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CONCISE  HISTORY
FEBRILE  DISEASES
OCCURRED IN THE PRACTICE
OP THE LATE
ELIJAH F. REE J), M. D.
Between the years 1789 and 1837.
*
READ AT A MEETING OP THE "HOPKINS MEDICAL ASSOCIATION,'
         FEBRUARY, 1837.
PRESS OF CASE, TIFFANY & CO

        1848.
yyyyyyvv w w v\ 
 
CONCISE  HISTORY
FEBRILE  DISEASES
OCCURRED IN THE PRACTICE
OF THE LATE
ELIJAH F. R E E D, M. D.,


  Between the years 1789 and 1837,
READ AT A MEETING OF THE "HOPKINS MEDICAL ASSOCIATION,"
         FEBRUARY, 1837.
      HARTFORD:

PRESS OF CASE, TIFFANY & CO.

        1848. 
Keeo 
FEBRILE  DISEASES,
  While medicine, as a science, in most of its branches, has been
more improved in the course of the  last half century,  than, per-
haps, in any other like period of time, it must be admitted that, in
regard  to  practice,  especially as this relates to febrile diseases,
there has never existed a greater discrepancy among practitioners
in this country, than for the last twenty-rive or thirty years.
  This, we conceive, has arisen, in part, from the influence of the
different systems of the later theoretical writers, and in part, from
a change not only in the diathesis but in the form of our diseases,
producing a  difference in the pathological views of our practition-
ers.  But sober experience, we  believe, has much  lessened this
discrepancy  in practice, both to the credit of the profession and
the good of the  community.
  It is  desirable that a still more perfect agreement in principles of
practice should be effected in this association, and  we conceive,
that were its members to communicate  histories of such  febrile
diseases as have fallen under their care, with the treatment adopt-
ed, and its result, whether successful or otherwise, the real exist-
ing difference in practice would  be ascertained,  and  facts be fur-
nished, that  might serve to promote the improvement of medical
practice.
  With these objects in  view, I purpose to give such a history of
some of the febrile diseases which have occurred in  my practice,
with occasional remarks, hoping this may be the commencement
of a series of communications  on the  same subjects, by other
members of  this association.
  I regret that I cannot be so particular in this communication as
I should  wish, as  no history  of cases was made  at  the time,
but many of these cases made too strong an impression on my
mind to be easily forgotten; others have  been since  kept in re-
membrance by frequent relation ; and I have improved what means
I had in my power to bring all cases  related, to more  perfect re-
collection.   A knowledge of the commencement and duration of
many of  the cases has  been  obtained from my  day-books ;  I
having ever  been in the habit of charging the medicines used from
day to  day, and, by examining these, many particulars in  relation
to some of the cases, have been brought to recollection.  I cannot
therefore pretend that my relation of cases will be entirely free
from error, but shall be careful to state nothing which I do not be-
lieve is essentially correct. 
4
   The first eight years of my practice (from the spring of 1789 to
 1797) were spent in Vernon.  During this time, the prevailing
 fevers were what were then  called inflammatory, or the synocha
 and synochus of Cullen.   The former were generally treated suc-
 cessfully, with bleedings, emetics, cathartics and nitre or antimo-
 nials  in nauseating or  smaller doses; terminating commonly  in
 about seven or eight days, by sweating and purging.  The  latter
 class of cases commonly terminated by sweating or purging about
 the close of the second week, on a more moderate antiphlogistic
 treatment, seldom requiring much support during the last week of
 disease.
   In the winters and springs of these years, cases of pleurisy were
 of frequent  occurrence ;  commencing,  commonly,  with  severe
 rigors; these were soon succeeded by great heat, intense thirst and
 acute pain in some part of the thorax, much increased by inspira-
 tion.   The pulse was always full and always hard, under the hard-
 est pressure of the finger ;  seldom counting more than  ninety or
 ninety-five in a minute ; the tongue  was early  covered  with a
 thick  brown or yellow fur, and  was dry and hard.  There was
 often for a day or two  in the commencement, but little cough or
 expectoration, the matter first expectorated was commonly a mere
 mucus, sometimes  streaked, but  never mixed with blood; this
 matter in the course  of the disease acquiring more  consistence,
 and becoming more puriform, and commonly streaked with blood.
   In the treatment of this disease, a very free and early bleeding
 would sometimes remove most  of the pain; but to do this and
 render the pulse much softer,  which was indispensably necessary,
 not unfrequently two or three bleedings would be needed in the
 course of the first twenty-four hours.  The after  treatment con-
 sisted in  freely  blistering the chest;  in keeping the bowels free
 until the excitement was much reduced ; and in the  use of nitre
 or antimonials, with squills or other common pectorals.
   The disease commonly terminated by sweating in the course of
 a week or ten days.   I recollect but  one protracted  case, which
 proved fatal. The  patient was an elderly man, was sick two or
 three weeks—the last half of the time was  rather comatose, his
 tongue was dry and hard and his teeth were covered with sordes.
 I have thought this patient might have been too much reduced in
 the first stage of disease and that he was not, later in the disease,
sufficiently supported.
   In the spring of  1794, there were  a  few cases of scarlatina,
which, with one exception, were mild,  and terminated favorably
under a moderate use of tonics, with little or  no evacuation, in a
week or ten days.
  The malignant  case proved fatal.   I saw the patient, a female
aged twelve years, on the morning of the 3d of May; she had com-
plained only of soreness of throat the preceding night; it was now
much swollen and filled with aphthae of a pale color; her tongue 
5
and mouth were moist and colorless, her pulse was frequent and
feeble, and she was pale and cold, but was able to walk the room.
I then considered  the  case a hopeless one,  but prescribed some
tonics, but  as I now  believe, much too sparingly ; at night she
was more feeble, went into the hands of a root doctor, died next
morning, and on account of a rapid change  in  the corpse, it  was
buried on the same day.
  In these first eight years of my practice, febrile diseases were in
general highly sthenic, but  in the summers and falls of  1797'8,
 (at which  time I resided in East Windsor,)  there  were many
 cases of fever, which were then called bilious remittents.  In
 most of these I bled in the commencement and made some evacu-
 ation from  the stomach or bowels, and for some of the first days, in
 most cases, made moderate use of calomel, or antimonials,but the
 cases generally lasted two or three weeks, and required the use of
 bark or other tonics in the later stages, more than I had expected
 at the commencement of disease.
                 TYPHOID PNEUMONIA.

   On the 5th of January, 1799,1 visited my first patient sick with
 typhoid pneumonia, a female aged about seventy.   She complain-
 ed of some pain in the side, had but little pyrexia, and little cough,
 and expectorated mucus in small quantity.    I directed a mode-
 rate cathartic and an epispastic on the chest.  On the  second day I
 found her in nearly the  same state, and made a small bleeding.
 On the third day she had expectorated mucus mixed with blood.
 She was now comatose, her face was  very florid, respiration was
 very laborious, and her  pulse was remarkably full.  I now bled
 her freely, she appeared in  some measure relieved, but her pulse
 soon became feeble and she died in about twelve hours, on the 4th
 or 5th day of disease.                                 .
    On the 12th of February, J visited a male aged about sixty-nve
 years.  He complained of pain in the side, which was not severe;
 ne had but slight pyrexia, little  difficulty in respiration, little in-
 clination to cough, and expectorated little or nothing  was able to
 walk the room, and  thought himself but little unwell.   I made a
 small bleeding, and blistered the chest.  On  the second[day he
 was in about  the same state, and was again  bled and blistered.
