimulant
practice in  the  spotted  fever of New Eng-
land and  New York,  who  himself enfored
and inculcated that practice boldly and ear-
nestly, has candidly appended as a summary
to his inquiry, that  he  believes the stimulant
plan had been often abused, and unfortunate,
but that its misuse was less dangerous in his
opinion, than errours in evacuation.
   The  remarks  on the pathology of local af-
fections in diseases of general debility, will
(if they are correct,) lead to inferences oppo-
sed  to the propriety of the highly stimulant
plan, in diseases of that order. Those inferen-
ces will regard more especially  the typhous
pneumony,  now so prevalent in  our state.
That with the general infirm, and on that ac-
count excitable  state, of the acting forces of
the body, we have local  affections of serious
character, does not require proof.  The most
important of those affections  is a weakened
and inflamed structure of the lungs.*  They

  * I have examined  three bodies said  to have lost
their life under the operation of this disease.   In all
of them there was pulmonary inflammation.  In each 
75
are organs too important in the ceconomy, and
too susceptible of injury, to resist successfully
when weakened, the hurtful agency of a dis-
proportionate force.  Though that force be
far below the natural standard of general  ac-
tion, if it be relatively too great, it will readily
enlarge the sum of local injury.  While there
is pain from that force, and on account of that
pain difficult respiration, while there is with the
pain, great excretion of mucus either tinged
or not with blood, and distressing cough,  the
general action (though considerably reduced,)
cannot be urged by stimulus, but at  the im-
minent hazard of life. I will not anticipate in
this place, the brief notice I contemplate, of
the treatment of our epidemick.  But having
just past over the general  ground on which I
would rest the estimate of stimulant agency
in  that, and every such disease,  I wished to
secure for that  general basis,  all the conside-
rations it may be entitled to.

                 Catharticks.

   In the  treatment of spotted fever, cathar-
ticks appear to have fallen into very general

of them the left lobe had suffered most.  In  one  of
them, that lobe was very dark down to its root from
 effusion of bloody mucus  into its  cellular structure.
 They were examined in very cold whether, when pro-
 bably little if any change had taken place subsequent
 to  the period when life ceased.
             K 
76
disuse and disrepute.  Some gentleman how-
ever exhibited  calomel, and  they say with
good effect. I am disposed to believe that they
were  exhibited improperly at first, and  too
much  neglected afterwards.  Few states of
fever can  exist without requiring evacuation
at some period.  When the body in maculated
fever  was roused  from  the state of torpor,
when  obstinate  vomiting came on, great heat,
anxiety, restlessness, and pain of  the bowels,
head,  &c. ensued,  could not  the body bear
evacuations  from  the  bowels,  or  a gentle
emetick?  Would  they not have been useful?
Were  they  not  necessary.   Where  the
tongue is foul,  heat, head ache, and  thirst
great, bowels painful  and costive, how often
do we obtain relief, by  opium, aether, and
brandy? We  are told those were common, al-
most constant attendants  on  spotted fever.
While universal coldness continued,  evacua-
tions were unnecessary and improper.   But
does not  that  very  state almost  uniformly
create a necessity for subsequent evacuation?
Why  is  bilious vomiting the general atten-
dant on chill?    When the body  is falling into
chill, what becomes of its blood? As it cannot
be found  on the surface, (in the usual quan-
tity,)  if it is not dried up we must look for it
in the large vessels. Does the blood stimulate
the organs to which it is distributed?  Then
what  effect  has the augmented  quantity of
blood in the vena portce?   Does it stimulate 
77
the liver to increased  exertion?  And if it
does, shall we  not  have an  extraordinary
quantity of bile  thrown into the duodenum?
Will this  bile irritate?   I believe we must
admit that it is to an irritation thus produced,
we are to look for the chief cause of the spon-
taneous vomiting which almost uniformly  en-
sues to chill.
   A debility  prejudicial to the body is by no
means  a  necessary  consequence of careful
purgation.  When a  local irritant is acting on
the body, which  evacuation can remove, or
when from any cause disordered arterial ac-
tions have been excited, catharticks judicious-
ly  administered, will produce an improved
state of general sensation, by carrying off the
one, or calming the other. The pulse becomes
more natural, and if before small, (from mor-
bid stimulus  or  irritation,)  fuller.   If names
could properly be thrown into the balance of
opinion, Sydenham, Hamilton, and in  our
own country, Rush, bear ample testimony,
that the body often rises from a state of pros-
tration  under the  operation  of purgatives.
How is the body relieved from torpor, tremor,
and feebleness, when morbid agents (poisons,)
which had produced those effects, have been
ejected from the stomach?  or in dysentery,
colick, &c. by evacuations  from the  bowels?
   A gentleman who has examined with very
meritorious industry, the fitness of the diffe-
rent remedies used in typhus pneumony, (the 
78
Maryland epidemick,) has said of purgatives,
"As to the idle notions  of cleansing the pri-
mae viae, and throwing up  b,ile from the sto-
mach, the whole matter is so perfectly absurd,
that  I  think it a waste of time to say a word
about it."  It can scarcely be wrong to re-
turn the compliment  we have received upon
the occasion;* "He has eyes, and sees not, un-
derstanding, and perceives not."  It will form
a curious (and I declare it is a very goodnatur-
ed,) illustration of the application of the retort,
to quote this gentleman's remarks in another
part of the same work: viz. "That great internal
heat was often complained of in this epidem-
ick, a symptom new to me in pulmonick com-
plaints, but which I had often met with in in-
termittent and  remittent fevers." I  would in-
quire very civilly, whether this gentleman has
ever indulged  the idle notion, of "cleansing
the primae  viae or throwing up bile, to remove
the great internal heat of remittent and inter-
mittent fevers."   We are informed (by him-
self,) that he is in the habitof giving pukes (see
the story of his friend and  the  blue stone,)
for intermittents, but  it may possibly be from
other notions than those of removing great in-

   * I  am really unwilling to be thought captious.
But when the opinions of one gentleman press heavily
in their detail upon the  practice of others, self de-
fence is not only  a right, but the importance of the
subject renders it a social duty. 
79
ternal heat, by throwing up bile and "cleans-
ing the primae viae."
   Is it true that the experience of past ages,
and of every day, is a fallacy?  That physi-
cians have been grovelling in  gross  errour, in
supposing that by cleansing the primae viae,
they could free  the  system from causes of ir-
ritation .unfriendly to its  security;  that they
could  arrest disordered  arterial actions, re-
sulting; from internal causes of  irritation?   Is
the plan of nature herself absurd in appoint-
ing periodical evacuations for the bod\ ? Does
the proper performance of those evacuations
depend upon the healthy state of certain se-
cretions in the  body?  Is the bile a product
of one of those  secretions? Do diseased con-
ditions of the body  disturb those  secretions?
Do they alter  the  properties  of the matter
prepared?*  Does it become by  this altera-
tion a cause of irritation which it is necessary
to remove?  Is  nature acting  unadvisedly and

   * The liver, when the health of the body is disturb-
ed, secretes a bile changed in its qualities, in the same
manner that the lungs  (and other  vicera,) modify un-
der similar circumstances, their appropriate secretion.
The latter  excites irritation  and  cough, the  former
produces irritation and vomiting.  Generally perhaps,
the meterial is in both, the natural  excretion imper-
fectly  prepared, in consequence  of general ami or-
ganick disorder, or want of natural  power.  But the
kind of local disorder (from a peculiar cause.) may
constitute a diversity in the nature of the secretion. 
80
foolishly in endeavouring to throw  out of the
body offensive materials.  Would it be better
that she should retain  an excreted material
which  in  the  lungs  provokes cough, in the
stomach vomiting, in the bowels  catharsis?
If those materials were innocent, would they
produce such  effects?  Are we deceived by
our senses, the patient by his sensations, when
we  find the body after  the  evacuations of
the  first passages,  relieved  from previous
irritation,  distressing  heat,  and  local  and
general disorder; when  we find it tranquil
and easy?   This gentleman says he adminis-
ters emeticks in billious fevers, I presume he
administers  (or he has  a practice truly his
own) catharticks also.  Why does he  give
them?  Because there are offensive materials
in the body which it is necessary to remove?
Something occasioning great internal heat?
or is it only from  an  idle  accordance with an
idle notion.
  When local  derangement  or disordered
condition f inflammation for instance J  exists,
the general body, if the part be an important
or sensible one,  will feel that derangement.
It will  be  thrown into diseased and wasteful
action, and we shall find it necessary  to take
off that sympathy with the diseased part.  We
can suppress or subdue it only by evacuation
of some kind. If the body be weak, and bleed-
ing is improper, nothing can meet the demand
so well as moderate purgation.   The part 
81
being inflamed  or deranged in  function is
more sensible than natural, and hence the ex-
pression of pain. By abstracting from gene-
ral action when it is too great,  either directly
or relatively, we take off the morbid sensi-
bility of the part,  the result of too  much im-
pressing force, and the cause of the continued
exertion of that  force.  If the latter be suffi-
cient (and  if it  were not, no pain,  would be
felt,) to keep up or extend the local derange-
ment giving pain  &c. such painful condition
will  necessarily give  occasion to  continued
exertion of that force, or action.   For the
evidence of the  living  condition, in other
words all animal action,  is  an obedience to
the laws of physical impression and percep-
tion.

Application of Elementary heat and Sweating.

  The application of foreign heat I think one
of the best modes  of external stimulation.  I
have said in a preceding part of this essay
that I  thought  it questionable  how far we
could calculate on the restoration of lost ani-
mal  temperature, by  a direct communication
of foreign calorick.  When we succeed in re-
producing general warmth by the application
of elementary heat, we accomplish the effect
by a stimulant impression on the living princi-
ple,  and through the medium of actions in the
body, answering to that impression.  In the 
82
  forming  state of the disease for the  epide-
  mickj we have been  considering,  foreign
  heat would no doubt be u eful.  We want a
  certain sum of action in the system.  And1 if
  elementary heat  were used with a view to the
  elicitation  of that action,  and that  only, I
  know nothing which could  properly take  its
  place as  one  mean of fulfilling the indication.
    But it is not probable that if foreign heat
  were urged so far as to provoke free sweating,
  we  should gain by the result. Very few modes
  of evacuation are more enfeebling  than free
  perspiration.   However produced it  is  an
  evacuation and a very direct and sensible one.
  That  it  is  always or even  frequently useful
  in diseases of languid excitement,  is a pre-
  sumption warranted by no satisfactory evi-
  dence.   Like  wasting diarrhea, it  generally
  ensues to that  state of lost vigour in which
„  the body is falling into ruins.    And it then
  always accelerates the event, the approach to
  which had produced it;  a total loss of tone,
  or the complete absence of the living condi-
  tion.  The testimony of experience is so am-
  ple on this head, that we find the respectable
  writers of Europe, where fever of the typhus
  character  are  more  common  than  in our
  country,inculcating the necessity for arresting
  the sweats which those fevers  frequently oc-
  casion.   In the  petechial  or  spotted fever
  particularly, the sweating state has been pro-
  nounced seriously hurtful.  Mr. Wilson who 
83
has consulted the best authorities on the sub-
ject, advises that this consequence should be
guarded against and suppressed,  if possible,
when it occurred.  Dr. Cullen to whom this
state of fever was familiar has directed us to
dread  nothing so much in their treatment as
free sweating. That the hazard of inflicting in-
jury in an attempt to restrain them even by the
use of cold water, was trifling compared with
the sure consequence of their continuance.*
   It  is  said  that the  disease to which our
view is  more particularly directed, (the epi-
demick of the last few years,) is  one  induc-
ing great ph\ sical weakness. And the object of
primary importance in combating it, the pre-
servation of the body's heat. I immagine that
free sweating must always diminish strength;
it also dissipates very rapidly animal calorick.
Those consequences  in fact  are no  longer
speculative;  we hold them on the ground of
positive knowledge.    Sweating  is  neither
useful or an argument  of improved condition
 save when it is the result of recovered natu-
ral action.   And when we succeed in resto-
 ring that action so far that natural perspira-
 tion commences, if we urge that consequence

   * A malignant fever (it  is doubtful whether epi-
 demick or contagious,) has twice prevailed in London,
 whose diagnostick trait was copious  sweating, this
 mark  of the disease gave it the name of "sweating
 sickness."  The arrestation of the sweat was the first
 indication of amendment.
            L 
84
farther, we waste strength, both by excessive
action and evacuation.  In regard to sweating
provoked by  external heat,  I  repeat,  that
when the body is cold and weak, free perspi-
ration  must be  decidedly mischievous.   It
cannot remove from the body a cause of dis-
ease;  and if so much renewed heat could for
a time be presented, as to prevent  the body
from growing colder than it  was, under the
sudorifick and vaporatory process, still  that
consequence must have a period, when stimu-
lus had exhausted the capacity to be impres-
sed;  and if the stimulus were  great, and the
capacity (or life,) trifling,  that period could
not be distant.
   Characters of the prevailing epidemick.


   The term  typhus pneumony has  been
used in the preceding part of this easy, as
more  appropriate than any other  to the
general character of the disease commonly
known by the name "prevailing epidemick."
It is significant of the disease however, only
in its  majority.  And comprehends besides
the strictly pulmonick affection, the varieties,
of thoracick disease denominated pleuritick.
I would include under the same head also, a 
85
form of the disease having more analogy to
the cynanche maligna of nosologists, than to
peripneumony.
   The epidemick so far  as  it has  fallen un-
der my notice, is  a compound generally of
pleurisy and peripneumony.  Upon the oc-
currence of chill, always  a primary  symptom
in a greater or less degree,  a pain is felt in
either side, most commonly the  left.   This
pain varies very much in the degree of seve-
rity in different cases.  Like the  pain  of
pleurisy it is aggravated  in  every attempt at
full inspiration.  But it does not remain long
fixed; a few hours after it is first  perceived
it changes its seat, and is  felt higher in the
side.   Or what is  most  common, it  declines
in severity in its original seat, is more diffused
through the chest, becoming less acute, and
giving us in this particular, the character of
peripneumony.  The pain and tenderness of
the lungs rarely passes away entirely, during
the progress of the disease.  It is complained
of, though in a diminished degree, even after
the general disease has been very much sub-
dued.
   Cough is not generally of early occurrence.
The pain, &c.  is often present for one or two
days, before the disposition to cough is fre-
quent or troublesome. And when we meet
with it, it is commonly after the pulmomck
symptoms have succeeded to those which were
more strictly pleuritick. 
86
   In  this respect it differs from ordinary
pleurisy and peripneumony. In those the cough
is an early and troublesome symptom.
   In a few cases however cough occurs early,
and unlike the couiih of common pleurisy, &c.
is productive from  its first existence of free
expectoration.   This  is generally when the
pain is severe, and of the pulmonick charac-
ter.   We then have  the expectorated matter
tinged  (sometimes very much,) with blood. In
lighter cases we are almost  without cough
throughout the whole disease; notwithstanding
there is considerable uneasiness  of the  side
and chest.
   The degree  of  fever  immediately subse-
quent  to  chill, is  very  various  in different
cases.  Sometimes it is fully formed in an hour
or two from the attack,  and  except  in the
force of the pulse we have all the indications
of high action,  common to ordinary pleurisy,
&c.   But again in other cases the fever is im-
perfect in its expressions.  The general heat
not greater than natuial,  with opcasional al-
ternations  of  rigour,  and  the  extremities
rather cool: the pulse small, quick and irregu-
lar.  Occasionally we meet  with  all the  evi-
dences of violent penpneumonick affection,
except  in the pulse.   We have flushed face'
pan in the chest, .cough, free expectoration
(sometimes bloody,) and  great  anxiety of
respiration.   But the pulse  neither  fuller,
stronger, or more frequent than in health.  It 
87
  is  the pulse of health, except in  vigour; it
  does not resist pressure.
    The state of the pulse  is in all the forms and
  degrees  of the disease, sensibly different from
  the pulse ofordinary pleurisy and pneumony in
  the particular just noticed.   The degree of
  resistance to pressure.
    The head is variously affected in this dis-
  ease.  It exhibits every degree of disorder,
m from  simple pain, to the most disturbed state
  of intellectual derangement. When it is very
  much disordered early in the disease, pulmo-
  nick  symptoms  rarely exist (except anxious
  respiration) in a great  degree at the same time.
     [In this respect also it differs from common
  pneumonia.  In the  latter much pain of the
  head, or disarray of intellect is rare, except as
  a temporary consequence  of unusual arterial
  excitement, and subsiding when that is  re-
  duced.]
     The face is in all cases of typhus pneumony
  (except in old  persons,) very much flushed.
  Whatever be the degree of fever  this symp-
  tom   is  almost invariably  present, after the
  first twenty four or thirty  six hours.   When
  reaction takes  place early,  and  fully,   the
  flushing occurs sooner.
     The epidemick has  considerable analogy in
  this particular with  bad cases of what  has
  been called pneumonia notha.
    Anxious, frequent respiration, accompanied
  with  repeated  sighing,  is universal in typhus 
88
 pneumony.  It is  greatly distressing to the
 patient, and even the observer. There is little
 difference in this respect, whether respiration
 is painful or not.
   In common  pleurisy  and pneumony,  the
 respiration if not painful, is rarely much dis-
 ordered.
   Extreme  loss  of physical power,   (or
 strength,) is almost an immediate consequence
 of attack in typhus pneumony. This infirmity  #
 is remarkable  even in cases comparatively
 mild.
  No other disease produces an equal degree
 of positive weakness in  the same  space of
 time.
  Great nausea,  and free and repeated vo-
 miting, are common in this disease.
  In ordinary pleurisy, Spc  they are less fre-
 quent.
   The feebleness and  irregularity  of  the
 pulse, or if tolerably full and regular, its soft-
 ness and compressibility, pain of the side,
 anxious, sighing respiration, constant flushing
 of the face, and extreme loss of animal vigour,
 offer the best diagnosticks of this disease.