 He continued in about the same  state until the 5th day of disease
 when as he still complained of some  pain, I again made  a smal
 bleeding.  On the night of the 8th day of disease  the patient
 sweat freely and became comfortable, but in the morning purged
 and became suddenly feeble, pale and cold with a small  frequent
 and weak  pulse, and appeared to be in a dying state, but  m  he
 course of a few hours, with the use of but very little of any stim-
 ulus,  reaction took place, the pulse became remarketlyfull the
 face very  florid, respiration  very laborious, and  he lungswere
 loaded with mucus.   By advice, he  was  now bled very freely,
 nrptetton became more easy, but he died within thirty minutes. 
6
  From the 1st to the 15th of March I visited seventeen other pa-
tients, sick with pneumonic inflammation.   These cases were dis-
tinguished from those of high sthenic inflammation, by less pyrexia,
heat and thirst;  by the appearance of the tongue, (this being less
dry and covered only with a thin fur, which was commonly white ;)
by the pain being less severe in the  cases of most pyrexia, or in
the cases of least pyrexia, more pungent and always less increased
by inspiration or by coughing ; by the appearance  of  the  matter
expectorated, this  being mucus,  sometimes mixed,  but never
streaked with blood,  and  seldom in any  degree puriform in the
course of disease; but still more by the state of the pulse, this be-
ing always more frequent and small, or if full,  less hard than in
sthenic disease.  There was also, in most of these cases, more re-
mission of fever in the morning, than is common in sthenic disease,
with an  exacerbation in  the  evening,  during  which there was
often some degree of delirium.
  Eight of these patients  were bled on  the first or second day;
one on the first  and third days ;  one on the first and fourth days,
and one on the first, second and fourth days, and  six were not
bled.   These bleedings were very sparingly made, as I doubted
the expediency of bleeding  at all.   All were freely blistered ;  in
the  commencement  the  bowels  were moved  by a few grains of
calomel or other mild cathartic,  and  in  some of the cases, some
little use was made of calomel or antimonials, on some of the first
days ;  but after this, all  were, more or less, supported by wine,
spirits, serpentaria or bark.  Little opium was used, and this only
after some days of disease.  In sixteen  of these  cases a favorable
crisis took place on the seventh day by sweating or purging ; but
the patient which I bled three times continued sick until the close
of the second week, but recovered.
   On the 25th of May, I visited another patient with pneumonic
inflammation, a male aged about sixty-five or seventy, who in
earlier life,  had been subject to pleurisy.  This case I thought
was not so  plainly  marked as  asthenic;  I bled  him somewhat
more freely on the first day, and again on the third, and treated
the case on more of an antiphlogistic  plan.  He died on the eighth
day.
   As one of those cases which indicate the disposition to asthenic
membranous inflammations during an  asthenic diathesis, I shall
here state that of a male  aged  about seventy-five, whom I visited
in the evening  of the 8th of March, in a  house  where two were
then sick with the epidemic.   He  had been unwell only a few
hours and had but little pyrexia.  He complained of a slight pain
in the head,  but of a severe and excruciating pain in  the throat,
and across the loins, with a constant inclination to  void urine,
which he had done frequently in small quantity with much  pain ;
his throat was swelled and the fauces were of a very dark  color.
To ease from these excruciating pains, strongly urged by the pa-
tient,! immediately, and now believe, injudiciously, made a small 
7
bleeding, while the patient was in a  sitting posture.   His pains
immediately subsided, he became faint, was laid on  the bed, and
immediately expired.
  There were again some few cases of this disease in the fall of
this year, one of which proved fatal;  an infirm man aged about
seventy-five,  who had  been accustomed to bleeding.   I bled, at
his request, merely for a pain in the side.   For several days after,
he was  not much unwell, but becoming suddenly much worse, I
was called to visit him, and found him with pneumonic inflamma-
tion.  I directed a cathartic and epispastic—on the next day he
died.
  Although this disease was not again epidemic until the fall of
1815, I believe that  from  1799 to that time, there was no  year
without some cases of it; of these  there were but  few in the
years 1800 '1 '2 '3 '4 and 5,  but more in the years  1806 '7  'S '9
and 10, and still more in 1811 '12  '13 and 14.
  On the 5th of March,  1801, I visited a man aged about sixty,
and broken  down by intemperance, on about the fifth day of dis-
ease ; he died on about the 8th day, with but little medication.
  On the 24th of March,  1806, I visited a man aged about thirty-
five ;  he had much pyrexia and pain in  the side,  with  difficult
breathing; the heat had been preceded by  rigors, and he had been
sick only a few hours.   I bled  and puked him ; on the second day
bled and blistered him; on the fourth  he  took castor oil, and on
the seventh died, his lungs filling with bloody mucus.
  On the 24th of  September, 1812, I visited a man aged about
thirty, on the first day  of this disease.  I bled, purged and blister-
ed him, and  again on the fourth day,  and prescribed  calomel in
small doses,  and laudanum with antimonial wine.  In about one
week he was nearly free  of any lung affection, but his fever con-
tinued with  remissions  and much sweating.  Bark,  opium and
spirits were prescribed, but owing to a prejudice  of  his  wife to
these articles, very little of either was used,  and he  died about the
close of the second week.
   On the 25th of November, 1812,1 visited the wife of this pa-
tient : she had been unwell for several days, and had taken an
emetic and cathartic without advice.   She had now much pyrexia,
with pain in the chest, and wished  only that I would bleed her, and
leave for  her some laudanum with antimonial wine  and  squills.
 I bled her, left for her  the medicines, and persuaded her to blister.
 I bled her again the next day, at her request.  She  died on the
 4th of December.                                           f
   About this time I visited a young man of about twenty years of
age, on the third day of disease. He had been purged and blister-
ed by advice of another physician, who had been dismissed,  at his
own request, saying the patient would die.  I was of the  same
opinion? and requested the advice  of a very respectable physician
of much experience, which I had.   The patient was bled  blister-
ed and  treated on a moderate antiphlogistic plan, and died on the
7th or 8th day. 
8
   Two sisters, aged from forty-five to fifty years, both in consump-
tion, and one far advanced  in that disease, were  attacked with
typhoid pneumonia, one on the 29th, and the other on the 30th of
March, 1814.   The first died on the seventh day,and the other on
the fourth of  this disease,  without  any  efficient  medication.
   These eight cases were  all that proved fatal from the spring of
1799 to the fall of 1815.
   Two of these  patients were aged and infirm, and had no medi-
cal attendance until after some days existence of disease.  Two
were consumptive.  In one  case  medical directions were disre-
garded by the nurse, and one prescribed the means of cure.
   Of these eight patients five were bled.   Among those whore-
covered during this time, I feel confident that two only were bled.
One of these, a female aged about fifty, I visited on  the 27th of
December, 1812, on the first day of disease.   She was puked with
ipecac, and purged with calomel; she  was repeatedly  blistered,
and on the fourth day was  bled ;  through the first week she was
in the use of calomel, in small doses, with opium; through the
second week in the use of opium, serpentaria and cinchona.
   The other, a  male aged about fifty, I visited on the 4th of Janu-
ary, 1813, on the first day of disease, bled him and prescribed an-
timonials and  an epispastic ; on  the  second day, calomel  with
opium; on the third, tincture lyttae and opium; on the fourth, ser-
pentaria.   The disease lasted about one week.
   In the summer and fall of 1815, there were many cases of fever,
and among these were some commencing without any lung affec-
tion, but in which the patient, in the course of two or three days,
would complain of slight pain in the side, and expectorate mucus,
somewhat bloody.   The pain would commonly be wholly remo-
ved by a single blister, and expectoration cease at the close of the
first week, although the fever would commonly  continue one or
two weeks longer, requiring, more or less, the use of tonic reme-
dies.  But about the middle of November, 1815,  typhoid pneu-
monia commenced as an epidemic, and continued as such until
about the middle of March, 1816.
   Previously to giving an  account of this epidemic, I would ob-
serve that during its prevalence, I  was unable to make my charges
so regularly, and specify so  particularly, the remedies used, as I
have done at all other times.  And further, that  in cases where
this was done, such was the number of sick in the same family
at the same time, or in quick succession, that I have not been so
well able to avail myself of the assistance of my books, in giving
the history of some cases.   I have, however,  attempted  to give
the history of none in which I am not satisfied I am essentially
correct.
   The attack of this disease was in most cases very  sudden, and
without any previous indication of predisposition, unless an occa-
sional momentary pain, shifting to various parts of the body, which
was felt by some few, in the course of the twenty-four hours prece-
ding the attack, may be considered such. 
9
  The cases differed much, not only in the manner of attack, but
in the progress of disease.  They also differed much in degree of
malignancy ; the patients  in the  greatest danger commonly be-
lieving themselves in little or none ; and appearing so likewise to
others unacquainted with the disease.
  Some cases commenced with  a sense of coldness  and rigors
which were always slight.   These were soon succeeded by febrile
heat and pain in some part of the chest, always confined to a very
small spot, somewhat,  but never  greatly increased by inspiration
or cough, the patient being able to distend the lungs in some good
degree.   The pulse, though not very small,  was never hard, and
not less than from 110 to 120 in a  minute.  The tongue would be
covered with a thin white fur, but  would never be hard nor dry,
nor would the patient be very thirsty.  The matter expectorated
was a bloody mucus, and in these cases only, or in those  of most
excitement, did this assume in the  course of  disease, anything of a
puriform appearance.   These were the most favorable cases among
those which  needed much medication and were evidently the least
asthenic.  In this class of cases I commonly commenced the treat-
ment by procuring some evacuation from the bowels, with calomel
or castor oil, and used calomel with Dover's  powder  for some of
the first days, when, if the heat was abating and the skin becom-
ing a little moist, or pulse was becoming smaller and increasing
in frequency ; or, without much  increase in  frequency,  was be-
coming soft, and the patient much  inclining to  sweat, I omitted
the calomel  and commenced the use of opium, spirits and serpen-
taria or cinchona   In the use of these medicines, under these cir-
cumstances, the pulse would frequently become more full and less
frequent, expectoration more free  and respiration more easy; but
in these'cases, when excitement  was not  very much reduced, I
have found more benefit from the use of squills and seneka, as ex-
pectorants, than in other cases, and when  the lungs were much
filled with mucus, have found an emetic of ipecac more beneficial
than in cases of less excitement.   All of these patients were freely
blistered.
   In this class of cases, bleeding might appear to be indicated, and
in five of them I bled, and  also in one other, which, although it
commenced with expectoration of bloody mucus, in other respects
was similar.   Three of these patients recovered and three died.
   Afemale aged about  twenty, in the nightof the 19th of February,
commenced expectorating very bloody mucus very freely, without
pain or pyrexia.  I prescribed a laxative Dover's powder and  an
epispastic.  On the second  day she had much pyrexia, with pain
in the chest    I bled and blistered her. ■ On the third day she took
opium and ipecac. On the fourth, her lungs were loaded with mucus
and respiration was difficult,  and she  was  puked with ipecac.
The disease subsided about the seventh day, with a moderate use
of stimulants.                                     ,
   On the 27th of Dec. 1815, I visited a male, aged aoout twenty-
                    2 
10
two, naturally robust and plethoric. I bled,  purged and blistered
him, and he had previously made use of a cathartic. His pulmona-
ry affection was much less at the close of the first week, but fever
continued  until about the close of the third, when there was hem-
orrhage from the  bowels, which was suppressed by injections of
laudanum  with acetate of lead.  He  was  in a moderate use of
opium,  bark and  spirits, until  the 1st of February,  about  the
thirty-fifth day from the attack, when he became cold and sense-
less, with  frequent suspension of breathing for  a half minute or
more.   Nothing had been swallowed for an hour or two, although
liquids had been turned into his throat.
   While respiration was suspended, a sudden and full inspiration
was effected by passing a feather, wet with aqua ammonia, well up
his nostril, the patient at that instant, throwing his mouth  widely
open.   Such an opportunity was improved,to turn into his throat
a large table-spoonful of brandy, with twenty drops of laudanum,
which was instantly  swallowed without in  the least arousing the
patient.   This dose was regularly given every fifteen minutes, for
three or four hours, the use of the feather becoming unnecessary after
a few doses.  In this  time, respiration had become regular,  the pa-
tient warm, wakeful  and perfectly rational, and with a more free
use of bark, opium and spirits than heretofore, eventually recovered.
   On the 25th of March, 1816,1 visited a male, aged about  thirty;
bled and blistered him, and prescribed antimonials in small doses.
On the third day, serpentaria, and on the fourth,  bark and opium;
but during part of the night,  the opium was omitted.  On  the
morning of the fifth day, found my patient cold, senseless and una-
ble to  swallow.   He was revived by spirits and laudanum,  got
down his  throat by means of a feather and  aqua ammonia.   On
the morning of the sixth day, he was in the same state as on the
fifth day,  and from the omission of  the  opium  in  the preceding
night.   He  was  now supposed so near dead, that some arrange-
ments were making for the attendance of  his funeral, but  he was
again revived by  the former process,  and by a continued and more
free use of opium, bark and  spirits, was  convalescing from the
close of the second week,  and eventually recovered.
   On the  22d of February,  1816, I visited a male,  aged about
seventy, and bled and blistered him; bled him again on the third
day, and he died  on  the thirteenth.
   On the 3d of  March, 1816, I visited another male, aged about
seventy, and purged and blistered him; on the second day  he  was
bled, and again on the third, and died on the eighth.
   On the  5th of  March,  1816, a female,  aged about sixty, com-
plained of an occasional pungent, but transient  pain, alternately,
in one ancle and  the bones of the nose; but was in no other way
indisposed.   On the next day she had fever with much affection of
lungs.  She took a cathartic, was blistered and used Dover's pow-
der ; was by advice bled on the sixth day, and died on the  eighth.
   The  bleedings, in all  of these cases,  was rather  small; but
 were the  most free in the two protracted cases. 
11
  The blood drawn in these cases, and in all others of this dis-
ease, when notice was taken of it, was of an uncommon dark
color;  and if the stream of blood were  made to strike on the side
of the vessel into which it was drawn, as it run down  its side, it
would  be of a dirty or muddy color, exhibiting  small granules,
like fine sand, passing down the side  of the vessel  more slowly
than the rest of the  fluid ;  and no visible spherules of blood  could
be made  to roll  across the vessel, by  an  oblique  stroke of the
stream on the surface of the blood drawn, as may be seen in most
sthenic disease or in health.   The blood on cooling, would exhibit
a very remarkably thick buff,  but  very little  cupped, of a lard
color, or of a yellowish tinge.   This buff might be separated from
the anor, with the greatest ease; and on slight motion of the  crass-
amentum, the  serum would  become turbid with red globules.
  A great proportion  of cases commenced with moderate febrile
heat, which was  preceded by  very slight  chills, or none at all.
The pulse was small, and not less than one hundred and twenty
in the  minute ; respiration was frequent, of which the patient was
insensible, making no complaint of difficulty of breathing, although
he would be able to  distend the lungs but  partially; the pain in
the chest which  was;commonly slight, was very  little, or not  at
all, increased by inspiration.  Some of these patients would,  in the
very commencement, with but little cough, expectorate very freely,
a bloody mucus.                                   .
  In most of these cases I procured  moderate evacuation from the
bowels by  means of calomel or castor oil; blistered freely and
made use of Dover's powder, with or without calomel; but seldom
used any calomel longer than two or three days, commonly inthis
time, finding my patients needing support,  I  had recourse  to the
use of more or less opium, spirits and serpentana or cinchona ; and
some patients when apparently near a fatal termination, recovered
under the use of these remedies.