         The particular symptoms.

                 CHILL.

  The chill in the incipient state of the dis-
ease, is in  no respect sensibly different from 
89
that of severe remittent fever.  Like the chill
in the last disease, it is irregular in its duration
and degree, and in like manner attended with
head-ache, and frequently nausea  or vomit-
ing.  In a few cases too, it has the remittent
character,  in a repetition  (though irregular,)
of occurrence.  Pains of the limbs are common
as in remittent chill.

                 FEVER.

  The fever  subsequent to chill is various  in
degree, and equivocal in its expressions. The
heat on the surface is not so great or general
commonly, as in ordinary fever. The pulse is
scarcely ever  full and round, never  hard:
generally small and frequent.  Internal heat
is  complained of, head ache  or disorder  of
mind occur, with great anxiety and frequency
of respiration.   Thirst  rarely considerable,
tongue  moist.
  When the disease is severe, its first sensible
impression on the body, appears to take off so
much from the  vigour of the animal functions,
that what is called full or  free reaction, can-
not take place. Hence we have feebleness of
the pulse from positive weakness of the heart
and arteries; and the anxious, and partly vo-
luntary respiration, (or sighing,) from debility
of the respiratory muscles.  The  frequency
of  respiration is  in accordance with the  in-
creased frequency of contraction in the heart, 
90
&c. from the impression of the morbid cause.
The breathing  may  be anxious or  difficult
when the pulse  is slow; but it is rarely very
frequent when  there is not quickness of pul-
sation.

            THE FLUSHING

  Of the cheeks is through all stages of the
disease, a consequence of weakness in the
small vessels of the face.   They become in-
jected with  blood, and have not tone enough
to empty  themselves  fully.   It is partial in-
flammation,  wanting only previous local  inju-
ry, or sufficient "vis a tergo" to make it com-
plete.

               THE PAIN

  Of the side and lungs, is from real inflamma-
tion, various in  degree in different cases.
When severe we have copious excretion of
mucus, sometimes bloody from the rupture of
small vessels.
   In the limbs,—From imperfection of natu-
ral action as in debility from cold, fatigue, &c.
   In the head,—From the same cause, as we
find in the head ache denominated  nervous.
Sometimes delirium ensues to this defect, as
in the "functiones animi turbatae" of low ty-
phus fever.  The maniacal state is a higher
grade of the same disordered function; or, the 
91
general action being too great for the reduced
tone of the cerebral vessels, partial inflamma-
tion of the brain may have taken place.* This
state may be detected by extreme sensibility
to stimulus of all  kinds, particularly, impa-
tience of light and sound.   And by the uni-
form continuance of deranged mental opera-
tion;  or the absence  of occasional quietude
and stupor.

     The petechial  and livid appearance.

   I have met with either in a few cases only,
and then not till the body had fallen very low
in its powers.-}-   When petechial occur, dis-
tinctly, they are a consequence of extravasa-
tion.  The livid appearance of the surface is
from  defective oxydation of the blood in the
parts.  The vascular forces, are insufficient
to  carry the general  mass of blood as freely
as usual through the pulmonary circulation.

   * In a few cases that  were examined after death,
from "spotted fever,,, the brain (it is said,) was in-
flamed, and  a thick mucus effused under the dura
 mater.

   f Petechial are said to occur frequently in the low-
 er counties of this state. 
92
               VOMITING.

  See  the  note  on the action of the liver,
under  the  head catharticks.  The material
discharged is generally bilious, and when pro-
voked by emeticks or catharticks, frequently
very dark.


         MUSCULAR SPASMS.

  Attendant  on nearly all febrile diseases,
when the body is low in vigour.
              STRANGURY

  Is said to have been a common sympton in
the spotted fever of New England.  In every
severe case of typhus pneumony, which has
fallen under  my notice, dysury, or impeded
discharge of water has been very much com-
plained of.  The bladder is rarely  pained  It
is strictly a disability, in the instruments of
ejection.   The urine appears to pass off by
its gravity simply,  without  the operation of
an  expelling  force, and  frequently half an
hour or more, is consumed  in its discharge.
The erect attitude is sometimes necessary to
favour its escape. 
93
  The most formidable, but fortunately the
least frequent form of the epidemick, is when
the local affection expresses itself chiefly or
altogether about the throat and fauces.  The
parts whicn constitute the superiour strait of
the pharynx, are then very  much swollen;
the tongue  also becomes greatly enlarged,
and the tumor about the walls of the oesopha-
gus in its upper part, renders deglutition and
respiration painful and difficult.  The impedi-
ment to both is increased by an external swel-
ling. The general volume of the neck is great-
ly enlarged, producing tenderness or impa-
tience to the touch.   This form of the  disease
like  its pneumonick character is  introduced
by distinct chill.  The softness, swelling, and
impediment to deglutition, &c. become imme-
diately sensible, and progress rapidly.   Not
unfrequently a fatal  termination  (by suffoca-
tion,) ensues in twelve and twenty four hours.

        GENERAL TREATMENT.

   No  definite mode of  treatment  can be
pointed out as proper even in common cases.
All treatment must  rest on existing demands,
and is subject to modification as frequently as
the cases are multiplied. No other disease ex-
hibits  such mutability of character, and di-
versity of consequence in the same case in
equal periods of time; and the diminished and 
94
 doubfful sum of physical capacity, renders it
 important to regard them all.  My remarks
 on this part of the  subject, will  be general
 and limited.  It would not  gratify me to be
 quoted as  authority  by those who are not
physicians.  Nor do I pretend to instrust those
 who are.  But to escape  the imputation  of
 arrogance, it is not necessary to relinquish the
 right of opinion.

               Bloodletting.

   I am in doubt whether there is any state of
 typhus pneumony, which  will  bear free*
 bloodletting.   The remote  cause of the  dis-
 ease induces so much  general physical debi-
 lity and derangement of organick  function
 that the system cannot permit a direct detrac-
 tion from the sum of blood it possesses at the
 time of attack.   The blood  is the  immediate
 stimulus to all  animal action.   And  the pro-
 cess of digestion and  assimilation being very
 much  broken up by the disease, a supply  of
 the  blood making material  from this source
 (the only one,) is doubtful.   The important
 function of respiration enfeebled  with  the

  *In particular  situations giving ordinarily the in-
 flammatory character to their diseases, and in a few
 cases in any situation, moderate bleeding, early in  the
 diseas  may be proper.  Where it can be borne, I am
 satisfied it would  be more useful than any other re-
 nted v. 
95
 other faculties early in the disease, becomes
 very much endangered  when we take from
 the muscles that  arterial  action necessary to
 their vigour. We find this function extremely
 imperfect  in  typhus pneumony.   It is not in
 that disease the hurried breathing of excessive
 action; it is the anxious respiration of muscles
 weak and easily falling  into  fatigue.  We
 observe it when the pul e is feeble and  not
 frequent,  and it produces in many  cases great
 proclivity  to  syncope.   Experience proves
 to us also that there is so great a waste of the
 vital principle in this disease that if we throw
 the body  below a certain  standard of action,
 we find it very difficult to prop or raise it up
 again.  If local affections exist, we jeopardise
 very much the security of the part by taking
 off that tone  dependent  on the quantum of
 action they demand.   We  see this fact fre.
 quently in oedema and sphacelus,  from dimi-
 nished tone of action.   A certain decree of
 arterial vigour is necessary to recovery,  and
 if it be destroyed, a part injured in structure,
 will readily perish.
   I have seen no case of the disease in which
 the arterial action could  properly be called
positively great or strong; it is often relatively
 so.  Too great for the injured structure, and
 reduced life of a part, or  such  as  will waste
 too much  the enfeebled  vital  powers of the
 general system.  But relative force of action
 is always  easily subdued; and must never be
V 
96
reduced very low.  We have  other modes
of depletion which while they calm disordered
actions, strike less directly than  bloodletting,
at the tone or necessary vigour of circulation.
   The faculties of the arterial  system are not
in this disease in that  state of oppression,
which will sometimes warrant  the use of the
lancet, even  when the pulse is small.   Its
faculties  (or capacity for exertion,) exist but
in a  partial degree.   The pulse is  small in
some diseases from  excessive stimulant im-
pression, and will  rise on the abstraction of
blood; but when the pulse is small from this
cause, it is also hard.   I believe the pulse is
never (or rarely,) tense in typhus pneumony.
I have  detracted blood in a few  instances
when the pulse was unusually full, and pain
of the  head  or chest distressing.   But in
every attempt the falling off of the pulse, has
limited the quantity drawn, to an amount con-
siderably less than had been apparently indi-
cated.   The pulse lost its volume, and with-
out being less frequent, became small, and
easily compressible.  The diminution of pain,
if sensible, was trifling and temporary.
   When, however, the throat is the principal
seat of local affection;  when the swelling there
becomes suddenly great, impeding deglutition
and  respiration, if we  can see the  patient
early,  I  think  we may sometimes, perhaps
frequently,  abstract  blood.   The  pulse is
generally fuller in this form of  the  disease, 
97
than in its pneumonick characters, and the
importance of the functions impeded  by the
local consequences of the disease, with the
rapid progress of those consequences, leave
us little to hope from less  direct attempts at
relief.   While we  stimulate  the infected
vessels of the part into the action necessary
to recovery, we must also repress the inject-
ing force, and any attempt  at the accomplish-
ment of this object, not immediately efficient,
would probably come into  operation too late.

         Emeticks and catharticks.

  The liver is generally very much disorder-
ed in its functions in typhus pneumony.  The
material excreted is offensive* to the stomach,
provoking free vomiting, and irritating to the
system, exciting  heat, restlessness, langour,
&c. I have in many cases observed the hepa-
tick symptoms predominate over all others.
The head ache, nausea, and sense of oppres-
sion and  heat in the stomach, are very great;
nor is the system relieved from the  distress
they occasion until  after free  and repeated
evacuation.   The material  discharge as in se-
vere cases of remittent fever,  is frequently
very dark, producing by its irritating proper-
ties pain,  and a sensation of heat, in its pas-
sage through the bowels.
   A feebleness  of  pulse  should  not  when
signs of biliary disturbance exist, restrain the 
98
exhibition or repetition of purgatives.   It is a
fact familiar to gentlemen who have treated
diseases of the bilious character, that the pulse
will improve in tone, and the general powers
of the body in vigour; under their operation.
When spontaneous vomiting has occurred, or
the disposition to that effort is considerable, I
think it  may be encouraged  or provoked.
But the chief attention (particular where there
is feebleness and languor) should be directed
to the evacuation of the bowels.  The system
is less agitated and exhausted by this mode of
depletion.  Of the necessity for a continuance
of evacuation we must judge  from its effect;
but while it is necessary it should not be post-
poned.  We have  not in this  disease much
time for delay; the capacity of the body to
resist the  operation of morbid causes is less
perhaps than in  any disease to which  we are
called, and has often been  found on experi-
ment an  insecure  resting  ground    While
medicines of this  class are indicated, their
exhibition should be continued until the disor-
dered action or distressing symptoms have
been brought into  a satisfactory state of sub-
jection.  Though our attention may be direc-
ted  for a time  to particular demands,  the
evacuant plan should not be abandoned while
it is proper.  There  is extreme  hazard in
pulling down, when we have begun too soon
to build up. 
99
  When the pulse is full and quick, the res-
piration  frequent, the head  and breast very
much pained, stomach sick,  tongue foul, and
skin dry,  (all frequent symptoms in typhus
pneumony,) I  should never hesitate to ad-
minister evacuants with a view to full and/ree
operation.   I feel entirely convinced that un-
der such  circumstances, free  evacuation is
highly important, if not indispensable to the
patient's security.
  No particular medicine possesses magical
properties.  The selection of such as are pro-
per for each occasion, must be left to the judg-
ment of the practitioners.  I have myself giv-
en a general preference to calomel,  in doses
of eight and ten grains,  and repeated, or ai-
ded by other medicine as I  supposed neces-
sary;  and  have frequently exhibited  from
thirty  to sixty grains, in one and two days.
Less active medicines however will effect the
sum of evacuation many cases require. When
the evidences  of  morbid biliary impression
on the system, exist but partially, or are alto-
gether absent, so much evacuation only is ne-
cessary, as will  preserve a proper balance
between the general acting forces, and the ca-
pacities of affected parts  or organs.  While
a force too  great for the security of a part is
checked  or repressed, the  ultimate security
of that as well as of the general body, requires
that a degree of tone sufficient for the purpose
of support and recovery, should be preserved.
            N 
100
  I cannot imagine the possible existence of
more than one case in a thousand, which will
not require some evacuation. And in that the
first sensible impression of the morbid cause
(or the chilly state,)  must be sufficient to kill
the body.   If that effect can  be prevented,
the progress of the disease afterwards,  even
in such a case, will generally give rise to the
necessity for moderate occasional depletion.
  The support of the body after evacuation
should receive guarded attention. Its powers
often fall very low in this disease; and in se-
vere cases their recoverv cannot be confided
to the  unassisted efforts of nature.  Foreign
aid is frequently necessary.  The instruments
of support will be most  properly selected,
when their adoption  is deduced from a care-
ful estimate of the general and  particular fea-
tures of the case.  They should always  be
simple. Cordial liquids, light alimentary pre-
parations; any thing the  appetite may select
which  will afford the materials of nutriment,
are often adequate  to the object proposed.
The medical tonicks  are sometimes necessary
and when they are,  I know nothing better
than the bitter infusions, and the preparations
of bark.   When we have any thing to appre-
hend from languid excitement,  good wine*

  * Porter and ale when good, are scarcely inferiour
to the best  wine The first is sometimes inadmissible
from its laxative properties.   The latter rarely pro-
duces disturbance of this kind. 
101
promises  every advantage which can be ex-
pected from the order of stimulants. I cannot
think  (for reasons already presented,) that
opium, brandy,  camphor,  volatile alkali,
aether, &c. can ever be proper aids to a weak
body, except for temporary purposes.

      Local applications and sweating.

   I refer  for their consideration to what has
been said in the general notice of local affec-
tions and  their remedies, under  the head
"stimulants." Of "sweatingr" I would observe
farther, that if it could be easily induced, and
restricted  in amount so as to serve the purpose
of moderate evacuation, it might be useful  as
a part of the evacuant plan.  A benefit would
also result to the patient from its existence to
a  limited  degree, in  cases where excessive
heat  was a cause of disturbed sensation, and
protracted disorder of action.   As the chief
natural conductor of animal calorick, it would
aid very much  in dissipating the hurtful ex-
cess  of temperature.  But if powerful stimu-
lus were  necessary to provoke perspiration
(as is frequently the fact,)  any affected  part
would be  exposed to  injury from  the action
excited.   The  vital principle must also incur
waste from that action, and the body be weak-
ened still farther in sweating thus produced,
by excessive drain from its sum of fluids.  For 
102
when thus elicited, it is rarely  temperate, or
controlable.
          GENERAL HISTORY.


  The  disease  exhibited  in the preceding
essay under  the particular appellations* by
which it was  designated  in different parts of
our country,  has been supposed generally, of
peculiar  nature, recent  origin,  and  novel
character.
  That it is a distinct and peculiar disease,
having its  species  and varieties, I  am very
much disposed to believe,  and before closing
this essay will propose some of the grounds
on which that  opinion is rested.  But inde-
pendent of the improbability that an epidem-
ick disease should have existed for the first
time within the last few  years,  the record
evidence both of Europe and our own coun-
try, I think is at war with the presumption of
its strictly novel character.