   There were several cases, in all respects, like the last described,
except that the patients had little or no cough, arid  no expectora-
tion, nor apparently much lung affection, until about the seven h
day of disease, when  the lungs would suddenly become  filled with
bloody mucus and the patient die comatose. These cases I treated
much  as the former, but made more free use of squills, seneka and
ipecac, but with no  sensible good effect  Would  these patients
have been relieved  by early and copious bleeding f
   There were several cases in which the Vf^™ £*?**£,
and one hundred and thirty or one hundred and forty in the^minute
the countenance  of the  patient sunken;  the  temperature  of the
body much below that in health; the skin aboutthe.mouth  under
the eyes and on the ends of the fingers, of the color of black lead
the tongue moist, and but little or not any furred; the patient not
thirsty, and not disrelishing food;  in respiration,  J*"**"^
quent, very little air was inhaled, of which the-patient wasinsen
sible, 'and complained of no  difficulty  in breathing nor of pain in 
12
the chest, unless questioned, and this pain was  not increased by
inspiration.  The patient would continue to sit or walk his room,
until on the seventh day, he would suddenly become comatose
and insensible, his lungs filling with mucus, and would die on the
following day.
   These patients were freely blistered, and made free use of various
diffusible stimulants; but, in no case, with the least sensible good
or bad effect, nor was there the least change produced by drastic
purging with Lee's pills and calomel, which had been taken by one
patient before  I prescribed for him.
   One patient, a female, aged about  fifty-five, on  the morning of
the 27th of January, 1816,  felt for a  few minutes, a very severe
pain near the hip; was well through most of the day, but was again
attacked with  pain in  the same parts.   This continued, with a
weak and frequent pulse, with little pyrexia or lung affection, for
about one week, when the pain suddenly subsided, her lungs be-
came filled with bloody mucus, and she died comatose, on the first
or second day after.
   Two cases commenced with  coma.
   One of these, a  male, aged about  thirty,  complained of some
slight indisposition in the evening  of the 1st of February, 1816.
Next morning he was found in a state of perfect coma.   By fric-
tions, application of heats,  blisters and  diffusible stimuli, he was
aroused.  He now had pain  in  the side,  with much pyrexia,
cough and expectoration of  bloody mucus.
   This patient recovered, but cannot say whether at the close of
the first week or later ; nor can I be very particular in giving the
treatment, (as there were several others in the family sick at the
same time)  but well recollect that I prescribed spirits, opium and
bark, early in  the  disease, and believe from  the first, that these
were used by the  nurse more freely than I had at first directed;
but finding my patient expectorating pretty freely,  matter more
puriform than  I had seen in any other case, a free use of the same
medicines was continued  by my directions, making, (as I sup-
posed) the case resemble a true case of pleurisy, much nearer than
any other case during this epidemic.
   The other patient, a female, aged  about seventy-five, was sud-
denly attacked in  the evening of  the 19th of February, 1816, as
with apoplexy.  I saw her within thirty minutes ; her lungs were
then filled with bloody mucus;  external means were used to pro-
duce  reaction, no  medicine was swallowed, and she died on the
next  morning.
   Another female, in  child-bed, two or three days after delivery,
about the 24th of March, 1816,  was attacked with fever and ap-
parent peritonial inflammation.   She died on the 31st of March,
expectorating bloody mucus.
   None of these patients, even  in the cases of most pyrexia, com-
plained of pain in the head.  But many of those who had least
pyrexia would, if questioned, say  their heads were " clear, re- 
13
markably clear," or, " big and light;" these were pleasurable sen-
sations.  This was invariably the case when the pulse was very
small and frequent, and the temperature of the body much below
that in health, with discoloration of the skin.
  In some cases where there was but little febrile  heats, the pa-
tients would, at times, be exceedingly distressed, with a sensation
like that of strangulation, as if produced by compressing the trachea
immediately above the sternum, inducing a belief, not only of the
sufferer, but of bystanders, that the patient was dying.   This affec-
tion might  always be removed for the time, almost instantly, by
a small draught of very hot sling, or a spoonful of hot infusion of
capsicum, by essence peppermint  on sugar, a strong dose of cam-
phor or aqua  ammonia,  or by any  means making a sudden and
very sensible impression on the  fauces ; but their recurrence could
be prevented only by a regular  use of opium, spirits and cinchona.
Every patient thus affected recovered.
  Delirium was very seldom seen,  even  in the slightest degree,
until within an hour or two of the death of some of those patients
that did  not die comatose.   In these cases the delirium  much
resembled hysteria ; the patient  apparently happy, conceiving him-
self well,  and  talking with  inconceivable volubility to the last
breath.
  Two protracted cases among  those patients whom  I bled, have
been related ; one of two  weeks continuance, and one of five or six.
These, with  one other,  are  all the protracted cases during this
epidemic.
  On the 23d  of November, 1815, I visited a male, aged about
thirty; gave him an  emetic and prescribed antimonials; on the
second  day he was blistered, and  made use of Dover's powder,
which was continued  until the seventh day, when  I found him
with a feeble pulse, lungs loaded with mucus, and respiration diffi-
cult.   I kept him for  some hours a  little nauseated  with ipecac,
occasionally exciting slight puking  by giving him hot sling with
laudanum and peppermint.   In this  time he was relieved, and by
a moderate use of opium, spirits and cinchona, at the end of the
second week was convalescing.
  These three protracted cases, and a very few which terminated
favorably on or about  the fourth day, were,  I believe, all among
those who recovered where  there was not a perfect  crisis on or
about the seventh day.   And with the exception of the two cases
related, in which the patient died in the  commencement without
medication, I believe that all my patients who died with this epi-
demic, either died on  the seventh or eighth day, or  at  that time
went into a state from  which there was no recovery.   The pa-
tient either becoming  suddenly comatose, or much more comfort-
able, febrile heat subsiding, expectoration lessening,  lungs more
free of mucus, respiration easy, but inspiration short and the pulse
smaller and much  increased in  frequency, these patients com-
monly died on  the eighth day. 
14
   Beside the remedies which have  been mentioned in my more
common treatment of this disease, I made use, in some of the more
sunken  cases, of Fowler's solution, tincture lyttse, and infusion of
capsicum;  and in some others, tincture sang, con., and of tincture
lobel. inf.,  but more sparingly than  I have since used  them,  and
with less sensible good effect.  1 also  made  some use  of seneka,
squills and other pectorals, without any sensible good effect, unless
in cases accompanied with the  most febrile heat.  In the lower,
sunken cases, opium and other diffusible stimuli, with tonics, were
the best expectorants.
   The number of my patients with this disease, during  its contin-
uance as an epidemic from about the middle of November,  1815,
to the middle of March,  1816, cannot now  be  ascertained;  but
from an enumeration mentally made soon after  the subsiding of
the epidemic, I believe the cases were not less than one  hundred
and fifty ; and  if to these be added the cases which occurred before
the close of the year 1816, I think they must have exceeded  this
number.
   Of these patients, nineteen died ; the first on the 21st of Janu-
ary, and the last on the 31st March, 1816.
   Four of the fatal cases have  been related ;  one of which, a
female,  aged about seventy-five,  died  in about twelve or fifteen
hours from the attack, without medicine.   Of the others, one was
a man aged about eighty, who died in a very few minutes after I
first saw him,  and in about twenty hours from commencement of
disease, without medication ;  one was  an intemperate  man, who
had been sick two or three days without medication, when I made
my first visit;  one was a child which had been sick two  or three
days before I saw it; one was near death with pthisis pulmonalis,
and one died of relapse  from fatigue and exposure to cold while
in a state of convalescence.
   Such was the number  of  sick during more than the last half
of the time, that I  was under necessity of visiting from twenty
to thirty patients  daily.   Under  these  circumstances,  I could
neither pay that  attention which many cases required, nor have
that advice of which I should gladly have availed myself, if cir-
cumstances had permitted.
   Dr. Bruce, of Hartford, saw a female, aged about thirty, in  the
commencement of disease, and visited her daily until the fatal  ter-
mination of the case.  He also visited a child three or  four years
old, on the second  day of disease,  and from that time  daily until
the patient was  convalescing, and made a single call  on several
others, one of which died.  The late Dr. Everett, of Canton, made
a single visit to a child, which died.   The late Dr. Coggswell, of
Hartford, visited another patient once, which  died.  The late  Dr.
Sparhawk, then of Hartford, visited one patient once, which died,
and Dr. Cooley, of Manchester, visited another twice, which died.
   These were the only instances of consultation during this  epi-
demic, the  most distressing and fatal that I have ever  witnessed. 
15
 In this situation of uncommon responsibility, I was under the ne-
 cessity of prescribing for my patients, not only with much mental
 anxiety, but with great bodily fatigue;  the  number and state of
 my patients while this disease was most prevalent, requiring mv
 unremitted attention by night and by day, and preventing my retir-
 ing for rest for twenty-two days in succession, or getting any sleep
 during that time, except in the sick-rooms of my patients   Du-
 ring this time I made no regular account of my services, to which
 circumstance it is  owing that  I have  not been more  particular in
 the relation of some  cases given.
   There were five or six cases of this disease in the northern part
 of the town, in February and March, 1816, two or three of which
 proved fatal.  There were also two cases about this time in the
 south part of the  town ; both proved fatal, one of which died in
 a few hours  from  the attack, without medication.  There were
 also in the fall  of 1815, one other fatal case in the south part of
 the town,  and  two  others in  the east part.  Beside these cases,
 which were under the care  of other physicians, I know of none
 but those which were under my care in the years 1815 and 1816.
   In  the winter and  spring months of, I believe, each of the suc-
 ceeding years, there  were some few cases of this disease.   I have
 supposed the number in these eight years to  have been eighty ;
 four of  which patients died, a male aged eighty-four, on the 11th
 of March, and a female aged  about seventy-five, on the 10th of
 December, 1818;  a male  aged about sixty,  on the  15th of Jan-
 uary, 1820, and a male aged about fifty, (the disease accompanied
 with  delirium tremens,) died in February, 1822.
   In  February,  March, April  and May, 1825,  this disease was
 again epidemic ; during which time, and in the remainder of the
 year, there were probably fifty cases,  of  which five proved fatal.
   A  male  aged  about sixty, died on the 20th  of February ; a
 female aged about seventy-five, on the 18th of March, and another
 female of about the same age,  on  the 21st of March,  and another
 female aged about  forty, on  or about  the 15th of May.
   In  February,  March and April, 1826, there were a few cases
 of this disease, I suppose fifteen.  The disease was mostly  among
 children, and was  less  malignant than 1 had seen it any preced-
 ing year, with, perhaps, the exception of 1799, and only one pa-
 tient died.  A young man whom I had visited from the 6th to the
 12th of April had recovered from this disease, and had been abroad
 at hard labor about one  week,  when he was again attacked with
 this disease on the  27th of April, and died on the 3d of May.
  On examination of his lungs after death, the most of one lobe
 was found hepatized  ; different parts of the lungs adhering to the
 pleura costalis ; a  very small  quantity of a sanious fluid in some
 of the bronchia; and, on cutting into the hepatized parts here and
there, a single drop of a thin and milky appearing fluid, but very
little resembling pus.
  In the years  1827-8, the disease continued  milder, but more 
16
affectino- adults.  I have supposed the number of cases in these
two years, thirty.  One patient only died.   A female, aged about
forty-five, broken down by intemperance, without nursing,  and
with but little medication, died in September, 1827.
  In  18:29   the  disease .was  more prevalent.   The  cases were
probably not less than thirty,  two of which proved fatal.
  A female, aged about seventy or seventy-five, died on the 12th
of March, and a male aged about seventy-five, on the  22d.
  There  were cases of this disease in each year, from  the 1st of
January, 1830, to 1st of January, 1837, but at no time were they
very prevalent.  I have supposed the whole number to have been
fifty, five of which proved fatal.
  A female, aged about eighty-five, died on the 28th of January,
and  another female, aged about sixty-five, and  previously sup-
posed to be laboring  under  hydrothorax, on the  19th  of May,
1830.
  A child, aged  three  or four, died on the 16th of July, 1832, a
male, aged  seventy-two, on the  5th of December, 1834, and  a
female, aged about fifty, on the 27th of December, 1835.
  In the  month of January, 1837, I had five cases of this disease.
One of these patients, a female, aged seventy-one, died  on the 14th.
The number of my patients with this disease, from the 1st of Jan-
uary, 1817, to the 1st  of February, 1837, I do not pretend to as-
certain.   I  have supposed the number in different periods of this
time, only for the purpose of approaching nearer the truth than I
could otherwise have done, and believe that the number of 260,
as supposed, is not too great.
  The whole number of fatal cases during this time, was nineteen.
  In the  year 1799, no child was  the  subject of this  disease, but
since that time it has  occasionally occurred among children, and
more particularly in the years 1826, '7, and '8.
  When  this disease attacks children, it  most commonly appears
in one of the  two following  forms:   The patient, in  the com-
mencement, has a very frequent and sharp pulse, with much heat,
and a florid  countenance; is  often somewhat comatose, and res-
piration  is somewhat laborious, with more or less of mucus on the
lungs, which is sometimes but not always bloody.   Or, which is
more seldom the case, the pulse,  although frequent, is soft; there
is but little heat on the skin,  or fur on the tongue, respiration is
quick, but not laborious, and, in  the commencement, there is but
little mucus on the lungs, and the child  is either  in some degree
of stupor or  restless.
  In the former  of these cases, after procuring moderate evacua-
tions from the bowels  by calomel or oil, I have commenced the
use of calomel in small doses,  and of tinct. sang. con. in such doses
as the stomach would bear, combining with this either  laudanum
or elixir  paregoric, omitting the  use of the calomel whenever the
pulse lessens in frequency, and heat abates; now combining with
the tinct. sanguin. more laudanum or elixir, and directing a mod- 
17
 erate use of spirits in warm sling, or of aqua ammonia, or infusion
 of capsicum.   If, in the course of disease, the lungs became much
 loaded with mucus, previous to an abatement of heat, or softening
 of pulse,  I have found light puking, induced by addition of tinct.
 lobelia inf. to the tinct. sanguin.,  or of ipecac, or squills, useful.
   In the other form of the disease, I have commenced the treat-
 ment with the use of tinct. sanguin. with tinct. opii. or elix. par.,
 making some  use of weak, warm sling, or infusion of capsicum ;
 continuing these if the pulse  became more full and less frequent,
 as it often will ; but if the pulse should become more frequent and
 more feeble, and the lungs more  loaded, I have prescribed, in  ad-
 dition, tinct. lyttse, or  Fowler's solution, in very small doses, fur-
 ther supporting the patient, in the most sunken cases, by sulph.
 quinine.
   In this mode of treating this disease,  when children are its sub-
 jects, I have some confidence, having lost but one of these patients
 in the last twenty years.
   This was a child three or four years old, which I first saw when
 it had been sick three or four days, and  in a state from which I did
 not expect it would recover.  It  died July 16th, 1822.
   In one case only has this disease commenced with diarrhea.
   On Dec. 11th, 1S30, I  visited  an intemperate man, aged about
 sixty, on the third day of  disease, he  having had diarrhea  from
 the  commencement.  His pulse  was  full, but soft, and not  re-
 markably frequent;  was  expectorating bloody mucus,  of a yel-
 lowish tinge, in considerable quantity;  complained of no pain,  but
 was slightly mentally deranged.