  * I have before  said that I think the forms of dis-
ease then described, all referrible to the same cause,
that they are generically similar, though specifically
distinct.
\ 
103
  The British medical writers of the eighteenth
century have described under the term "sy-
nochus pleuritica," and  "pleuroperipneumo-
nica," a disease strictly similar to the one we
have reviewed.   It was  with them, as here,
a winter  epidemick;  and appears  to  have
wanted in Europe none of the common or
casual marks, which have distinguished  it in
America.
  The  celebrated  Huxham has given us a
minute account of this disease, in some parts
of his  works  on epidemick  diseases,  and
epidemick constitutions  of the air.  Speaking
of the diseases of January 1738, he observes:
  "There are  some pleuritick fevers, but a
spurious  peripneumony  is by far more fre-
quent, attended .with  cough, and severe pains
of .the limbs.  The fever is  light, commonly
nervous, and sometimes  subsides on the ninth
or  eleventh day, after  an  eruption of red,
burning pustules."
  Again in March of the same year;
  "Pleurisies  and peripneumonies  are fre-
quent.   Often  both  the side and lungs are
  "Febres pleuritides aliquaj, peripneumonia notha
vere longe frequentior est, tussis, gravis arthritis tor-
quet permultos. Febris lenta, nervosa frequcns, quae
nonnunquam rubris, urentibus pustulis, die  nono, vel
undecimo, erumpentibus, solvi videtur."
  "Pleuritides et  peripneumonia frequcntes.  Ssepe
etiam  et latus vehementer affectum est, et pulmo 
104
 very much afflicted.   They call  the disease
 "pleuroperipneumony," in which  while there
 is pain of the side, there is at the same time
 cough and  oppression  of the  breast.  The
 disease is more distinct  if bloody  mucus is
 expectorated.  In this form of the disease
 also, burning  pustules  frequently  appear
 about the breast, scapula, and neck;  gene-
 rally on the fifth or seventh day."
   In 1739-40 he remarks:
   "Pulmonary fevers rage very much, (per-
 furunt,) and are far more malignant than for-
 merly;  being often attended  with black, livid,
 and brown spots.  The head and back are se-
 verely  pained.   The parts  about the chest
greatly oppressed.   Fierce  delirium almost
 always  occurs, and from the  commencement,
 an ulcerous angina seizes the whole fauces.
The expectorated matter is crude or bloody;
 dark, turbid urine, without sediment. Luckily
Morbum vocant pieuroperipneunionia;  in  quo  dum
sevit lateris dolor, urget simul tussis et gravitas pec-
toris.  Fit evidentior si sputa sanguinolenta expuan-
tur.  Nunc quoque in his  malis baud raro erum-
punt pustulse urentes, circa pectus, scapulas, cervi-
cem, quinto circiter aut septimo die."
  "Perfurunt febres pulmonarise, magis multo jam
sunt maligna, maculis, nigris, lividis, fuscis sjepe sti-
patse.  Dolent vehementius caput dorsumque; seinqer
quoque fere accedit phrenitis effera, ac  srepe angina
ulcerosa ab ipso initio totas  fauces correptans.   Vel
cruda, vel saniosa expuunt.  Cruda, lurida, turbida 
105
sometimes in the latter stages  of the disease,
pustules  and biles break  out.   But  com-
monly the disease proves fatal in a very few
days inducing great anxiety  after  the man-
ner of  paraphrenitis.   Frequently  also the
patients are attacked with "hepatitis" indica-
ted by  the seat of pain, jaundiced complexion,
and intense  yellowness of urine.
   "A putrid petechial fever also occurs which
carries off many sailors, and common people.
Those  fevers are often complicated, and rage
with united force,  viz.  the pulmonary and
petechial."
   Of the epidemick of 1745, the same writer
remarks:
   "Peripneumonick fevers prevail very gene-
rally; highly dangerous and frequently fatal.
Some  expectorate  but  little,  or not  at all,
urina, nihil unquam deponit.   Fauste interdum, sub
morbi finem, pustular erumpunt:  ssepe vero jugulat
segros morbus, dira anxietate jactatos, perpaucos in-
tra dies, more  quasi  paraphrenitidis.  Etiam baud
raro hepatitide correptos, nam situs doloris, et color
ictericus, et intensa flavido urinae, hoc indicare visa
sunt.
  "Etiam  grassatur febris putrida, petechialis  quse
pleurimos nautas orco dimittit atque inter  popcllum
multos.  Hse febres sajpe complicate, ct unitis viribus
sseviunt; pulmonaria nempe, atque petechialis."
  "Increbescunt valde febres peripneumonicse, peri-
culosse quidem et haud raro lethales.  Aliqui parum
aut nil expuunt; plures biliosa perliquida, aut spumo- 
106
others a  liquid frothy  bilious matter, badly
concocted;  many a dark or blackish sanies.
They breathe with difficulty, and are afflicted
with a sense of weight about the breast.   It
appears to me there is more danger to those
who have this pneumony, where the oppres-
sion of the breast, and sense of weight about
the precordia exist to a great degree although
the pain  is trifling  and not acute, than when
they suffer more  with pain of the breast or
side.   For in the latter case a loss of blood
frequently  produces relief.   In the former
however  it is not  only useless, but frequently
in no small  degree hurtful.   You might per-
haps be  led to expect  considerable benefit
from a repetition of  bloodletting.  On  the
contrary, it is followed by extreme debility,
suppression of expectoration, great anxiety,
sa, minime cocta; nonnulli  sanium  fere sub atram,
anhclant maxime, sum ma pectoris gravitate premun-
tur.  Magis mihi videtur impendere periculum pneu -
monicis, ubi  permana urget  pectoris oppressio,  et
grave quoddam precordiorum pondus, etsi levis tan-
tum et obtusus adsit dolor, quam si pectore aut latere
magis acute torquentur.  Hie enim sauguinis missio
plerumque adfert levamen:  in priore casu  ita ssepe
non juvat ut etiam haud parum sit noxia.   Sperares
forsan,  magnum a repetita sanguinis missine auxili-
um, accedit e contra, debilitas maxima, sputi supprcs -
sio,anxietas gravissima, vigilice perpetuscdelium, tre-
mores,  frigidi sudorcs. tandemque frequenter, mors
inopinata." 
107
incessant  vigilance, delirium, tremors,  cold
sweats, and frequently sudden death."
   It  is unnecessary to trace minutely  the
points of  relation or similarity between the
disease here described, and that known to us
by the term typhus pneumony. In their gene-
ral character, as also in the more remarkable
individual traits,  there is  an intimacy of re-
semblance which must obviate all doubt as
to intrinsick analogy of cause and nature. We
detect in fact less discordance than  is gene-
rally sensible in other diseases of the  epidem-
ick character,  common to Europe  and our
own country;   to wit,  those differences  or
modifications we have been accustomed to
refer to variety of climate, and manner of life.
   In some years, the disease appears to have
put on there, as in this country, the petechial
and maculated character.   At other periods
of its occurrence, that expression was rarely
manifest,  or in  particular  cases only.  But
then, both the general and individual  features
exhibited an obvious and  decisive variance
from ordinary pulmonary disease in that coun-
try, and a similarity amounting even to preci-
sion, with the distinguishing marks oftheepi
demick pneumony among us.  There was the
same  generality of existence, and dangerous
tendency.  The same order and character of
local affection, as indicated by the state of the
lungs, brain, &c.  The same remarkable  de-
gree  of physical  incapacity, in  the  debility
           o 
108
and disorder of the vital and animal functions.
And  what particularly defines the essential
analogy of character,  a similar result in the
impression and consequence  of the same ge-
neral remedy.
  When  we regard the particular evidences
marking the early, progressive, and terminat-
ing stages of the European disease, the ana-
logy is drawn still more close and  sensible.
We are informed by the same authority, that
"A light chill is first felt, succeeded by equi-
vocal and irregular heat, alternating with ri-
gours. The sense of feebleness is very great
attended with  pain of the side or chest, and
through the limbs.  The head is affected with
pain, often acute, and rising to delirium.  The
pulse is frequently small, and irregular; some-
times interrupted, and readily suppressed by
pressure.   Nausea, and vomiting of dark,
or bilious matter attend, also great  distress
and  difficulty of respiration,  with occasional
spasms, or tendinous twichings.  The tongue
is moist, and thirst not great.  As the disease
advances, the disorder of the head is  increas-
ed, the restlessness becomes very great, the
fauces grow dark, and  foul,  the surface be-
comes livid, the pulse more weak, and tre-
mulous, and the extremities cold. Sometimes
coma and coldness exist for a day or two be-
fore absolute death takes place."
  In one of the years in which the epidemick
pleurisy  or  peripneumony prevailed, Hux- 
109
 ham informs us, that many cases occurred in
 which the disease (as with us,) was confined
 in its  local  operation  to the  throat,  in  the
 manner of cynanche maligna, or tonsillaris.
» He speaks of it as generally and rapidly fatal;
 and recommends Bronchotomy in bad cases,
 though without much apparent confidence,
 from the proclivity of the disease, as  he  re-
 marks, to pass afterwards into the lungs.   A
 consequence he says he has often noticed.
  A presumption that the typhus pleurisy or
pneumony, has existed as an epidemick in
this  country also, many years since, will de-
rive  support from  a regard  to  the extracts
from the correspondence of Mr. J. Bartram,
quoted in this essay when speaking of earth-
quakes.   In reverting to the date of  those
communications it will  be found  that the dis-
ease existed here, a few years after the period
in which Huxham noted its prevalence in
Britain. "This winter,  ('47-8,) says Mr. B. a
kind of pleurisy, is followed by certain death:
But the, yellow fever, dumb-ague,  and pleurisy
joined, are  the chief actors  in  this tragick
scene."  In '49, he again remarks "the sick-
ness and mortality in our country are very
grievous.  A kind of pleuritick fever, mixed 
110
 with yellow fever, or what some call the Hun-
 garian fever, with black vomitings."
   That the pleurisy alluded to, was essential-
 ly different from the common pleurisies of our
 country, we must infer from  the manner  in
 which it is noticed.  He says a kind of pleu-
 risy. He means of course a disease different
 from the one known generally by that name.
 The "yellow fever," and "dumb ague" which
he says  were mingled with it, appear to indi-
 cate the vomiting of dark matter, and irregu-
 lar protracted  chillings,  which  we observe
 frequently, and indeed  generally, in the  well
 marked cases of the epidemick of the present
 time.  Hepatick symptoms were also common
 attendants  (Huxham says,) on the epidemick
 pleurisy or pneumony of Europe.
   We must suppose from Mr. Bartram's lan-
 guage, that the disease he describes,  unlike
 common pleurisy, was general or epidemick.
 "The sickness  and mortality in our country,
 are very grievous." This phraseology is too
 comprehensive to have allusion to sporadick
 cases of disease.
   This gentleman notices  also, the supposed
 similarity of the disease he is speaking of, to
 the "Hungarian fever." But from his silence
 on the  subject,  he does not appear to have
 been in possession of the characters  of that
 disease.   The  British writers  mention  the
 Hungarian  disease, but  I have met with none
 of them who describe  it.   It holds a place 
ill
in some of the catalogues of European fevers,
but without a particular definition.
  Mr. Bartram dissents from the general opi-
nion of the time as to the influence of changes
in the atmospherick condition (temperature,
density, dryness, &c.) in producing the epi-
demick of '48, and '49, but proposes no opin-
ion of his own, touching the cause of its gen-
eration.
       GENERICK CHARACTER.

  In noticing current opinions in relation to
the peculiar nature of the  recent epidemick
of our country, I  suggested an  intention of
examining its claims  to a strictly  generick
character, an attribute which I then said I
thought it might properly arrogate.
  The disease in question appears to be es-
sentially typhus in its nature and tendencies.
But the  reasons  why we should hesitate to
class  it under  the general head established
for that order by  nosologists, appear to me
sufficiently  plain  and  argumentative, to be
entitled to respect.
   The nosologists of Europe have derived
an  authority from very general consent for
defining their generick typhus, "a contagious 
112
disease."   This attribute I know, has  not
been universally assented to among patholo-
gists.   But the ground of objection has never
been sufficiently  strong  to  shut it out from
the schools of physick.  Without affecting
any part in the controversy, I shall take the
definition  as  one point of  discordance,  be-
tween that, and the epidemick under conside-
ration.
   The latter appears under all circumstances, •
a disease  of solitary origin.  If it were con-
tended  that some species of the typhus of
nosologists, are not  necessarily contagious,
but require a particular concurrence  of cir-
cumstances to give  them  this character, I
again propose the evidence  of general expe-
rience, and the result of individual observa-
tion in support of the position, that no une-
quivocal proof can be found of contagion or
infection under any form of the epidemick, in
any circumstances.*  From the manner of its
production in many instances, we must assent
unreservedly, to the correctness of the first
proposition,  namely, that  our epidemick is
frequently of solitary origin.  And from that
fact alone it would appear a fair presumption

  * The epidemick in its various forms has occurred
in cities, among the poor and dirty—in crouded fami-
lies—in hospitals and jails, yet under none of those
circumstances, has it exhibited  an  evident capacity
for self-multiplication, by contagion. 
113
that it is always  so.   I cannot well imagine
the possible existence of two different causes
of disease, which shall each be adequate to
the production  of the  same effect.  If one is
sufficient, it alone is necessary.
  That the different species of common ty-
phus may communicate disease by contagion
under some particular  circumstances only, is
very possible; and is owing I should suppose,
to the different degrees of force  in their ca-
pacity for producing their appropriate effect,
and diversity of resistance in different situa-
tions, on the part of the body exposed to its
operation.  But  I should  think  also,  that if
they were intrinsically  contagious, the same
disease, never could exist by any other ope-
ration, or have any other cause of origin than
the specifick contagion.   That when it did
not exist from  this cause, it could have no
existence. We know that contagious diseases
(particularly some of those called cutaneous,
which are also strictly systematick,) vary very
much in the degrees  of force they are fitted to
exert on different bodies.  But  a principle of
contagion thus low in its powers, is rarely pro-
ductive of consequences involving the secu-
rity of fife.  Though I  confess myself in some
uncertainty on  the subject, I should doubt a
compound mode  of disease  (its incidental
origin, and  occasional contagion,  and vice
versaj on  the authority of the fact, that 
114
diseases which are positively communicable *
are not known to exist from any other cause,
or to be in any other manner producible.  If
ordinary typhus  is  generally  contagious I
must believe that a determinate mark of dis-
tinction exists between it and the prevailing
epidemick  in  this particular.   And that the
line of separation may be properly drawn be-
tween them, through all their specifick forms.
  2nd. The scene of impression  also, and con-
sequence, defining a period of  disease, very
different in duration, from that  embraced by
the  laws of ordinary typhus,  indicate very
strongly a presumptive diversity in the kind

  *  As variola  and lues.
  The origin of those diseases is a speculative ques-
tion  of difficult  solution.   Whether  we regard them
as judicial or on the other hand as  what we under-
stand by natural, equal perplexity is interposed.  If
the first, why they were originally found peculiar to
a particular  people—if the latter, why they have pre-
served all their  distinguishing traits  when transplan-
ted, though in no other place than that of original or
natural creation, have in  any instance existed (so far
as facts determine,) in any other manner than  by
individual communication, or specifick contagion. We
have not any facts to prove that even in the countries
where small  pox and lues were first found, either of
them are ever of solitary  origin, and every where
else  they appear exclusively  contagious.   While
other diseases, which from their mode of prevalence,
are  evidently peculiar to situation and climate, are
neither contagious there, nor transferable by conta-
gion to other places. 
115
as well as degree of agency.   Nothing marks
more decidedly  the  similarity of diseases
(whose  symptoms correspond generally,)
than the aggregate amount of the operation of
their laws, in regard to the ratio of time.   In
its generick character typhus  runs a pro-
tracted course as simple fever,  inducing in a
manner peculiar to itself, general not parti-
cular imperfection of  the  vital and  animal
functions.  (I shall notice those more particu-
larly in concluding.)
   3rd.  Local affections, are not common  or
proper attendants on the typhus of nosolo-
gists.  They frequently exist not at all, and
when they do, are consecutive and incidental.
Generally when present they are partial and
unimportant; and for the most part  eruptive,
not organick.  In this respect only they have,
a slight shade of difference in their definition
from simple fever.
   In all the forms of the epidemick, there is
much organick disarray, and local affection. In
that species denominated spotted fever,  (the
one  most  nearly allied  to  some   forms  of
common typhus,)  the throat we are told was
so uniformly inflamed as to  constitute a pro-
minent pathognomonick expression of the dis-
ease. The stomach and bowels were also very
generally disordered in their condition, be-
coming early a seat of fixed local disease.  In
the variety  of the disease at present  of fre-
quent occurrence, and known to us by the
           p 
116
 characters ofcynanche, we have a considera-
 ble aberration from the operation of ordinary
 typhus.   The local affection, and even the ge-
 neral  action, are decidedly inflammatory  in
 effect, wanting only an increase of positive
 force  in  the  systematick excitement, to ex-
 hibit the full inflammatory character.  Unlike
 the specific states of common typhus attend-
 ed  with local  affections, this disease runs its
 course  with more than the rapidity of even
 the worst forms of croup; frequently termina-
 ting life in a few hours.
  Where the  epidemick assumes the charac-
 ter we have denominated "typhus pneumony,"
 its specifick local  consequences, become still
 more distinct and sensible.   The lungs suffer
 in their economy with a degree of uniformity,
 and to an extent which appear  to cut us off
 from the opinion, that this particular derange-
 ment is casual, and distinct from a connection
 with the remote cause of the disease.*   Any
 state  of contingent  circumstances (weather,
 exposure, &c ) can scarcely be  supposed to
 exist, whence we could derive a predisposition
to a consequence so regular, as to be almost
if not altogether universal.   Nor can we look
for its occurrence to a state of parts gradually
produced,  by a previous operation of diseas-
ed action in the general body.   Pain and im-
  * An affection  of the throat is common also in this
 form of the disease, sometimes predominating  over
the pulmonary symptoms. 
117
perfect function of those organs exist simul-
taneously with the first sensible impression of
the noxious cause; and appear to result di-
rectly  from that impression, whether speci-
fically  on that part or on that part with the
whole, is of no consequence.   The tendency
when definite, and uniform, is of impression
sufficient to mark the distinction.
   We may be told that common pleurisy will
give as in this particular the same expression.
That pain is one of the first indications of the
existence of that disease.   But limiting the
remark to simple pleurisy, it is perhaps always
at first a local disease, and of casual occur-
rence.   It is never epidemick, and in all  its
phenomena essentially different from the dis-
ease we  are considering.
   The above condition of the thoracick vis-
cera so uniform in typhus pneumony, is notic-
ed by no writer as an orignial or even  second-
ary symptom of any form of ordinary typhus.
The extreme  anxiety of respiration  is also
 nearly peculiar to this disease.  In common
typhus and  some of its species and varieties
we have great mobility and restlessness, and
 sometimes frequency of respiration. As a ge-
 neral  fact however, the respiration in typhus,
 is rarely much  disordered in  this particular,
 save in the last stages of the disease.
    There is no point of physicks  involved in
 more mystery  than the aetiology of epide-
 micks. ' The remote cause of many if not all 
118
of them, appear to act on the body in such a
manner as to affect especially some particular
part or organ, rendering its function unfit for
the healthy purposes of the economy; as we
see in the state of the hepatick operations in
intermittent and remittent fevers.  By what
kind of agency the body falls into sympathy
with the part or organ, it is difficult to deter-
mine.  Whether the  material excreted in the
disordered state of the function act positively
on  the body as a cause  of systematick dis-
ease, or the body sympathises with the  de-
rangement of function, by a general law of
its Ufe, in a manner distinct from any peculiar
morbid impression, I should hesitate to pro-
pose  an opinion.  The impression of some
causes may perhaps affect in the first instance
the general sentient system, producing conse-
quences  on  particular  parts in  conformity
with the  degree of disturbance in the  whole
economy.  But it appears to me that dis-
eases uniform in  their character and opera-
tions have their peculiar agent, and that such
agent effects its  first determinate operation
on particular functions.
  Epidemicks  appear to derive their exis-
tence from specifick poisons, for the obvious
reason, that negatives produce  no positive
consequences.  And the  supposed mode of
operation would acquire a considerable firm-
ness of footing if we  may be permitted to ar-
gue from analogy  with similar agents less re- 
119
moved from our notice in their modes of ope-
ration.   The action of specifick  poisons on
particular organs and secretions; as the alter-
ed function of the skin in small pox, and mea-
sles of particular parts in lues,  hydrophobia,
&c. appeared to indicate that the secretions of
those parts are so changed under the opera-
tion of a foreign cause, as  to become  syste-
matick poisons.   The matter secreted, when
transferrable in the sensible state, as in lues,
variola, hydrophobia, &c. will be vehicles of
the same disease to other bodies;  and if such
poison be removed from a part before the
function of that part be  subdued to its laws,
the body  will  escape  systematick  disease.
We can never detect the intrinsick nature of
a  mischievous  agent.   All positive causes
(as before said,) are ((poisons," and  must act
by their peculiar qualities.  I think we may
as rationally conclude that causes different in
kind, (however produced,) will as readily af-
fect respectively, the  state and functions of
other  organs  and  parts,  the liver,  lungs,
throat, &c. and thus subdue the body to their
peculiar laws, as that  specifick causes should
operate as noticed in the instances adduced.*
Perhaps the variety of local point of operation
   * Whether epidemick diseases thus produced can
generate a matter capable of communicating the  same
disease to other bodies, is a question, which, judging
from  observation  and record testimony, 1 should be
disposed to decide in the negative.  Though I confess 
120
and disarray of  function, when original and
uniform, marks more strongly than any other
evidence the diversity  (though essentially in-
scrutable,) of cause.
   4th.  Genuine typhus of the familiar charac-
ter, is formed slowly. The patient complains
of indisposition  many days  before absolute
confinement is necessary.   Sometimes chilli-
ness is the precursor of its distinctive symp-
toms; but frequently it is not sensibly present
at any period of the disease.
   The  different forms of  the epidemick are
ushered in hastily; and  primary chill is uni-
versal.   The morbid impression also is great,
as it is sudden.   Life is endangered from the
moment of its occurrence.  Occasionally it is
true the  incipient  state of  typhus  is  more
distinct and severe.  Chilliness,  vertigo, and
debility,  are then  very  great.   But in the
epidemick the early marks  of  violence are
scarcely ever absent.

there are affirmative arguments of a speculative cha-
racter, whose force is  not easily eluded by any other
than the above appeal.  The difficulty would be less
if ii were admitted, (and I can  see no positive reason
why it should not,) that causes of a different  kind,
may have a general analogy in their mode of opera-
tion as it respects the laws of the body, in producing
their appropriate effect.  An ultimate variety of con-
sequences dependant on the peculiar properties and
laws of the cause,  would not be affected by such  an
admission. 
121
  5th. In the state of many of what are (ar-
bitrarily J distinguished, by the terms animal
and natural functions,  there is much diversity
between ordinary typhus,  and the forms of
disease we contrast with it.   Among the ani-
mal functions in the former, the senses gene-
rally, are very much  impaired when the dis-
ease is fully formed.   The  eye, the ear, and
the instruments of taste, touch, &c  are ex-
tremely  insensible to their appropriate sti-
muli. Among the latter, or natural functions,
the stomach and intestines are generally tor-
pid and inexcitable: often to an extreme de-
gree.  In  the  latter  disease,  the organs of
sensation, and the capacity  of receiving intel-
ligence by them,  remain unaffected in their
powers, or without sensible change, until the
whole of the physical faculties are rapidly
giving way.   Or, when  this infirmity of the
sentient principle exists early in any  case of
the epidemick, it is sudden in its occurrence,
and in many respects obviously different from
the state of stupor, gradually induced in nearly
all cases of common typhus.  The excitable
disposition also, of the natural functions (the
sensibility  of the  stomach,  intestines,  &c.) is
equally great as usual. Often from the com-
mencement, morbidly  augmented.*

  * The distinctive traits of typhus, which I have
adduced in evidence of the supposed  dissimilarity in
the laws of operation, (and by influence of the mode 
122
   A  considerable variety might  be  traced
still  farther, in the relative  state  of minor
characteristicks; as the expression  of coun-
tenance, the kind and order of cerebral af-
fections, &c.  But it is unnecessary to pursue
an examination, in which we can arrive at no
positively determinate conclusion; and I am
unwilling to enlarge a work already perhaps
more extended than useful. Notwithstanding,
I believe there is a peculiar cause of origin for
the epidemick now prevailing in our country,
distinct from the modes of creation for ordin-
ary generick and specifick typhus.  I am sa-
tisfied also, that in the progress of the former,
and especially in its advanced and dangerous
states,  we  shall have an intimate analogy in
the condition of the body, with regard to the
degree, and in some measure kind, of impres-
sion, on the vital and animal faculties. I would
prefer  the term "synochus" as indicative of
the  epidemick in the majority, in the early
period  of its existence and operation.    But
the tendency of that operation is always to a

of origin,) between it, and the prevailing  epidemick,
are taken from medical histories of that disease by
Scotch and British writers. It would appear that the
former disease, is both  of more common  occurrence
and definite character, in Europe, than in our coun-
try.   In America I believe an original simple typhus
is rarely met with.  This state of fever, is generally
with us consecutive of a preexistent synochoid form of
disease, either simple or specifick. 
123
general condition, to which the name typhoid
is correctly appropriate.  And we can derive
from no source so sure a defence against its
apprehended consequences, as from an inti-
mate knowledge of the attributes and demands
of that state in its general and  specifick cir-
cumstances.
   THE defects of the manner of this little
work, have some  excuse in the fact,  that
having been put in press a few days after its
commencement, and the sheets printed as first
written, a particular regard to order or dress
was  precluded.  Its  faults  in matter, (and
many may possibly be found in it,) have no
apology, and cannot claim indulgence.  No
consideration can properly give to errours in
science, either weight or  security.
a 
 
APPENDIX-
   THE practical department of medicine, includes 119
remedy for disease, of earlier adoption* or a more ge-
neral use, than bloodletting.  None whose merit has
been more the subject of discussion  and  controversy:
none whose application has been  more influenced  hy
examplc and authority; none which has been more the
instrument  of caprice, and the resort of ignorance;
none which posseses superiour fitness for  benefit to
man; and  none  which has been so often  made, the
agent of his destruction.  With the abstract question,
how much importance can justly attach to the lancet,
as a mean of defence in our hands, for health and life,
against the inroad of disease, I am not at present en-
gaged.   This essay, embraces  particular  inquiries,
rather than a general view.   But were it  necessary
to propose an opinion upon this keenly litigated sub-
ject;  or attempt  the  establishment of a  just distinc-
tion, between the indiscriminate rejection, or  recom-
mendation, of that remedy, there could be no difficulty
in determining, that both the one, and the other, were
alike inconsistent with reason and  experience;  were
equally causeless, unfounded, and pernicious. The fide
of sentiment upon  this subject, has undergone many
vicissitudes of ebb and  flow, in the successive eras of
medicine.   While at one period, the lancet has been
permitted  to rest undisturbed in its sheath, at another
it might be seen  incessantly dripping  with  human
blood.  While decried by one set of men, as the uni-
form implement  of destruction; by another  it  has

   * Since physick had any rational claim to the title of a sci-
ence. 
126
been held up to  view,  as the infallible harbinger of
security.
  This disgraceful  controversy, has  unfortunately
not been confined to those periods of medicine, which
have some excuse for their ignorance.  The periods
when  the  doctrines  of plethora,  or  putrefaction of
human fluids, constituted the extent of medical opi-
nion.  It has travelled down to the present time.  And
it  is  but recently that medieal philosophers might
have been distinguished, by those who bleed for every
disease, and  those with whom opinion had  rendered
human blood sacred.   By those who  affected a  con-
troling interference over the powers of nature by the
lancet: and those who stood passive spectators of her
struggles with disease,* or tendered her aid  through
the medium  of articles,  foreign, and for the most
part, noxious to her  economy.*   Both were wrong.
But the indisposition of mankind, to  search for that
knowledge which is  accessible only to exertion; the
facilities which it possesses for application to  practice;
and above all, the convenient refuge it affords, against
the imputation of that ignorance, the weak, and dis-
ingenuous are unwilling to acknowledge; has given to
the lancet a  frequency of use, alike  unwarrantable
by  science  and secure from  opposition.  And it will
continue to be wielded, so long as those causes, con-
spire to render  it necessary.  It is against the des-
tructive consequences, of such an instrument, direct-
ed by such motives, in the hands of such men, I would
guard  the  unfortunate victims of accident or disease.
  The  distinguished professor of medicine in  the
Pennsylvania medical academy, has for many years
past, afforded a  tribunal of appeal as respectable au-
thority, for the free, and frequent use of the lancet.
"Nil despcrandum  auspice  teucro,"   has been  the
motto  of thousands, who have held this instrument
poized against disease, under the presumed  sanction
* Diffusible stimulants. 
127
 of this justly venerable name.  Particular circum-
 stances, at one time, induced that gentleman, to pre-
 pare and offer to the  publick, a diffuse inquiry into
 the just application, and comparative advantages, of
 this remedy. And in proposing his '''defence of blood-
 letting," he  has assigned it a rank among the  re-
 sources of the profession, with which  no other can
 claim a competition.   In the early  stage of that in-
 quiry, the professor  has  quoted a sentiment from
 Botallus, upon this subject, in the following  terms;
 "one hundred thousand men perish from the want of
bloodletting,  or from its being used out of time,  to
 one  who perishes from too much bleeding, prescribed
 by a physician."  Although this sentence is equivocal
 and unmeaning as expressed, yet were the sentiment
 intended to be conveyed, strictly just,  I  should  be
 either combatting a chimera, or  contravening the
 best interest of mankind, in pursuing this examina-
 tion, one step farther.  Common philanthropy, and
 professional honour, would combine to forbid the pre-
 sent purpose, and enforce a loud acclaim to this so-
 vereign source of universal  physical good.
   But I entertain an honest conviction, derived from
 fair and full observation, that this inference i§ at war
 with fact; and in  opposing its  adoption, I believe
myself discharging a duty whose obligations are para-
 mount to every restraint imposed by authority:  that
 I  am contesting, not  so much a  speculative and un-
 important maxim in physick as a practical opinion,
 whose truth  or errour, is qualified to affect society,
 with the most serious,  and decisive consequences.
   No  man venerates  the character of  doctor  Rush
more than I  do; no one is more sensible of his gene-
ral merit. I  would not, were it in my power, remove
a single stone from the lofty edifice  of his fame; and
would be among the first to inscribe on  that column,
 "Esto perpetua." In his hands, I have no doubt, the
lancet was frequently an instrument of benefit, rare- 
128
 ly of mischief to society.  But we have not all enjoy-
 ed  the advantages  which fell to the  share of doctor
 Rush.  The multitude in medicine, like the croud in
 common life, are often rendered by peculiar circum-
 stances, the unthinking slaves of precedent and opi-
 nion,  the undiscriminating advocates of  right and
 wrong.  It is because I hold the weight of this gen-
 tleman thus imposing, that I view his errours as dan-
 gerous. And it is because I believe what was truth in
 his understanding, and good by his management, has
 been frequently made  errour by the ignorance, and
 evil by the  abuse of others; that I  have suspended
 the particular objects of this essay, to take a cursory
 notice, of some of  the  maxims  inculcated in  the
 doctor's view of the same subject.
  It is but justice to doctor Rush to  premise, that *n
 making selections from his "defence of bloodletting,"
 his indefensible and doubtful positions only, will  be
 brought into view. A reason has been already offered
 for such procedure; that reason will be a sufficient
 apology for omitting to notice, the  general intelli-
 gence, accuracy, and research, which his essay must
be acknowledged to exhibit.  The quotations will be
 made fairly, and in no instance shall the text be cut
 off from its immediate comment, or any annexed rea-
soning, which will serve the purposes of illustration.
  In concluding the perusal of doctor Rush's general
writings, every  reader must be struck with the ap-
plication of his  philosophy in medicine,  to its prac-
tice.   The decided tendency of doctrines to an active,
and  almost exclusive interference, with the laws of
disease, and the  operations of the animal eeonomy.
In the full range embraced by those doctrines, noth-
 ing, or but little, is trusted to the controul of nature,
 more  strictly speaking,  to the powers of the body.*

  * The doctor in his "review of the comparative state of
 medicine in Philadelphia," &c. speaking of  his own sys- 
129
 Perhaps this is the most serious objection, to  the
 doctor's rules of practice. For although they are not
 without some defence in this  particular, on the score
 of judicious  application, still the objection will  not
 be removed so long as there is hazard in the issue,
 and much difficulty remains, in making the necessary
 discrimination.
   Such  a notice of the doctor's  views in science, is
 not inappropriate.   From them  is deduced the mo-
 tive,  which gives to the  lancet its  almost unlimited
 agency in disease.   It will  serve as a clue to that
 minute,  and  extended detail;  as well as to the bold
 and daring practice, which his writings exhibit and
 inculcate.   And  it will shew  us the way, in which by
 following this great man, without his skill and dex-
 terity, wre are so much exposed to get adrift upon  the
 ocean of medical adventure.
   I have heard this subject examined with (in  my
 opinion.) much good sense, in the institute chair, of
 the Baltimore medical college. A serious endeavour
 has been there made, to impress on  the minds of pu-
 pils, a due respect to the appointed economy of the sys-
 tem. They have been taught to believe that that econo-
 my was  organized to preserve health, and to resist
 disease, within certain limits,  and that it required  aid
 in such an effort  more frequently, than absolute con-
 troul. This is not an indifferent consideration. There
 are many conditions  of the body,  consecutive to vio-
lent assaults of disease, in which  a respect, or disre-
gard, for such consideration, will decide  the fate of
the patient; experience has proved that the  decision
effected by the latter, was for the  most part, fatal: no
language is more unmeaning, or less warranted by
fact,  than  that  which speaks familiarly of curing

 tern, says, "it rejects an undue reliance upon the powers of
nature, and teaches instantly to wrest the cure of all violent
and feeble diseases out of her hands." 
130
 diseases;  except in a  few instances, such  language
 degrades  science,  because it violates  truth.  The
 principles of that science, are upon many occasions,
 applied usefully, only when employed negatively; na-
 ture in disease, requires a friend, not a governour; an
 aid, rather than a dictator.   I speak with  reference
 to the powers of the body in  our ordinary business
 with disease.
   It may possibly be intimated, that I have travelled
 out of my way to offer, the incense of  eulogium, to
 the  gentleman alluded  to.*   I hold  in  derision,  all
 petty malignity. The subject in my opinion is vitally
 important; and whoever contributes  to its elucida-
 tion, or renders  it subservient to  the  cause of huma-
 nity, confers a benefit for which acknowledgement is
 not a gratuity, but  an obligation.   I  detract nothing
 from the mint to which authors may have a claim; I
 speak  not of what may have  been, but of what has
 fallen  under  my own observation.  I am aware that
 a regard to  the natural powers  of the body,  is not
 new, in the history of medicine; or rather that it was
 not new one hundred years ago. The principles of our
 science such as they were at, and antecedent to that pe-
 riod, were intirely grounded upon  the  broad admis-
 sion of an animal faculty.   What were the  princi-
 ples deduced from that admission,  and the practice
 res ulting from those principles, it cannot be necessary
to   inquire.   They will not be defended on the ground
 of reason, or against the imputation of errour,  and
 absurdity. On the other hand, it  will  not, I presume,
 be contested, that much of the modern philosophy of
 medicine,  has overlooked,  or  transgressed, the res-
 traints of natural laws, in its grasp  after  dominion
 over disease: and if not  denied, it cannot be doubtful,