   One tablespoonful of spirits, one of infusion of capsicum, with
 one  teaspoonful of tinct. sanguin. and  one of elixir paregoric, or
 ten or fifteen drops of laudanum,  was given  every thirty minutes
 from Saturday evening until the next Thursday morning; the  pa-
 tient in the course of  Wednesday night first tasting the pepper.
 He also, from Sunday night to Thursday morning, took about  six
 ounces of decoction of cinchona, and from six to twelve grains of
 sulph. quin.  in the course  of each twenty-four hours.  On Thurs-
 day  morning he was rational  and nearly free from fever, having
 had no evacuation from the bowels from the commencement of
 medication, and soon recovered with a moderate use of tonics.
  For the last twelve or fifteen years, I have made a much more
 free  use of tinct. sanguin., tinct.  lobelia inf., and of tinct. or inf.
 capsicum  in  this disease than formerly,  and am of opinion that in
 cases of much pyrexia and difficult breathing, the free use of tinct.
 sanguin., with or without calomel in small doses, tends to lessen
 heat, soften the pulse, lessen its frequency, procure ease in breath-
 ing,  and promote expectoration.   But that, in cases with a small
 and very frequent pulse, with  but little heat, and if  breathing be
difficult from much mucus in the lungs, calomel is injurious;  and
that, in these cases, the use of tinct. sanguin. with opium, of spirits,
of capsicum, and of sulph. quin.  or decoction of cinchona, will
                3 
18
tend to increase  the  fullness  of the  pulse, lessen  its  frequency,
render expectoration  more free, and respiration more easy.
  So Generally has a crisis in  this disease occurred on the seventh
day, that when the disease has terminated favorably at  an earlier
period, I have believed this the effect of medication happily adapted
to the case ; and  that, when the fever has continued two weeks or
longer, this protraction has been effected by medication, and that
the disease would otherwise have ended on the seventh day, either
in death or recovery.
  In the five protracted cases which I have related, I bled two of
the patients once; one I bled  twice, and one I bled three times;
all were purged, and used either calomel or antimonials, and near
the close  of the first week, I believe they were not sufficiently
supported.  To these causes I have attributed the protraction and
also the  hemorrhage from the bowels  in  the case longest pro-
tracted, having never known  a hemorrhage of this kind occur in
this disease in any other case.
  These five protracted cases related, are all which I can recol-
lect among my patients, but  have  seen  others which, like mine,
might have been induced by a reducing mode of practice.
  On the  30th of October, 1830, I visited, in consultation, a fe-
male, aged about thirty, on about  the sixteenth day  of  disease.
She had been purged with calomel, and had used it in small doses
through the first week or longer, by  which her mouth had been
affected, and which was now, with her throat, filled with thrush;
her pulmonic affections had  in great measure subsided,  but her
breathing was not free, and  deglutition  was very  difficult.   She
had had, for several days, some diarrhea,  and her bowels were
somewhat tumid.  There was so much stupor upon  her that it
was with difficulty her attention could be attracted.   Her pulse
was small and frequent, and she was inclined to sweat.
   In the course  of the next  twenty-four hours, she took  six pills
of  opium, of from one and  a half to two grains  each, eighteen
drops of Fowler's solution, with sixty of laudanum, about a half
pint of decoction of cinchona and galangal,  about a half pint of
spirits, and about a  half pint of pepper tea, to which her throat
was at first insensible.  On the next day, her pulse was more full
and less frequent, her  mouth and  throat much more comfortable,
deglutition more easy, her sweating had  subsided, and  she was
free from stupor.
   This course was continued for about a week, during which time
 she had no evacuation from the bowels.  She was now convales-
 cent, and soon recovered under a moderate use of tonics.
    Copious  bleeding, in  the  commencement  of  this disease, has
 been said to have produced most salutary effects.  That this may
 have been true  in some cases, I  am  inclined  to believe, but more
 from the affirmation  of others than from my own  experience.
 But in what particular  cases, I am yet uninformed ; and that it
 can be indiscriminately and advantageously used,  I am to be con-
 vinced by the experience of others, for there are  many cases in 
19
which bleeding appears to me not  indicated, and in which I have
found a  very different practice successful.
  Of all the patients with this disease under my care, I believe I
have bled only  twenty-six, sixteen of which recovered, and  ten
died; but of these sixteen, three proved protracted cases, the pa-
tients recovering under  a free use of stimulants and tonics;  and
of the other thirteen which recovered, eleven, which were sick in
1799, I  have ever believed would have  recovered without bleed-
ing.   These bleedings, as has been noticed, were generally small,
and not  always made on the first day, but in some cases repeated.
  Are there cases in which bleeding is more indicated by difficult
respiration, than by the state of the pulse, in which an  early and
copious  bleeding, immediately followed by a free supporting course,
would be the most successful practice ?   And might those cases
in which with a small pulse of 130 or 140  in the minute, the tem-
perature of the body of the  patient being much below that in
health,  his  countenance sunken, and lips and the skin on different
parts of the body  of a lead color, be successfully treated in  this
way.'
  The number of cases of pneumonic inflammation, which I have
termed ptyphoid, which have fallen under my care in the  course
of the thirty-eight years, from Jan. 1st, 1799,  to Feb. 1st, 1837,
it would  be impossible  to  ascertain, or compute with any great
degree of accuracy; but to  approach the  number as nearly as
practicable, I have considered different portions of this time, and
have made the following estimate, which, although it  probably
is, in some particulars, incorrect,  I believe  does not exceed the
true number in the sum total:—
In the winter and spring of 1799, the num-
  ber as  ascertained, was  .....20, of which  3 died.
In the succeeding months, (supposed,)       5,     "     1   "
In the next 11 yrs., to 1st Jan.  1811, (sup.)  20,     "     1   «
In the 4 yrs., 1811, '12, '13,  '14, (sup.) -  45,     "     5   «
In the years 1815, '16,  as estimated soon
  after,...........200,     «   19   «
In the next 8 yrs., to Jan. 1835, (sup.)  -  80,     "     4   "
In 1825, in the  spring—the  disease  epi-
  demic—(supposed,)  ------  50,           5
In 1826,  (supposed,)......15,     "     1   "
In the 3 years, 1827, '28, '29, (supposed,)   60,           3   "
In the next 6 years, to  Jan.  1837, (sup.)  50,  _   "     5   "
In the month of Jan. 1837, were sick,   -   5,     "     1   "

Estimated number of patients in the 38 yrs. 550, of which 48 died.

  This list is intended to include all cases of this disease, however
mild, and all who have been much conversant with it will  be sen-
sible that in such a list will be included many cases in which the
patient would recover with little or no medication, or even with
light, bad treatment.   In such  cases it is admitted that success is 
20
no  certain proof of the best treatment.   They also know that
among the aged, and  those broken down  by intemperance, there
will be many fatal cases under any mode of treatment; and in my
list of fatal cases, there is, I believe, an uncommon proportion of
these.
  Of the forty-eight who died of this disease, three only were
children.   Of the adults  (of whom  nineteen  were males, and
twenty-six were females,) five were from twenty to thirty years
of age; thirteen  were  from  thirty to  fifty ; thirteen were from
fifty to seventy; and  fourteen were from  seventy to eighty-five
years of  age.
  Two of those whom I visited, died, one in a few minutes, and
the other in a few hours, without medication.   One was broken
down by intemperance, had  but little  nursing or medication.
Three were intemperate, two of which I first saw on the second
or third day of disease, and the  other became affected  with de-
lirium tremens  and unmanageable. Three were in a consumption.
One had  been  supposed previously laboring under hydrothorax.