  * Dr. Davidge was professor of institutes at the time to
 which I refer.  I have enjoyed the pleasure of hearing but few
 lectures since then in that institution.  I think it second to
 no medical school in our country. 
131
whether a rational adjustment of this difference, is
important, or inconsequential.
   I have frequently heard it asserted that many phe-
nomena of •the epidemick, whose  character, &c. has
been noticed in the preceding essay, resulted  from
an oppressed state of  the  system, and that bleeding
was necessary  to  relieve the vital actions from that
oppression,  and thus raise the pulse,  &c.   If the fol-
lowing criticism on "the principles of bloodletting"
is eorrect, many parts of it will  have a bearing on
that subject, sufficiently obvious  to render specifica-
tion unnecessary.  The reader's memory will furnish
him with the proper grounds of application.
   Doctor Rush says,  "the effect of bloodletting, is
as immediate, and natural in removing fever, as the
abstraction of a particle of sand, is to cure an inflam-
mation of the  eye, when it arises from that cause."
In many states of fever, bloodletting is certainly the
speediest, and most effectual mode of restraining the
violence of fever, and averting its  consequences from
particular organs, or  on the body generally.  But
there is no  just analogy, between the abstraction of
blood,  and the  removal of a grain of sand.   The one
is naturally present, and  proper, to  the  body; the
other foreign, and necessarily mischievous.  The one
is the  immediate cause of injury,  the other the indi-
rect medium of evil.   The one  acts of itself; the
other requires  to be acted on.  The properties of the
one are inimical, the qualities of the other friendly to,
the system.   Whether the blood ever becomes  by its
quality, or quantity, a source of  fever, is  doubtful,
probability is rather opposed to,  than in favour of,
               R 
132
 such opinion.  The blood vessels, are the immediate
 agents of mischief.
   A general argument in favour of bloodletting, has
 been  inferred by doctor Rush, from the presumed
 purposes of particular parts of structure*  The spleen
 and thyroid gland, have been the peculiar subjects of
 this view, doctor Rush calls them, "basons furnished
 by nature, to hold  redundant blood."*   The proof
 of this  position, rests  upon  the  assertion of  en-
 gorgement  in the spleen,  in severe, and  fatal cases
 of bilious fevers.  The spleen,  he  says, is sometimes
 too  small  to perform the office of reservoir;  and
 bleeding thus  becomes  necessary.    He  draws  the
 same conclusion, from the relief said to be procured,
 in chronick, and  winter intcrmittents, from bloodlet-
 ting.
   Nature never  leaves her work incomplete.  And
if the spleen is ever too small, when in  its  natural
condition, to perform the office of reservoir, such is
not the  function for  which nature designed it. That
it is  always  too  small, to serve effectually,  the pur-
poses of retreat, for a part of the "blood in fever,
must be immediately obvious, to a reflection upon its
comparative capacity,  to  the general  quantity  of
blood:  and this  fact  affords  conclusive  testimony
against  the  just  attribution of such an  office.  Ad-
mitting  for  a moment, the capacity for,  and perfor-
mance of, this supposed function: whither would it
lead? what becomes of this retired portion of blood?
does  it remain insulated, and cut off from the circula-
tion, during a fever  of three and five days? and if it
 does, what preserves its living condition: its  equality
 of life with the circulating mass?

   * Keil, one of the oldest anatomists whose writings we
possess, entertained an opinion respecting the recipient of-
fice of particular organs, very similar to the modern senti-
ment. He attributed  a capacity for  receiving redundant
blood to the liver. 
133
   Engorgement or obstruction of the spleen has been
 exclusively connected with bilious fever: why this as-
 sociation?  why limit its friendly offices, to one form
 of febrile disease? simple inflammatory fever, pneu-
 mony, and  phrenitis, arc diseased conditions of the
 body, producing an equally elevated range of arterial
 excitement, with bilious  fever.   They  are equally
 dangerous  to life, and of course, equally  demand
 sympathy,  and succour.   Respecting  the  cure  of
 chronick and  winter intermittents, by bloodletting,
 experience  would establish as a  general  fact,  that
 the  most successful mode of  relieving  the  system
 from that condition, in which this form of disease
 consisted, was by aiding it in making for itself an in-
 creased quantity of blood.  But there  is no  conside-
 ration, which so completely puts  to rest all doubt in
 the decision upon this subject, as this inference drawn
 from analogy in structure, as to similarity of func-
 tion.  In parts naturally  fitted to receive an occa-
 sional increase of the quantity of blood, with a  view
 to the performance  ot  a natural  office, we have  an
 evidence of such capacity and fitness, in the mechan-
ism  of that part.   Dissection or injection,  has never
 yet  detected a cellular  arrangement of structure in
 the  spleen,  or thyroid gland.*  It is unnecessary  to
 say  in what part nature has made this provision.
  "Bloodletting, (says doctor Rush,) frequently stran-
 gles a fever in  its forming stage,  and  thereby saves
 much time, and expense to the patient."   Had  doc-
 tor Rush said that bloodletting in the  early  stage of
 fevers,  frequently  prevented  a local  disease as  its
 consequence, I should have agreed with him, in the
 correctness and utility of the maxim.  As it is ex-
 pressed, I confess there appears to me much risk, in

  *  I first heard this objection to the recipient attribute of
 the spleen, &c. proposed by doctor Davidge in his lectures
 on physiology. 
134
 reducing farther  those powers  of the body, which
 are always low,  in  the forming  stage  of fever.
 Doctor Rush might discriminate correctly under such
 circumstances, but his opinions are in the hands, and
 influence the practice, of those who have not so much
 penetration as  that gentleman possessed.
  * "In the period of menstruation," doctor Rush says,
 "the uterus is in an  inflamed state, and the whole
 system plethorick,  and excitable.   Bleeding there-
 fore, is more indicated,  in fever of great  morbid ac-
 tion, at this time, than at any other."   Of the preg-
 nant condition, he remarks,  "the inflammation  and
 distension,  induced upon the uterus by  pregnancy,
 and the  inflammatory diathesis  thereby imparted to
 the whole system, renders bleeding in the  acute state
 of fevers, more necessary than at other times."
   Were the opinion  derived from our forefathers
 upon the subject of menstruation,  correct, viz. that
 this function required for its  performance, a pletho-
 rick condition of the body or  the organ, or both; the
 doctor's  inference would be in part just.  But if this
 office is natural to the organ, we must unavoidably
 reject all deductions, founded upon the presumption
 of  its generally  inflamed condition in  the  discharge
 of that office.*  If  natural to the organ, it is neces-
 sary to the health of the body.   Why its perform*-
 ance, if  thoso principles are correct, should produce
 a plethorick and excitable,  in other words a diseased
 state of the system,  we should be puzzled to discover.
 But affording  the doctor's  presumption the  utmost
 latitude, admitting  local inflammation, and  general

  *  We know that the due performance of this function, is
generally if not universally necessary to the full health of
the female bod v.
  Inflammation is disease: ami that a diseased process should
constitute naturally, an essential part of the regular, healthy
economy, is an absurdity in physicks, too gross for refuta-
tion. 
135
 plethora, I should be still at a loss even to imagine,
 why fever of great morbid  action from this  cause,
 should indicate a necessity for more bloodletting, than
 fever of great morbid action, from any other cause.
 Neither "inflammation or distention of the uterus,"
 are a natural consequence of pregnancy; nor is there
 any "inflammatory diathesis" ordinarily imparted to
 the whole  system, by the pregnant condition.   The
 enlargement, and increased  capacity of the uterus in
 pregnancy, are gradual and  necessary changes in the
 state and economy of the organ, effected by regular,
 and  healthy laws.  The natural actions of the  body
 are increased by pregnancy, because they have a work
 to accomplish, not embraced in their ordinary circle;
 the production, and  nourishment of the foetus, &c.
 But this increased action and operation,  is neither
 diseased itself, nor dependent upon  a diseased condi-
 tion.   There is more blood  at that time present to
 the body.  But there is no disproportion between the
 quantity and the  demand.  It is present, because it is
 necessary.*
   "The chills which follow bleeding (says Dr. Rush,)
 are the effects of a change in the fever, from an un-
 common,  to  a common state of malignity." I would
 earnestly warn young practitioners, to be cautious in
 prosecuting  bleedings, which are followed  by chilli-
 ness.  That system is generally feeble in its actions,
 which is agitated in  this manner by the loss of blood.
 If by "a common state of malignity," is meant a real

  * On the subjects of menstruation and pregnancy, I have
 heard much, that I thought just  and rational, in the medical
 school of Maryland.  A few intelligent men had hinted at a
 secretory function  of the uterus in menstruation, prior to
 1793j Doctor  Davidge at that time embodied and improved
 the arguments in favour of this sentiment,  in an inaugural
 essay.  They are  now proposed to his class, as the most
correct theory of this part of female physiology 
136
diminution of disease, the body should be less disturb-
ed in its operations under such circumstances.
   "Coldness of the extremities, and  of the whole
body."   "This cold state of fever,  (says D>..Rush,)
when it occurs early, yields more readily to bleeding.
than to cordial medicines.',   Are coldness of the ex-
tremities, and of the whole body,  always, attended
by fever^ And if they are, will that condition of fever
always, will it generally, bear bloodletting? 1 pass by
those states of, the system, of which such  symptoms
are usually indicative.  They are familiar  to  every
one. But this remark is accompanied by no reserva-
tion, and  if  received in other than the most limited
application, it is certainly destructive.   I am not ig-
norant that there are certain forms of serious local
disease, in which the  expressions of the general sys-
tem, are equivocal.  And in such circumstances, we
may have active inflammation, in a particular part,
or  organ, with coldness of the surface and extremi-
ties. In diseases of the head, stomach, and intestines,
this state  of  things, is not uncommon.   But even
here, we are not left  without  admonition,  from pre-
vious experience, and the evidence of the senses. The
operations  of the  mind, the expression of the eye,
and  of the general, countenance, the  pulse at the
wrist, the arteries about the neck and temples, or the
comparative  force of the  heart, might all  be ex-
amined,  with  a view  to  correct  opinion,  in  dis-
ease of the head.   For the  stomach and intestines,
where we could  have  no surer indications, the kind,
violence, and duration,  of pain, would serve us as
guides.  But we  are  to take the  expression as it
stands; and before adopting it as applicable  to prac-
tice in simple fever, attended as we shall usually find
it under  the circumstances mentioned,  (viz. cold sur-
face and extremities,) by frequent and  feeble pulse, I
would beg every practitioner, to think seriously on the
consequences. 
                         137

    The  caution inculcated in the preceding remarks
 upon bleeding in chilliness, will be equally applicable
 to the practical inferences of the following paragraph.
 ".Uncommon weakness, succeeding bloodletting, is the
 effect of sudden depression,  induced upon the whole
 system, by the cause before mentioned, or, of a sudden
 translation of the excitement of the muscles, into the
 blood vessels, or some other part of the body. These
 symptoms,  together with all the others, which have
 Oeeii mentioned, are so far from forbidding,  that they
 all most  forcibly  ln<iu£?  a rePetition °f# bloodlet-
 ting."   I shall add but little to the preceding noticc
 of this subject.  When  the  powers of the body, are
 oppressed, not exhausted, by  the cause or kind of dis-
 ease,  repeated bleedings can be proper, only when
 followed by comparative vigour instead of diminished
 strength. I mean as it regards the bloodvessels.  They
 are the only index which should be known to the phy-
 sician, under such circumstances.  If the body sinks
 in power, and the arteries do not acquire energy, con-
 tinued  bleeding,  must  be hurtful or worse.   Were
 the sentiment adopted with a guarded application, to
 the translated excitement into the  blood vessels, when
 that excitement was sensible, it would  be less objec-
 tionable; but the doctor, has said, or some other  part
 of the body.
   Doctor Rush rejects the distinctions established up-
 on  the appearances of blood drawn  in diseases.  He
 says, "dissolved  blood, is an evidence of the highest
 grade of inflammatory action; and is the consequence
 of  the  force of impression upon the  bloodvessels,
 rending and  tearing the blood to pieces."  Those dis-
 tinctions are  not always just.   The state of the blood
 should never be a sole, or even a weighty  considera-
tion, in the  management  of the  lancet.  But that
state of the blood,  to which  the. term dissolved, has
been usually  applied, I think  is correctly understood
to be a general consequence of weakness in the body. 
138
 I cannot believe that  any cause  can  impress the
 bloodvessels in such a manner, as to make them rend
 and tear, the blood to pieces, I should prefer the sup-
 position, that this condition of the blood,  was  the
 consequence of the loss of some of its necessary parts,
 from diseased action; But more particularly  result-
 ing from a defective performance of the blood-making
functions.
   In enumerating the conditions of pulse, which indi-
 cate  a  necessity for bloodletting,  the  doctor  has
 brought into view nearly all the expressions, which
 it gives  us under any circumstances.   I  shall notice
 but three of those states of pulse.   The  first is, "an
 uncommonly frequent pulse, without mueh tension;
 beating from one hundred twenty to one  hundred se-
venty or eighty strokes in a minute." What is strict-
ly meant by without  much tension, it  is difficult to
establish; but so  far as my observation serves me, a
pulse of one hundred  seventy or eighty, is rarely tense
at all: and if there is no  tension in  such a pulse, I
sincerely believe  there are few states of it in which
bleeding would be less proper, or more dangerous. It
is peculiarly that condition of  pulse, which we  find
portentous of a fatal termination,  in  the advanced
stages of inflammatory disease.
   The second is, "a  soft  pulse, without much  fre-
quency, or fulness."    Generally speaking this is the
pulse of ordinary health.   Or,  if  local  disease is
sometimes attended by this state of pulse,  bloodlet-
ting, in such disease, can seldom be necessary;  its
consequence is doubtful,  and must frequently be per-
nicious.  A part, or organ under such circumstances,
is debilitated in its functions, or has suffered in  its
structure; the system does not sympathize actively,
with such part,  or organ, but is making temperate
efforts for its relief.   The success of that effort, de-
pends upon a certain  degree of tone, in the general
powers: that tone is now at a medium; reduce it, and 
139
the death of the part, or a protracted,  perhaps per-
manent, disarray of structure, will follow.
  The third is, "an imperceptible pulse."  Where
this occurs even in the first moments of disease, blee-
ding must be frequently, I will say generally, impro-
per.  The absence  of pulse at the wrist, may ensue,
from any cause which communicates a violent shock
to the vital powers; producing a temporary  suspen-
sion of their functions. We find it in general syncope;
this condition may be produced, through the medium
of the senses: by the active, and  sudden operations
of the mind: or, by the preternatural force of a na-
tural  action, directly exhausting, or overwhelming,
the natural  energies.  An  "imperceptible  pulse,"
may occur also, from any  cause,  immediately redu-
cing the tone of a necessary action.   Any thing, for
instance which materially affects the vigour  of eon-
traction in the heart, or the due performance, of the
respiratory function.  It is  a consequence of some
states of concussion,  or of mechanical  injury of the
brain,  from accidental violence.  And is an  usual
expression of the  sympathy  of the  general  system,
with the offence offered that organ, in the first stage
of apoplectick diseases.  In all these conditions (and
others which might be noticed,) the sum, and relation
of  excitability, and excitement, is reduced and lan-
guid; and  scarcely adequate to the preservation  of
the phenomena, and  faculties of life.  Both depend
upon the laws of circulation.    With this result pen-
dent upon them, their operations thus feeble, can  be
subdued farther by the lancet, but at the peril of the
patients.
  " Doctor Rush  says,  he has sometimes "wished,
that the  Chinese custom, of prescribing from feeling
the pulse only, without seeing, or  conversing  with
the patient, were imposed upon all  physicians."  It
cannot be necessary to notice this remark seriously;
or to ask what would be the consequences, of such a
             S 
140
 restriction.  How, without the aid of inspiration, wc
 are to carry the doctor's own principles into benefi-
 cial operation, thus limited, I cannot even conjecture.
 With  him,  bleeding may  be necessary, in almost
 every state of pulse.   In many, it can be admissible,
 only from peculiar circumstances.   Whether  these
 circumstances  exist, we are here left  to imagine.
 The chance of errour, is  at least as great, as the
 probability, of accuracy.   Doctor  Rush  says, that
 continued  bleeding  is  sometimes necessary,   when
 the pulse  sinks tinder  it, so as to be scarcely per-
 ceptible.   Does the pulse  at  that  time, prefer an
 argument of such necessity.  The doctor also consi-
 ders bleeding occasionally indispensable, where "the
 surface  and extremities are  cold."   The  pulse of
 course, generally feeble.  Where  "the pulse  is with-
 out much frequency, or force." In "depressed states
 of pulse."  And in, "the imperceptible  pulse." pro-
 perly speaking, where there is none. The doctor can-
 not  mean,  that those states of pulse, always require
 bleeding.  How, in obedience to  this "Chinese cus-
 tom," are we to discriminate, when they  do?  But the
 subject is unworthy of discussion; I will close it, by
 inserting a  sentiment of Mr.  Hunter, quoted  with
 approbation, by doctor Rush, in his "defence of blood-
 letting." "In inflammation of the  brain, the pulse va-
 ries more,  than  in inflammation of other parts; and
 we are led  to judge of inflammation there, more from
 other symptoms, than the pulse."   I will add  a re-
 mark, for which the  doctor  himself is  authority.
 "But in misplaced states of fever,  the pulse, like folly
 in old age, points at a different mark  from nature."
   In speaking of "the difficulty in deciding upon the
 use of the  lancet, where the pulse imparts no sign of
disease,"*   the  doctor  remarks,  that  "when   the
disease is recent, the  part affected important to life,
  *The doctor's regard for truth, here  again stares the
"Chinese  custom" in the face. 
141
 when pain is great and respiration difficult, where
 there is redness  in the face, and a watery, lively, or
 suffused eye, the pulse may be disregarded in the use
 of the lancet*"   No one of those symptoms, nor all of
 them together, will warrant the use of the lancet,
 without regard to the pulse.  In some disease where
 important  organs arc  affected,  there  is  great  real
 weakness of the  natural powers from the earliest pe-
 riod of attack.   Great pain and difficult respiration,
 are frequent consequences of very opposite conditions
 of parts, or of the whole system.  Redness of the face,
 occurs in fevers of greatly reduced arterial energy, as
 well  as in  those  of  inflammatory excitement.   The
 capillary vessels are  debilitated; unable to contract
 vigorously, and  propel their contents,  they become
 injected.   This is  not always a consequence  of  in-
 creased impetus,  or vis a tirgo.  The system of which
 those vessels make the capillary series, is.enfeebled,
 reduced in tone,  and  incompetent  to  communicate
 the energy which they want.   What  is  the hectick
flush  in every period, and to  the fatal moment of
 phthisis?   What is the crimson hue, of the advanced        *
 and closing stage of pneumonia?*bf fatal  small-pox?^*^**'^'*
 of angina maligna? of many states of typhus? and of/44^w^ ^-
 most of those  conditions of fever, indicative  of ap- ^i***'  .
 proaching  sphacelus, of some internal part?  In none ~*f*T K
 of those  diseases thus producing  "redness  of  the td-**£^$~
 face," can the pulse be "disregarded  in  the  use of ^ dcJ*.
 the lancet,"  but at the peril, the probable sacrifice f
 of life.  A "watery eye" is not always proof of even
 local inflammation;  never, except attended by other
 indications of that condition.  Taken  alone,  it  can
 afford us no evidence of the state of the general sys-
 tem.   A "lively  eye," is frequently  the consequence
 of an excitable and vigilant condition of the system,
 dependent upon debility; and very different from that
 which requires depletion.   A "suffused  eye,"  is  no
 unusual herald,  of approaching death.   When  the 
142
tone of fine  vessels, is greatly reduced, their appro-
priate  fluids, are permitted to escape.   What is  the
mucous perspiration of extreme debility?  and what
the effusions which are poured into cavities, in arti-
eulo mortis?
   Doctor Rush attributes  the "prejudices against
bloodletting, to an ignorance of the rapid manner in
which  blood is  regenerated, when lost or drawn."
And says, that even  where no aliment is taken into
the stomach, "an adequate  reproduction of blood is
effected; by the chyle which is secreted  in the liver,
from the fat of the omentum."  This tortuous physi-
ology,  will require but little attention. I never heard
of a law in  physiology, by which two different effects
were produced from the same cause, or in the animal
economy, by which a single  organ, performed  two
distinct  functions.   How  does the liver get in pos-
session of the fat of the  omentum?  through  the ge-
neral  circulation! or have  the absorbents, (the only
instruments for furnishing this material,)  found  out
some more  direct route to the liver, than the thora-
cic duct, and subclavian vien?  And if this material
arrives  at  the liver, blended  with  the circulating
mass,  in what way does this  organ select and sepa-
rate it, from that mass  for chylopoetick  purposes!
What  becomes of the biliary secretion; while the pro-
cess is going on?   By what route does this hepatick
chyle,  when manufactured, find its way into the duo-
denum? Is the road common to it and to the bile? Do
they travel together yet touch not? Or do they mix,
yet undergo no change?
    Doctor Rush says "in  pregnancy the uterus is  al-
 ways affected with that grade of morbid action, which
 I formerly called inflammation: this is evident from
 its exhibiting all  its usual  phenomena in other parts
 of the body."   They are
    1st. "Swelling or enlargement." 
143
   There is no swelling in pregnancy.  The enlarge-
 ment, is a natural growth of the uterus.  When this
 increase of substance, is no longer necessary, the ab-
 sorbents  take away what is  not essential to the or-
 dinary functions of the organ.
   2nd. "Hemorrhage."   "The  lochia are nothing
 but a slow, and spontaneous bleeding  performed by
 nature, and intended to cure the inflammation of the
 uterus, after  parturition."
   The lochial discharge cannot properly be termed a
 bleeding or hemorrhage.*
   It is a  healthy evacuation,  not intended to cure,
 but to prevent inflammation.   It  is one effect of a
 ■ystem of natural laws, destined to restore the uterus
 to the condition antecedent to pregnancy.
   3d.  "Abcesses, schirri,  and cancers."  These with
 doctor Rush  are the consequences of  "pregnancy,"
 "parturition," and "menstruation."  They  occur in
 women under all  circumstances.  More  frequently
 in sterile women, and those who want  menstruation,
 than in prolifick, and menstruating females.
   4th. "A full, quick, tense, or frequent pulse: want
 of  appetite,  nausea,  puking, syncope, and convul-
 sions."  Those  circumstances are  not necessarily in-
 dications  of  inflammatory condition.   None of them
 are peculiar, to  pregnant, or parturient women.
   5th. "Sizy blood."  This to  a  certain  degree, is
 not always,   or even  generally,  inconsistent  with
 health.
   6th. "A membrane."  Doctor Scarpa, says doctor
 Rush, has  proved the membrana decidua, which is
 formed during pregnancy, to be in every respect, the

  * After the detrusion of the foetus, the uterus in gather-
ing up to a smaller volume, forces out from the patulous veins
or sinuses part of the blood no longer necessary to its econo-
my.   The evacuation when natural in quantity, is rather a
discharge of extravasated fluid, than a hemorrhage. 
144
same in properties,  with the  membrane  which is
formed  upon  other inflamed surfaces;  particularly
the trachea,* the pluera and the bowels."   Where
is  this proof?  In established fact, or mere fancy?
Are the latter membranes when formed, possessed of
living capacities? Do they serve any purposes proper
to the natural economy?   Are they  not dead matter,
extraneous and hurtful to the body, as soon as formed?
Why did not doctor Scarpa go on,  and say that the
placenta, and foetus, were analogous in their produc-
tion, and properties, to those membranes, or to sehir-
rus and calculus?
   "Parturition, (says the doctor,) is a higher grade of
disease, than that which takes  place in pregnancy,
it  consists of  convulsive or clonick spasms in the
uterus,  supervening  its inflammation.   By  some
divines these symptoms,  and  particularly pain,  have
been  considered as a standing,  and  unchangeable
punishment of the original disobedience of women; and
by some physicians, as indispensably necessary to ena-
ble the uterus  to relieve itself of its burden."
   Oh nature, or rather  nature's god! how much has
thy goodness to thy creatures, been misapprehended,
and perverted  by the whimsies  and caprice of man.
"Crescite et multiplicamini." Heaven's first, and best
law, to humanity is disease.  Who ever saw "convul-
sive, and clonick spasms," of the uterus, in natural la-
bour?  Who has discovered this condition of the ute-
rus, to  exist  in any labour?  The parturient  capa-
cities of  this viscus, may be irregularly, or not pro-
perly  exerted; but there is no evidence, that this ir-
regularity or defect, consists in  a  "convulsive, or
 clonick spasm."  What have divines to do, with the

   The material found in the trachea,  on the pleura, bowels,
&c. is not a membrane; it is never organized, and is. nothing
more than mucus, or lymph rendered thick and viscid by the
loss of its more fluid parts,  either by evaporation or absorp-
tion, sometimes by both. 
145
"symptoms" and "pains" of labour ?   I believe they
seldom meddle with this  subject;  If they ever do,  it
is an  indiscreet interference,  with what they  can
know  nothing about.  Some physicians, can consider,
and  conjecture, any thing in physiology, rather than
fact, or rational inference.   It must be such physi-
cians, who suppose that the detrusion of the foetus, de-
pends  solely, upon the convulsive and clonick spasms,
and pains, of the uterus.*  But conceding for a  mo-
ment, all that has been contested, in what consists the
necessity  for bloodletting?   Is  it to promote, or pre-
vent,  those  "convulsive  and  clonick  spasms,  and
pains," of the uterus? The doctrine says they already
exist; it says  also,  that  they are indispensable.  To
assist  then, is  not  requisite; to restrain must do
harm.   If menstruation, pregnancy, and parturition,
be disease, alike inconsistent with health,  are secre-
tion, nutrition,  and  every  evacuation.   They are
equally nature's laws; equally uniform and necessary,
they exist upon principles but partially different,  if
not entirely analogous.   With  the ordinations of pro-
vidence, I dare not interfere; they are doubtless just.
But  whatever divines, or physicians, may  have ima-
gined,  I believe them too far removed from our com-
prehension, to  serve  the purposes of  argument, in
the discussions of science.f Brutes have not offended
heaven;  have incurred no penalty  for  disobedience.
Yet they  too, bring forth with  pain.


  * The strictly uterines action in labour, is simple and
limited.
  t That the denunciation of heaven, "in pain thou shalt
bring  forth children," has  been  accomplished, I have no
doubt.  But this is no evidence that labour is a disease, con-
sisting in "convulsive and clonick spasms, and pains, of the
uterus, requiring the use of the lancet. 
146
   But I have done with this subjeet.  It has received
its proper  colouring, from the hands  of an  abler
painter.*
   From the numerous and  just claims of doctor
Rush, I have already said, I felt' no wish to  detract.
His memory is entitled to the gratitude of his coun-
try, and of the profession, for his benevolent and in-
dustrious exertions in the cause of humanity, and of
science. Engaged in examining, and endeavouring to
expose, the misapplication of the lancet, I wished to
take-  from ignorance  and idleness, every security,
which they might hope to  borrow, for its abuse, from
a  partial, or  perverted construction of respectable
writers. In this view, the doctor's, "defence of blood-
letting," lay  incidentally  in my way; I have touched
nothing else and am  now done with that.
   "We must do something," is the most unfortunate
and pernicious maxim, which has ever been introdu-
ced into the policy of medicine. At the moment when
it received the sanction of professional reputation,
professional imposture was legalized, and ignorance
and artifice acquire  confidence, from feeling securi-
ty.  I refer to no particular  authority for the incul-
cation  of  this  sentiment.   It  has unhappily been
stamped with the approbation,  and received the con-
nivance of numbers, who  could have wanted nothing
but reflection, to have  refused  it their assent.  Its
adoption has never wanted advocates; it has been ea-
gerly received, and amply exercised; and the profes-
sion is  to this day disgraced by  the admission that
"mankind  must  be amused."   Had half the  painB
been  taken  to  acquire  professional understanding,
which have been practised to impose on soeiety,  this
maxim might long since have been committed for the
more honourable sentiment,  that mankind must be
instructed.
   * Vide doctor Davidge's  letters to professor Barton, in
the 1st number of "P. Sketches." 
147
   It is under the covert of this professional mask,
that the  prejudices of the  world have been pressed
into the service of the practitioner; and its ignorance
arrayed against its security.  It is  thus  that a con-
venient resource has been provided against that false
shame which dreads a candid avowal, and the physi-
cian armed with implements, for whose use  or conse-
quence, he apprehends no responsibility.   Among the
weapons of this licensed warfare  against  decorum
and  integrity, the lancet holds a distinguished rank.
Like the sword of Alexander, it is the universal sol-
vent for every difficulty; and has often been made  to
sever the gordianknot, which defective ingenuity was
incompetent  to unravel.  Justice would be violated
were those remarks pointed solely at the worthless
herd whose business is imposture; who openly repose
their claims upon the hopes and fears, the follies and
the weakness, of their fellow creatures.   They reach
even him to whom contingent  circumstances have
opened  a more ample and elevated range in profes-
sional relation; who  without an effort to improve that
profession, is solicitous to enjoy by other  means, the
benefits of its exercise.
   Is the opinion so generally cherished by the vul-
gar and uninformed with regard to  the  advantages
of bloodletting, in a  majority of diseases, and in near-
ly all  accidental injuries,  the  result of reasoning
strictly their own, or the consequence of impressions
derived from  a  familiar notice  of practical habits
among professional men? we cannot withhold our as-
sent from the latter. Nor is it the experience of time
past alone, which contributed to the establishment of
this  sentiment.   It  is fully  warranted  by the daily
observation of mankind at the present period.
   1. Should some mechanick or artificer, engaged in
prosecuting  his ordinary business,  be unfortunately
precipitated from an elevated point, thus incurring
violence, what is the usual condition produced by such
               T 
148
accident? and what the efforts on the part of the phy-
sician, for  the relief of the patient?   In a majority
of instances such an occurrence will be succeeded by
a suspension, or  but feeble exertion of all the powers
dependent upon the due performance of the vital func-
tions.  There is disturbed or abolished  intellect, a
loss of sensation and motion, imperfect respiration,
diminished energy of the vital  and natural powers,
particularly of the heart and arteries, with a loss of
temperature on the surface and extremities. To these
symptoms may be superadded, a  more or  less con-
siderable train of contingent circumstances; mechani-
cal injuries for instance, as fracture,  &c.  or, deran-
ged office of particular  organs, as vomiting.
   The first idea which presents itself to the minds
of those who have collected about the sufferer, is the
necessity for  immediate bloodletting.   A physician is
called;  for what? to exercise  the  principles of his
profession  as aids in restoring the functions and pow-
ers of life? assuredly; does he make that application
upon the just deductions of reason and science?  I an-
swer generally,  he does not.   Perplexed by phenom-
ena which  he has not qualified himself  to compre-
hend;  submitting to prejudices which  he  has neither
intelligence to refute, or firmness to resist, he  feels
a security  only in a concurrence with common  opin-
ion, and customary habits.  He does  precisely  what
he should  avoid.   He  bleeds,  or  attempts to  draw
blood,  "lie must do something."*  In this case all
the natural powers  of  the body, sympathize with a
peculiar condition, or direct injury of some important
organ, concussion for instance, or violated  structure


   * It is unnecessary to remark that I do  not suppose such
 would be the conduct of all physicians.  And every  man's
experience will furnish him with proof that such is the con-
duct of many who are so called. 
149
of the brain.*  Or the impulse communicated to the
body generally* without local violence, may have pro-
duced a suspense, or derangement in the operation of
the laws of the  whole  economy.   Under those cir-
cumstances, the energies of the heart are the forlorn
hope of the body.  Those energies depend primarily
upon the vital functions;  these are interrupted  or
impaired, and can only be restored through the me-
dium of circulation,   The heart enfeebled by a tem-
porary severance of its connexion with the vital func-
tions, (or more  strictly; cut off from the immediate
influence of the brain and nervous  system,) on what
depends the continuance of its action, and the repro-
duction of general energy in the system?   I answer,
upon its remaining capacities for  impression, acted
upon by the properties  of the  blood; and by the sti-
mulant effect of a certain degree of fullness in the
heart, and large arteries. Take away blood, and you
detract from  both; you disable more particularly, in
removing the support afforded by the latter.
   It is of no consequence whether the  heart derive
its energies   from a  particular organ, or  a general