One died  in a relapse from fatigue and exposure to cold while in
a state of convalescence ; and one in a recurrence of disease, after
having been at  hard labor in the open  air for about one week.
  Thus,  beside the two cases which proved fatal without medica-
tion, there were ten  others of the remaining forty-six,  which, if
curable  in any way, were very improper  cases  to  test  the  pro-
priety or impropriety of any mode of  practice which should not
prove successful.
  Having been  located where this disease has been much more
prevalent than in any other place within my knowledge,  and hav-
ing lost,  in  the time specified, more patients by  this than by all
other febrile diseases, it has been my intention in this account to
notice, as far as was in my power, every particular relating to the
disease, tending to an elucidation of its character, and every par-
ticular in  my treatment that would  show  the effect of  medicine,
whether  salutary or  injurious, hoping, that if useful in  no other
way, it might be of some service by attracting the attention of this
Association to this important subject.
  In the summer and fall of 1799, and of  1801, '2, and '3, there
were many cases of common typhus, in which, after some evacua-
tion from the first passages,  in the commencement of  disease, I
found tonics necessary, and, in some cases,  a pretty free use of
them early in the disease, the  cases in general continuing two or
three weeks.  But in the year 1800 fevers were not so asthenic ;
they more resembled  the synochus of Cullen.   In some of these
cases I bled, and in many made some use of calomel or of antimo-
nials in the commencement, but most of them required the use of
tonics in  the course of the disease.
  In one case, the patient, a  robust,  plethoric  male, with much
pyrexia,  and, for some days, with some pain about the chest, I
made six small bleedings in  the course  of  the first week, and
purged and blistered him.  On about the tenth or twelfth day, he 
21
 began to expectorate; I now commenced  the  use of tonics, and
 he eventually recovered, but the fever was of three or four weeks
 contmuance^and was probably protracted by too much evacuation.


                   DYSENTERY  OF 1801.
   While typhus was common in the fall of 1S01, dysentery com-
 menced as an epidemic.   In September, October, and November,
 I visited from forty to  fifty patients with this disease, most of
 which were children.   When adults were  the subjects of disease,
 it commenced in most  cases with slight  chills and pain in the
 bowels, back, or limbs, soon succeeded by pyrexia, with  a small
 and frequent pulse, and dysenteric evacuations,  with distressing
 tenesmus.  But in some cases, more especially among  children,
 the disease commenced with diarrhea, the evacuations of some be-
 coming  dysenteric, with tenesmus and pyrexia, with the same
 small and frequent pulse as in other cases.
   I visited  my first patient with this disease,  a  child two or three
 years of age, on the 9th  of September.  In this case, I made use
 of some laxatives, and of some  laudanum; the evacuations con-
 tinued, and the child died on the seventh day of disease.
   On  the 27th of September, I visited a  young man,  on about
 the  third day of disease, who had taken one or two doses of ca-
 thartic salts.  His evacuations were very frequent, and tenesmus
 very distressing.  I directed a pretty free use of laudanum, and on
 the next day, the fourth of disease, he was much more comfortable.
 But as there had been very little discharge of foecal matter from
 the commencement of disease, 1  directed a  dose of castor oil  and
 continuance  of laudanum.   By  the oil  little  or no discharge of
 foecal matter was effected, but the tenesmus was much increased.
 On the fifth day the laudanum was continued, and another  dose of
 oil was given, producing all the  bad effects of  the former.  The
 next four days he was kept much more comfortable  by a free use
 of laudanum; but as there  had  been but very  little  discharge of
 fcecal matter from the first, another laxative was used, with no
 other effect  than an increase of disease.   Laudanum was now di-
 rected, with  hot sling, in such doses as should keep  the patient
 more comfortable,  and laudanum by injection immediately after
 each evacuation.   He now  began to improve, but the disease was
 followed by diarrhea, requiring some use of tonics with laudanum
 for several weeks.
  On the 29th of September, I visited a young child affected with
 diarrhea, but with little or no tenesmus.   I directed an infusion
 of rhubarb and senna.  The operation was followed by dysenteric
 evacuations  and tenesmus.   These were not suppressed by lauda-
 num given, and no injection was  retained.   The child died on the
sixth or seventh day.
  On  the 4th of October,  I visited another child affected with
diarrhcea, with little or no tenesmus, and made use of a cathartic,
with an increase of complaint.    I was now  determined to depend 
22
on a free use of opium alone, but this plan was not approved of by
the parents ; another physician was employed—the  patient took
a little rhubarb daily, used but very little laudanum, and died in
a few days.
  On the 4th of October I visited another young child which had
been several days sick with dysenteric evacuations and tenesmus.
I directed laudanum  injections, and laudanum  by the mouth, if
necessary.   I saw it again in two or three days ; little laudanum
had  been given, and no injection had been used, and the child died
without any efficient medication.
  In further proof of the bad effect of cathartics, one other case
may be adduced.   About this time I was consulted in the  morning
in the case of a child, from one to two years old, which had been
troubled with diarrhea the preceding night, which had now sub-
sided, and the child was apparently well and playful.  I advised
the use of laudanum in case the diarrhea returned, and piescribed
nothing further.   The diarrhea did  not return, and the child con-
tinued apparently well; but, to prevent  disease,  at sunset, by the
advice of another physician, it took castor oil.  With  its operation
dysenteric evacuations  were procured, with tenesmus,  and  the
child in three or four days died under the care  of the physician
who had given the oil.
  Having noticed the injurious effects of cathartics  and  of laxa-
tives, not only in the fatal cases related, but in others from which
the patients  recovered, I was determined to make the least pos-
sible use of them in my future practice,  and, by means of opium,
control the discharges, and procure  ease, so far as practicable, for
my patients.
  To produce  these effects by opium it  was commonly necessary
that it should both be taken by the mouth and used by way of in-
jection.  In  all cases when  the evacuations  were very frequent,
and  tenesmus very distressing, it was necessary to give opium by
the mouth in quantity sufficient to ease  from pain,  and  prevent
evacuation for the time, and  to  make  use of the first  injection
while the patient was in some degree under the influence of the
opium taken.  This injection might be retained for several hours,
and  if care were taken  to repeat  the  injection immediately after
each evacuation, (not giving time for the second,) these would be-
come less and less frequent, and be attended  with less and less of
pain, and when the evacuations were not more frequent than once
in four or six  hours, they would contain some foecal  matter, often
more than could have been  procured  by a cathartic, and the pa-
tient, in a week or ten  days, would be  free from fever and pain,
and  his evacuations would be natural or nearly so.  But in some
cases, a regular use of opium every two, four or six hours, was
necessary to ensure the retention of the  injections.   I made use of
little medicine  beside opium, but in cases of apparent exhaustion
in the course of disease, and in some of the most  asthenic cases,
from the commencement I prescribed a moderate use of brandy or 
23
spirits in warm sling, and  am confident that I made use of no ca-
thartic or  laxative.                         *
  The number of my patients in this epidemic treated in this way.
I have not ascertained, but believe it not less than from twenty to
thirty.  They all recovered.   Although since 1801 dysentery can
hardly be  said to have been epidemic in any one year, there have
been few  years in which I have not had some dysenteric patients,
all of which I have treated, in general, on the plan last adopted in
the epidemic described.  I have very seldom, indeed, made use of
any cathartic or even laxatives, and believe never with any sensi-
ble, ultimate good effect.
  In  September, 1834, I lost  two dysenteric patients, both  chil-
dren.  One  of these, four or five years old, in the course of dysen-
tery, voided many worms, and in eight or ten days dysenteric com-
plaints had  subsided, and  the bowels had become nearly regular,
when the  patient was attacked with spasms  and  diarrhea.  Be-
lieving that worms were the cause of these, I prescribed spigelia,
calomel and oil.  The child expelled several more worms, but the
spasms continued with return  of tenesmus,  and the child died on
the next day.