   * Some writers have attempted the establishment of a pa-
thological principle, which has acquired weight  from the
general approbation of the highly respectable Pott, viz: In
concussion of the train, to bleed not at all; in mechanical vio-
lence of that  organ, to do so always.   The distinction is
intended to apply more particularly to the immediate conse-
quences of the injury.  And however just the first part of
the maxim may be in its general application, there is but
one  consideration (and that one  so far as my observation
extends overlooked by all writers,) which can afford a ra-
tional ground for immediate bloodletting in the latter condi-
tion;  viz. lsesion'of the organ; it is when from the character
of the injury,  and the state of the arterial system, we  have
reason to apprehend that the vis a tergo will produce farther
violence, by continuing to pour blood upon the brain, from
the ruptured small vessels.  Here we may bleed, to arrest
sucli hemorrhage, by abstracting from the forces which sup-
port it. 
150
system; independently from the brain, or immediately
from its connexions with the vertebral column.  The
consequence is still the same.  The laws of sympa-
thy are universal.  Any cause affecting the body in
such a manner as to produce the evidences of gene-
ral disability, which we find in the first stages of vio-
lence from accident, will enfeeble for a time, and to
a degree the force of circulation.
   That there is this remaining  capacity in the or-
gans of natural action, in  suspended,  or interrupted
animation, must be admitted, or suspended animation
must always produce absolute death.  For rationally
speaking, the body cannot  immediately receive from
any foreign source, either the principal of life, or  a
capacity for its production.  But for this remaining
capacity also, the experimental physiologist, would
be operating upon matter  absolutely dead, the mo-
ment he had insulated a portion  of the living body;
as no part of sueb body,  posseses  of  itself, distinct
and independent properties of life.
   That a certain relation between capacity and con-
tents, or a due support from  the quantity of blood, is
essential to the  tone  of vascular action, perhaps, to
life itself, cannot be denied, until hemorrhage ceases
to produce direct debility, convulsion, syncope, and
death.
   I will examine the arguments of which those blood-
letting gentlemen have been accustomed  to  learn.
One  of them is the fashionable phrase of "suffocated
excitement."  An apprehension that too much blood
has been  thrown  upon the  heart   and large  arte-
ries.  It is easy to relieve them  of .this solicitude.
The  consequences which  they dread, are precisely
such as  the system requires.  In this state of reduced
vigour, a preternatural stimulus is  indispensably ne-
cessary  to the reestablishment of action and energy,
in  the heart and arteries.   That stimulus is the blood
accumulated in parts possessing the greatest  living 
151
capacities.  Why if the proposed ground of defence
for this practice  be correct, do we hesitate  to draw
blood in the chilly stage of an intermittent?  a condi-
tion in which  though the actual debility of the heart
be ltess than under the circumstances we are  conside-
ring, and the engorgement equal or greater, we dare"
not increase that debility, or take off that fullness by
the lancet.
  2. Has some unfortunate been  tumbled from his
horse, or thrown from his carriage; or has he received
a blow, a kick,  &c. and is found by a physician Who
has  been called, in the state of insensibility previ-
ous!^ described; with the faculties of life suspended
or but imperfectly performed?  On every hand there
is  expressed an evidence of curiosity and solicitude,
in the countenance of the  attendants.   All  eyes are
turned on the  physician.  He prefers his answer by
unsheathing his laneet.  Happily for the interests of
humanity, the condition  of the sufferer  frequently
affords him a  security against the pernicious  conse-
quences  of this gross  and vulgar  ignorance.  The
arteries  in many instances  are  not in  a condition to
pour out  that blood  for which a passage has been
opened.   But for  this circumstance, the conclusion
of a copious bloodletting, and the  commencement of
burial* pi'eparation, would not unfrequently be syn-
chronous.   And the physician effectually  avert  the
indefineable consequences which he fears, by putting
a period to the life of the patient.
   Again I  would ask, from what principle,  of philo-
sophy, science, or common sense, is deduced the neces-
sity for  immediate bloodletting under  those circum-
stances?  If the shadow of a reason can be offered,
I  will  make  an  unreserved  apology  for all I have
written.  It is a practice  without principles; a tame

   * This is not fancy hut fact.  I know that such a conse-
 quence has been thus induced, in more than one instance. 
152
submission to prejudice  and example;  and an  un-
manly retreat from a fair inquiry, or a candid ac-
knowledgement.
  I  have already slightly noticed a  phraseology in
medicine, which all affect to understand; and from
which perhaps this practice may receive some illus-
tration.  The doctrine of excitability and excitement;
with  their supposed  varieties of  relation to  each
other.  If excitability be accumulated by the sudden
reduction of excitement, thus producing a dispropor-
tion, or loss of natural  relation,  how will a farther
reduction of  excitement,  reproduce an  equilibrium?
Upon what depends excitability?  Upon  the natural
actions, in other words, the general excitement.  It
is the capacity, of life supported by the living actions.
If not  in  this way,  excitability  is  no part of the
economy of the  system.   It is foreign  to the body,
incidentally present, and when reduced  could not by
the body itself, be restored.   How  is an interruption
or suspense of the exertion of those powers to increase
the excitability which  is dependent for its natural and
healthy state, upon their full and perfect exercise?
If by the sudden reduction of excitement, an augmen-
ted sum of excitability is  present to the body, why
and how is it, that the  natural agents, or stimuli, of
light,  sound,  appulse,  heat, &c.  lose in part  or en-
tirely, their  accustomed  effect?   And if by morbid
accumulation  under  those  circumstances, is  meant
concentered excitability, excitability increased in a
part, but the increase limited to  such part, or parts,
how, I repeat, is bloodletting to equalize it?  If that
eondition docs exist, and bloodletting can restore the
equipoise, why have we neglected to use it in cases of
exanimation from submersion, and of asphyxia from
cold?
   3d.  Is some poor labourer called upon under par-
ticular circumstances for an exertion which he is in-
competent, to bear, but which he makes, and falls 
153
enfeebled, exhausted, and almost expiring?  What  is
the usual consequence of his being found in this con-
dition by a physician?  His blood must be shed.   If
this were not ignorance, I should  call it inhumanity.
   4th. Is a  publick  speaker engaged in discussing
with  freedom  and energy a subject which arouses
his attention, and interests his feelings.   While pur-
suing it with ardour and enthusiasm, do the functions
of the body, unaccustomed to this excess of mental
exertion, fall off in vigour, and  refuse him their sup-
port!   Does  he turn pale, totter, and sink!   At this
moment  should a physician urge his way through the
crowd, he has  scarcely arrived, ere  the bloodletting
instrument gleams in his hand; the bandage and the
bason are called for,  or perhaps without their arrival
a vein is opened. For what is this? shall we be told,
that because convulsions  sometimes attend  such a
case, bleeding  is necessary?   Do convulsions always
depend for their occurrence  upon existing  excessive
excitement? are they not sometimes consequent upon
defective arterial energy, either direct, or secondary?
and from either case is immediate bleeding necessary;
or safe?   If it  be to save the  brain, that the lancet is
resorted  to under such circumstances, we  are both
too late and  too early.   If the  injury of that  organ
has  suffered no particular  violence, such  violence
may  never  accrue, or if it  does, fever must first
supervene.
   And in the inordinate sympathy for a single organ,
is no respect to be paid to the condition of the gene-
ral body? most assuredly, the safety of that organ  is
all important.   But the existence of injury, and the.
security  thus offered it,  are  altogether speculative.
And no man in his senses will consult that security
under  such circumstances, when by  doing so,  he in?
volves a  possible, or probable sacrifice of life.
   Who are  the subjects of the condition refered to?
generally, the  weak and unhealthy;  those with con- 
154
 stitutions of mind and body, delicate and susceptible.
 Who hold life under a peculiar  liability to its in-
jury or loss, from contingent circumstances.  Various
 considerations challenge an estimate in consulting an
illustration of the phenomena attendant upon  this
 condition? The  orator if unaccustomed  topublick
speaking, may be affected by the novelty of, the situa-
tion in  which he is placed.  He feels himself the ob-
ject of pointed regard, to a numerous and respectable
audience:  he  recognises the necessity  for acquitting
himself with  distinction, yet wants a confidence of
success.  It is of no  consequence to inquire, in what
precise  manner such causes of impression act.    TT.he
fact that  causes  of this  nature, do give occasion for
the minds operation upon  itself will require no evi-
dence.  That a disturbance  in the economy, both of
mind and body; is the consequence of that operation
is equally well known.
   Superadded to this enfeebling  impression on the
mind, is the difficulty of a rapid conception, arrange-
ment, and illustration of appropriate ideas.* The  ope-
rations  of the mind  thus  become embarrassed, de-
ranged, and painful.  The  very  consciousness of per-
plexity, then increases the  distress.  Its actions irre-
gularly  performed, its energies become wasted.  Con-
fused perception, with vertigo succeeds. The body is
early brought into associated sympathy.  Losing the
natural  controul, and affected by  the  disturbed con-
dition of  the  mind; iis  functions fall  into disarray,
and soon became enfeebled; and at the moment when
vertigo  succeeds to the agitation of mind, all  the  ani-
mal  operations which require the direction,  or cog-
nisance  of the will,  are  suspended.   The vital ac-
tions too,  (those  of the  heart and arteries,)  ordi-
narily independent of  the  will,  but subjected  under

  * We are presuming  the address extemporaneous, from
the pulpit,  in the senate, at the bar, &c.
> 
155
certain circumstances to the laws of intellectual sen-
sation and operation, partake of disturbance and debi-
lity from loss of sensorial  energy and contcoul, and
partial, or complete syncope ensues.
   But distinct from defective  confidence in the com-
mand of the mind over the subject of its operations,
producing  the general consequences referred to, the
same  condition of  body may be  produced  by any
cause exciting efforts in the mind,  to which its pow-
ers are incompetent. The interest of a subject, view-
ed as essentially important, may lead the mind in the
discussion  of it, into  the  indulgence of fancy, and
imagination, beyond the healthy range or limit, of its
operations;  where its energies falling  off, the volun-
tary and vital powers of the body, suffer in their func-
tions from a rapid waste of the principles of support,
induced by  their sympathy with the preexisting and
present condition of the mind.  The ardour  of reli-
gious  enthusiasm under peculiar  circumstances, has
been a frequent cause of this  condition.   In  fine, the
various  modifications of strong passion and emotion
of mind, may all  under certain states of either sud-
den, or gradually accumulating operation,  produce
this effect.   Consecutive to the various force, mode,
or kind, of impression, we shall have in a greater, or
less degree, debility, suspension, or exhaustion, of the
faculties  and functions of the body.  If in this con-
 dition mischief take place, it is either by positive in-
jury from the first impression of those passions upon
 an organ, or, by an enfeebled state superinduced di-
 rectly, or mediately upon the general whole, or upon
 a particular  part, subjecting  such part to  violence
 from  the comparative force  of the general  powers,
 when reaction comes on.   In the first, (viz. organ-
 ick lesion,) immediate bleeding cannot remedy what
 has already happened;  and when  (as  is usually  the
 case,) the body has fallen off in vigour it must pro-
 tract, or prohibit general recover*.  In the last, it
              TT 
156
  is irrational to prescribe for a condition antecedent
  to  its existence; and which  can be  judged of only
  from the evidence it affords  when actually present.
  The  same general objection  also, opposes itself to
  the practice in the latter case, as in the first,  viz.
  that reaction may be altogether prevented by arresting
  entirely the remaining languid circulation, on which,
  and a certain capacity in the  vital organs, the repro-
  duction of the phenomena of life depends.
   There is  another cause  apart from the agency of
  interrupted  relation between  mind and body, which
  may deprive the  latter of its capacities, or suspend
 their  exercise; and produce the prostrated state of
 animation we are considering. In the active and long
 continued exertion of publick speaking, the organs of
 speech and of respiration, are brought into frequent
 and forceful operation; the general actions are roused
 into preternatural excitement, this excitement  con-
 sumes rapidly the oxygenous nutriment of the body,
 and if the situation be confined, the air of the room,
 though sufficient  for  the common purposes of life,
 may cease to afford a supply of that pabulum,  ade-
 quate  to this extraordinary demand.  In a subject
 sinking from this  cause, but one consequence can pos-
 sibly result from  enfeebling farther the respiratory
 forces by the abstraction of blood; that of augmen-
 ting the danger of the  patient.  In  suspended  ani-
 mation, life can never be restored, except by causes
 which are efficient for the restoration of action  and
 energy in the heart and arteries.
   5.  Violent pain, whether from accidental violence,
 or the consequence of more gradual changes of con-
 dition, has been considered by  the artists of the pro-
 fession, as an adequate  warrant for the free use of
 the lancet.  I refer more particularly to the former;
 the severity of pain from casual injury.   We find it
 sometimes in fracture, more frequently in dislocation.
In each of those conditions, pain is produced by cau- 
157
ses, and in a manner which we cannot  affect by the
immediate use of  the  lancet; or  if  we succeed in
moderating it,  such relief is obtained at the serious
expense of the  patient.   Under those circumstances,
pain does not afford that kind of artificial support to
the general powers, which they sometimes receive
from it; and on  which we may occasionally depend
for security in  the abstraction of  blood.  Beyond  a
certain point or degree, pain directly  exhausts the
vital powers, and suspends their  functions.  Wbile
the cause of irritation continues, and its peculiar ef-
fects exist,  bloodletting is dangerous in the  extreme.
Those  effects  are, universal  relaxation, disorder of
particular functions, a disposition  to syncope, or the
complete collapse into that condition.  In some cases
of displaced bone, those consequences occur  to an ex-
cessive degree.  Paleness of the countenance, labo-
rious,  imperfect respiration, copious sweat,  feeble or
imperceptible pulse, and general immobility  from loss
of voluntary controul, mark the condition.*  The first
attempt of the  practitioner when called to such a case,
is reapposition.   If from aukwardness he fails of
success, what  does he next? why to escape the blush
of embarrassed ignorance, unsheaths his lancet, and
draws blood freely; he has heard that bleeding would
obviate difficulty under such  circumstances.  I have
seen such a case.   After  fruitless attempt io reduce
a dislocated humerus, in a patient semianimate, and
gasping for breath  from pain,  I have seen  him bled

   * Among the  rare  aberrations of that mighty stream of
knowledge, whose course has been traced by the strictest
laws of science, I mean the medical philosophy of J. Bell, I
think we may justly rank his' opinion on this subject; viz.
that luxation is unproductive of pain.  He has advanced that
opinion in support of a doctrine certainly correct in its gene-
ral features; viz. That ligament, tendon, and membrane, are
insensible when uninflamed.  But this appeal to the effect
of excessive violence was unnecessary for its establishment. 
158
 copiously, and immediately again subjected to violent
 distracting forces. The second attempt was not more
 fortunate than  the first.  The expressive horror  of
 the patient's countenance now procured him a short.
 respite; he Mas permitted to lie down, or more pro-
 perly carried to a bed,  from whence he never  again
 rose.  Nor is it pain from actual violence only which
 leads  the mechanical practitioner into errour.  Pain
 from  any cause which directly debilitates the neces-
 sary functions of life, may throw the body into a lia-
 bility to the occurrence of death, from a farther re-
 duction of its powers superinduced by free bloodlet-
 ting.  Let the forces of the  heart and of respiration,
 be enfeebled  to an extreme  by pain, and a lancet  at
 that time be  used from habit, or thoughtless accord-
 ance with custom, and its use will not unfrequently
 sever  the feeble ligaments of life.  I should  smile  to
 hear it asserted that physicians do  not  bleed  from
 habit.
   6. In large  and mixed  companies  for whatever
 purposes assembled, (generally of devotion or amuse-
 ment,) there  are two descriptions of persons peculi-
 arly exposed  to inconvenience or injury.   They are
 females whose pulmonary organs are constitutionally
 infirm, or have been rendered  so by disease, and
 those in the pregnant condition.  Persons in either of
 those states, after  remaining some time in  a crow-
 ded room,  experience a feeling of languor, which not
 unfrequently goes on to the state of syncope.  It hap-
 pens commonly that medical  men are present at those
 assemblies, and considered as guardians of the health
 of society.   They are called upon by others,  or vol-
 untarily come forward, to  direct the  treatment of
 those who have fallen into this fainting or insensible
 state.   Here  again, when observing what that treat-
 ment is, to which such sufferers  are  frequently sub-
jected,  every intelligent professional man,  if he  is
 also an honest one, must  join in  reprobating the ig- 
159
 adrance by which such a procedure is dictated, and
 proclaiming the mischiefs consequent on its adoption.
 We have in this case the same mechanical conduct,
 the same  absurd misapplication of the resources of
 the profession,  as in the antecedent parts of this es-
 say, we have held up to that contempt, we sincerely be-
 lieve it merits. It is not asserting too much to say, that
 in  a majority of the instances before us,  the solici-
 tous look, or the eager inquiry of friends  suggest to
 the mind of the practitioner^ the idea of the bandage
 and the lancet.   If the patient does not speedily re-
 cover, her chance of  doing  so,  is diminished  by his
 carrying that suggestion into operation.
   Though at first view there exists an  apparent di-
 versity of circumstances producing a liability to the
 fainting state, in the two varieties of bodily condition
 which we have  said  were most obnoxious to it, in
 crowded companies, viz. the infirm and delicate, and
 the pregnant female;  yet in  reality the  effect is the
 result of causes essentially the same  in both.  The
 first of those two descriptions of persons, the  weakly
 or  perhaps phthisical female, carries  into those pla-
 ces, a system either actually diseased, or labouring
 under a predisposition to its occurrence: and excita-
 ble because it is feeble.  The atmosphere of the room,
 saturated  with moisture, and raised in temperature,
 by  the respiration and secretion of numbers,  produ -
 ces on this excitable condition, a temporary increase
 of action;  with a rapid exhaustion of  tone or power.
 This is the ordinary consequence of excessive stimu-
 lus upon the weakened irritable body.  But in  addi-
 tion to this, we have in the present case, an imper-
fect pulmonary system, with impure air.*  Either of

  * An occasional cause of the fainting state of females in
 crowded assemblies, may also  arise from  artificial or me-
 chanical impediment to respiration. I allude to  tight lacing.
 That fashionable folly which destroys symmetry, renders de-
 formity more obvious, and violates health.  When the capa-
t 
160
those causes considered apart might  be adequate to
the  production  of the phenomena  presented  to us;
their combination can only contribute to render their
effect more considerable. A healthy animal body pla-
ced in a polluted atmosphere,* will fall off in its  pow-
ers in proportion to the unfitness of such air for the
purposes of health; to persons afflicted with pulmo-
nary infirmity,  the slightest deterioration  of air is
sensible; a more considerable loss of purity endangers
life.  There is  no  more •difficulty in  assenting to, or

city of the thorax  is thus contracted a proportionate diminu-
tion of the number of cubick inches of air recieved in the
lungs will necessarily occur, and of course a relative loss of
oxygen.    If the air of the room is also reduced (by the res-
piration of numbers,) below the common standard of oxyge-
nation, the loss will be still greater and  more sensible.  As
the ordinary mode of relief where a defect of oxygen is felt,
viz. the inhalation of an increased  volume of air by full or
voluntary inspiration, is precluded when the descent of the
diaphragm is prevented by pressure on the abdominal  mus-
cles and viscera
  In large assemblies or warm rooms, the fainting state may
occur to persons thus dressed, even though no diminution of
oxygen be present.  The heated condition of the air acting
as a stimulus will  occasion some increase of general volume,
and the laced jackett will then become a mechanical irritant
to the sentient system, producing pain  and disorder of the
sensorial function. Nausea, langour, and  proclivity to syn-
cope are often induced by local, pressure in dress.


   * There is a condition of the body bearing in  some  of its
phenomena considerable analogy to the state of syncope, but
essentially different in its cause, and demanding a very dif-
ferent treatment.   Persons of excitable habits after walking
briskly, or making unusual exertions, sometimes loose sud-
denly their voluntary faculties, and fall into a state of insensi-
bility.   Here the excitement produced by the exercise  or ex-
ertion, has inflicted injury on the source of the vital princi-
ple (the brain,) by effecting partial congestion.  And the
interruption or suspense of particular functions, has resulted
from imperfect distribution of vital capacity.  This state of
things may occur at any time under the given circumstances; 
161
 explaining this position, than in admitting, or account-
 ing for the obvious faet, that marasmus ensues  to a
 diseased condition of  the  stomach.   The principle
 diversity is as to the duration necessary for the effec-
 tuation of the consequence. The mode it is also cer-
 tain is not precisely the same; they differ by  the ap-
 pointment  of nature.    But a  defective support of the
 body is the result of either, and of both.
   Were a  man of common intelligence however un-
 skilled  in  the laws Of, animal operation,  to  be  told
 that health and power depended upon a certain sum
 of action  in the  body and with this knowledge were
 to be shewn a  living body in  which that action had
 fallen suddenly far below  the natural standard, can
 we suppose that it would occur to him as possible that
 health  and power could be restored to such body by
 reducing  still  farther the action  already too  low?
 Having no acquaintance with the absurdities  of me-
 dical conjecture, he would be governed  by common
 sense, and through this medium would view as errour,
 what  medical  phantasni has held up as truth.  I

 but when the body is predisposed to such condition by the
 circumstances mentioned, (action considerably raised, &c.)
 the complete lapse into that state will readily occur upon en-
 tering a crowded room, where cheated air, with other stimu-
 lant causes, aid directly in its production.
   Though at first  view such  a  state of unconsciousness,
 might readily be mistaken for ordinary syncope, it uniformly
 exhibits  phenomena never present in  the latter condition.
 The face instead of being pale as in syncope, is more red
 than usual,  sometimes a  darkish red not dissimilar to the
 countenance of apoplecticks.   The respiration too is more
 anxious and oppressed.   In syncope it is slow and  languid,
 or what  is termed sighing. But  the most remarkable dis-
 cordance, is in the state  of the  pulse.  It will always be
 found in the condition above described, full and generally
 slower than in health.   In syncope it is always weak some-
 times though not uniformly frequent.   To take off the mor-
 bid impression on the brain by the lancet, is the proper ob-
ject when the body has fallen in the manner suggested. 
162
know that philosophy is ambitious; the pride of spu-
rious philosophy particularly, repudiates what is com-
mon, and impels its votaries in the pursuit of novelty,
into crooked paths, but for the honour of the pro-
fession, I hope we shall never be called on to refute
an assertion, that we may  safely disregard common
sense,  in the practice of medicine.
  In the second description of persons exposed to the
liability under consideration, viz. the pregnant  fe-
male, it is not necessary to our purpose in  account-
ing for the effect, to presuppose the  existance of lo-
cal  or  general infirmity. We have said that the phy-
sical default constituting  syncope,  resulted  from  a
cause common to this with the former condition.  To
wit; defective oxygenous nutriment.  In the first case
we  suppose an organick incapacity for its perfect ap-
propriation to the purposes of the body.  In the lat-
ter  we  presume an inadequate supply of the oxyge-
nous material.   During the period of gestation and
increment of the foetus, its circulating fluids can re-
ceive the  oxygenous principle only from  the blood of
the mother  by means  of the  placental  apparatus.*
On  this ground there exists in the pregnant condition
an uncommon demand for  pure air, and  of necessity
that condition will soon perceive and afford us an evi-
dence of any considerable deviation from the state of
purity  necessary for its economy.  Having two sys-
tems of animal operation to sustain  during the con-
tingent state of pregnancy, and the supply of oxygen
being indispensable to both, the pregnant female will
experience considerable languor, or fall into syncope,

  * This presumption  stands equally firm whether we ad-
mit the doctrine of direct transfusion of the maternal blood
into the fcetus, or the more rational physiology that the foe-
tal blood is the product of its own vessels. The latter opin-
ion  is taught by the professor of  anatomy in the  Baltimore
university, as also that there is a natural capacity in those
appendages, for oxydating the fcetal from the maternal blood. 
163
in an atmosphere sufficiently vital for the ordinary
purposes of others.
  This last is more particularly the state in which
the unreflecting, or rather uninformed  practitioner
will be disposed to unsheath his lancet.   There is a
silly prejudice adopted at first without  reason, and
subsequently  received  without  examination,  that
every thing connected with pregnancy was subject to
the governance of that instrument.   All the pheno-
mena relating to parturition especially, whether  na-
tural  or uncommon, are to be regulated by bloodlet-
ting.   With its advocates it is equally efficient in ac-
celerating or arresting labour.   When the parturient
efforts are too feeble it will strengthen, when too vigo-
rous it  will restrain them.   No inconsistency is too
glaring, no absurdity too  great to be reconciled with
a practice which  saves the trouble of thinking,  and
is fortified by  custom.
  The  prevention of premature birth is the motive
alleged by gentlemen for shedding the blood of preg-
nant females upon whom syncope has been casually
induced.   When  all the  muscles of the body are
quiescent, or even for a time parylitick, I confess
I see no danger of such a consequence; or if it really
existed, I am  equally at  a loss to imagine how  by
bloodletting, it is to be averted.  If abortion is drea-
ded from the atonick condition in syncope, bloodlet-
ting must throw the patient more completely into the
relaxed state;  I have  no  comprehension of what is
meant by "rousing the energies of the system through
the agency of  bloodletting."   It ought to be known
also that the fcetus does not, and cannot escape from
its  natural lodgement by relaxation.  But that a condi-
tion opposite to inaction is necessary for this effect. If
(he convulsions which frequently attend the synoopick
state in pregnant females, give rise to apprehensions
of  mischief, it ought likewise to be remembered that
when occurring under the circumstances referred to,
            X 
164
they are simply expressive of greatly defective natu-
ral stimulus.   Bloodletting if this view of the sub-
ject be correct, can be resorted to in  such a case only
as experiment,  and  before its advocates can be per-
mitted to argue that it  may not do  harm, it is just
they should prove it can possibly produce benefit.
   Though I am rather noting what I conceive to be
wrong, than prescribing  what I  believe would be
right in the cases I have adduced for illustration, I
think it not amiss to  indicate what science and com-
mon sense dictate as  proper in the circumstances we
have been  last  considering.  Those  casualties occur
frequently; and the wise should not  feel  affronted if
I attempt to inform the ignorant.  Air, absolutely or
relatively impure, is  the chief cause of the fainting
state with  the persons of whom we have been speak-
ing.  This should first be obviated by admittiug pu-
rer'air.  It is  better  if it can be done, that pure air
should  be  admitted  to the patient,  than that they
should be carried in search of it;  all motion is mis-
chievous.  The next consideration is that the recovery
of the patient depends upon the reestablishment of
circulation.  In consulting this object, all mechani-
cal obstacles to its accomplishment should be  remo-
ved. A recumbent posture is best, as  in this way the
heart can  with greatest  facility send on  its  blood,
having  neither gravity  or resistance to  overcome.
Supporting patients (as is generally done,) in the se-
mi-erect attitude, is essentially wrong.  In this posi-
tion the heart and large arteries arc unable to distri-
bute the blood, particularly for the cerebral circula-
tion.   Another ill consequence results from this er-
rour.   Without the patients be entirely unconscious,
they waste when thus held up,  the partial remains of
power, in fruitless efforts at self support.
   Regarding those conditions of pulse upon the exist-
ence of what practitioners have grounded their au-
thority for the  abstraction of blood,  I shall say but 
165
little.   I consider it unfortunate for medical science
that so  many such vague, and  contradictory senti-
ments upon this subject are already upon medical re-
cord.  Many writers both ancient and modern, have
been  worse than uselessly  employed in  details and
definitions of this kind.  With  both, pulses,  like dis-
eases have received  many fanciful appellations.  Like
the reveries of imagination generally, they will be
found capricious, unmeaning, and arbitrary.  Among
the ancients J. de Gorter and Galen have given us in
the aggregate more than forty varieties of pulse,
which arc to serve as  legitimate expressions of pe-
culiar diseased condition. The modems have trodden
in their footsteps; borrowed some of their definitions,
equipped others in  a new dress, and appealed for the
invention of a few more to their own creative genius.
Neither  science or  society are debtors for  those la-
bours.   Beyond a  few general criteria, referring to
more distinct and sensible conditions of pulse, no ac-
curate idea can be  conveyed in written definition to
minds unpractised in frequent and cautious examina-
tion; none which can be made abstractly, the basis of
a safe and rational practice. I have no hesitation in
asserting a belief that thousands have fallen victims
to the ignorance and errour resulting from a servile
confidence in written histories  of specifick  states of
pulse.   Independent of those expressions  of pulse in-
consistent from  particular and inscrutable causes,
with existing diseased  condition, its  more  ordinary
phenomena partially modified,  not unfrequently pre-
sent serious difficulty to the mind of sensible and pru-
dent men, as to the actual character of  the disease
they represent.  The propriety of using the  lancet is
under  those  circumstances in  an  especial  manner
equivocal.  We are subjected to doubt and hesitancy
in adopting or rejecting it, from the contrasted im-
pulse of expected good and apprehended mischief, in
either its use or neglect.   The patient's lif« is  often 
166
involved in the decision, and every physician who has
not emancipated himself from the eontroul of  con-
science  will deliberate before he determines.   When
he does act, it must sometimes be from considerations
distinct from a regard to the pulse, of course such as
cannot be fully exhibited in its definition,  viz.  the
actual, perhaps peculiar, condition of the patient.
   There are two states or varieties of pulse,  which
more particularly produce  a  perplexedness  in  the
mind of the  practitioner.  The small and  the full
pulse.  Each of those conditions may be,  and fre-
quently are,  significant of two directly opposite  gen-
ral conditions. Conditions which it is not always  easy
by the pulse alone, to detect or distinguish.  A pulse
may be very small, hard, and quick; or very small,
and either quick or slow, but not hard. In  the first,
the small, hard pulse, there is commonly an excessive
inflammatory action.   An excess of stimulant power
and effect, which communicated to the arteries pro-
duces in them a greatly increased force of contrac-
tion;  and of necessity, a diminished volume  of the
vessels; as their muscular capacities when  exerted,
must unavoidably approximate the  general  wall of
the artery to a common  center, thus reducing its lu-
men or caliber.   Hence arises the resistance to pres-
sure, or the feeling of hardness;  and this condition
of pulse, may perhaps be justly said to indicate the
highest degree  of stimulant agency.   By  bleeding,
we take off in part, or entirely, the morbid impres-
sion, and  the harmonyof action between the muscu-
lar and elastick coats of the artery is restored, or be-
comes  less disproportionate.   The vessel acts more
usually in obedience to its natural laws, and regains its
volume. The small, quick, and weak pulse, marks the
advanced stage of the action above noticed.  It is the
necessary  result of that action, when not  changed
by the  natural powers, or the  successful  interfer-
ence  of art.   The action  ab initio was produced by 
167
causes affecting the whole system, or soon become
ing general in their operation. The morbid agent has
subdued the system too fully to its laws for the ex-
ertion of its natural faculties, or what we understand
by the term reaction.   The  same kind of impression
is kept up, and the same condition of the acting pow-
ers of the body, exeept as it  regards their real force
or energy, and their capacity of suffering or resist-
ance.  The excess of  stimulant power  produces in
the heart and arteries a frequency and force of con-
traction which soon exhaust  the vital capacities,  and
a fatal termination ensues rapidly.  Acute diseases
of vital organs, inflammation of the brain,  stomach,
heart, and  substance of the lungs when extensive,
exhibit the  phenomena and consequences referred to.
  A full pulse, when not remarkable either for quick-
ness or compressibility, is strictly natural.  There is
then a proper balance in the  operation of its opponent
capacities, (the contractile and  elastick  forces,)  and
a harmony  and equipoise of  stimulant impression on
the general body.                       *■
  But the pulse, may be full in  a very different state
of the system, and from  causes essentially distinct
from those above assigned.  We shall sometimes  find
the pulse full where the system is yielding very sen-
sibly to the force of a morbid action, and occasionally
it  gives us that expression  within a few  hours of
death. Under those circumstance, together with  the
perception of fulness,  we have great frequency,  and
remarkable incapacity for  resistance  to  pressure.
This state of pulse is readily induced by the operation
of acute diseases,  on weak and excitable systems. It
is a consequence also of some forms of continued fe-
ver in any  system; and is often a precurser of fatal
termination in many states of febrile disease which
have been termed  chronick.   We  perceive it in the
advanced  stages  of  hepatitis,*  (with  or  without
  *  It is common in hepatitis, when that disease is induced
by habitual debauchery. 
168
effusion,) and in some cases of pulmonary disease,,
either original or consecutive.
   The full, quick pulse attendant on any of the condi-
tions enumerated, is uniformly an argument of ex-
treme physical infirmity.   The arterial energies es-
pecially, have fallen very low.   Hence the fulness.
The muscular faculties (vascular contractibility,) is so
far reduced as to have lost in great part, its controul
over the resistance of the elastick power, and we have
no longer more than a partial alternation of the sys-
tolick  and diastolick action.  The artery approaches
somewhat the state  of a vein, we perceive  rather  a
vibration, than a  distinct contraction  or  pulsation,
and  the vessel  retains  its volume because the con-
tractile faculty is inadequate to more than imperfect
approximation of  its general  wall.    Fulness and
quickness here, are the perfect  opposite ot frequency
and hardness. 
 
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