  The other patient, two or three years old,  was at  first affected
with spasms, succeeded by diarrhea, the evacuations  soon becom-
ing dysenteric.  For two or three days the patient appeared to be
doing well, in this time voiding several worms ; was then affected
with  spasms,  took spigelia, calomel and oil, and voided several
more worms,  but with increased tenesmus  and  continuance  of
spasms; the child died in a few hours.
   Although worms may have been the immediate cause of death
in both of these cases, there  was an increase of tenesmus in one,
and a return of it in the other, as I suppose, from the use of physic.
These are the only dysenteric patients which I have lost since I
changed my practice in the epidemic in  1801, and have never lost
one, unless some cathartic had been used, with the  single excep-
tion in the case of 1801, already  related, in which no physic was
given, nor was  opium  used as directed.  I have seldom seen a
dysentery succeeded by diarrhea in my practice.  When it has
occurred I have found no difficulty in overcoming it by opium and
acetate of lead, with tonics ;  but have seen several cases in which,
when the patients had been  sick a week or ten days, all evacua-
 tion from the bowels was,  by the opium,  prevented for several
days, when the patients would have a free and natural evacuation,
without pain, the bowels from that time continuing regular.
   To this account of my treatment of this disease, I  have only to
 add, that  for the last fifteen or twenty years, I have made use of
 the  tincture and infusion of capsicum, seldom, however, in the
commencement of the disease, unless in some of the  most asthenic
cases, but in the course of disease, when there was great exhaus-
tion, I have used it, I think, advantageously; but  more especially
has it been  useful in cases of longer continuance, when the patient
is much exhausted with frequent mucus discharges, and tenderness 
24
 of bowels.  This tenderness of bowels, commencing  late in the
 disease, I think  I have  seen lessened by the use of this medicine.
   In the  spring and summer of 1804, there were many cases of
 fever, mostly among children, in some respects differing  from any
 I had before seen.   These commenced suddenly with  severe pain
 across the forehead ; the patients  were remarkably  sensible to
 lio-ht and  to sounds; the pulse  from  120 to 140  in the minute,
 small and rather sharp than hard ; the skin was very hot and face
 flushed, and in some cases there was, at times, apparently, a com-
 mencing rashy eruption  on some part of the face, or on the breast,
 or ears, lasting,  however, only for a few minutes at a time.  The
 tongue, in the very commencement, was covered with a very thin,
 and  very white  fur.   After two or three days,  the  pulse would,
 suddenly,  become less frequent, counting not more than sixty or
 fifty or even forty-five in the minute, but be regular.   The patient
 would now be more cool and free from pain in the head, but in
 this state there was in some cases torpor of bowels and of urinary
 bladder, this becoming distended without giving pain, and the pa-
 tient without inclination or power to expel it readily.   Some pa-
 tients, in this state, would be at times  affected with severe pain in
 the bowels or limbs, but more of them with a distressing sensation
 of suffocation, as if induced by compression of the trachea, imme-
 diately above the sternum ; and many complained at times of a dis-
 tressing pain in  the angle formed by  the junction of the clavicle
 with the  scapula,  and  this commonly, if not invariably, in  the
 right side.   In the commencement of these cases I procured some
 evacuation from the bowels, directed  wetting the head with cold
 water, and exposing the patient to cool air.  When the patients
 became cool, and the pulse unfrequent, I commenced the use of
 some of the diffusible stimuli, and in the cases of torpor of bowels,
 or of the urinary bladder, made use of spirits, tincture of guaiac,
 tincture of lytta, mustard seed,  blisters or  sinapisms.   An evacu-
 tion of urine might sometimes be procured  by the sudden applica-
 tion of heat or of cold to the region of the  pubes, at the instant of
 the patient's attempting to expel it.   The pain in the bowels or
 limbs might be removed by the use of laudanum with hot sling,
 and the distressing sensation of suffocation almost instantaneously,
 by the same means, or  by essence of peppermint,  by aqua am-
monia, or  by camphor, or by any thing that would make a strong
 and sensible impression on the fauces, but were  to be  prevented,
 only by a  regular use of opium and cinchona with spirits.  Most
 of these patients recovered in the course of a week or ten days,
 with a moderate use of these remedies; but some few continued
 sick for several weeks, requiring a more free use of these medi-
 cines, particularly of opium.   No one  of these patients died.

                      SCARLATINA.
  These fevers of 1804 which discovered great irritability of the
nervous system  in  their commencement, and  were  evidently
typhoid, were succeeded in the spring of 1805, by  scarlatina,
which prevailed  as an epidemic. 
25
  Under the term scarlatina,  I would be understood to include
Cullen's  scarlatina, scarlatina anginosa and  angina maligna, be-
lieving they are but different forms of the same  disease, and that
this is always asthenic, never prevailing as an  epidemic, but during
a general asthenic diathesis;  but that yet, as this is a contagious
disease, it may be communicated  to one not strongly  disposed to
asthenic  fever, and thus a case may be produced of  the mildest
form in the midst of a malignant epidemic, which like other mild
cases, might be safely trusted to nature, needing neither reducing
agent to lessen excitement, nor stimulants nor tonics  for the pur-
pose of raising it, which in these cases might prove only irritants.
All such cases I have considered as needing very little medication,
unless, in the course of the disease, some laxative should become
necessary to lessen irritation,  as  when the patient becomes rest-
less, with a small, sharp and more frequent  pulse,  with increase
of heat, or when  the  pulse becomes more frequent and small, and
soft, with diminished  heat, and the patient perhaps drowsy, now
requiring, as in  other malignant cases,  the use  of various stimu-
lants or tonics.
   Having made these remarks on the treatment of the milder cases,
what I shall further say respecting the treatment of this disease,
will relate only to those more malignant.
   In all  of these cases the pulse was very frequent, in some cases
small, quick aud sharp, with much febrile heat in the commence-
ment ; but in others more soft and weak, with less heat, and the
patient sometimes drowsy.  The inflammation  which in this dis-
ease is commonly mostly confined to the throat, in many cases ex-
tended to all parts of the mouth, internal nares and meatus audito-
rium, and these parts, as  well as the mouth,  were filled with can-
ker, which, on sloughing, left deep corroding ulcers, and in one
case caused deafness.   Some of the few blisters drawn were also
filled with canker, and were very injurious, tending to  exhaust the
patient  by their irritation.  In some cases the throat was much
swollen,  causing difficulty in deglutition and in respiration.   In
some there was diarrhea in the commencement; in some others
this commenced in the course  of disease.
   In the treatment of these cases I was careful not to reduce my
patients by evacuations from the stomach or bowels, and procured
none but with the lightest means,  and only for the purpose of les-
sening irritation in the cases of much febrile heat; nor did I make
use of any antiphlogistic remedies for the purpose of lessening ex-
citement, but endeavored to support my patients from the com-
mencement, by  making use of some of the  diffusible stimuli, as
aqua ammonia or camphor, or weak, warm  sling,  using  also an
infusion of serpentaria, continuing this through  the course of the
disease, or in the more  sunken and malignant cases substituting a
decoction of bark.  I also prescribed laudanum,  when this was
                        .- patient
there was much heat, that the room should be kept  cool.  All
                 4 
26
other cases, though less malignant, I considered as asthenic,  and
(excepting those too light to need medication,) I treated as such,
adapting my remedies to the degree of disease.  I also made use
of various astringent and detergent gargles, but with little sensible
good effect, beside  cleansing the  mouth and throat from acrid and
offensive matter.
  In the course of the last thirty  years, this disease has, at several
different times, been epidemic, but at no time so prevalent nor ma-
lignant  as in 1805.  In  the treatment of these cases it  is only ne-
cessary to say, that I  have continued my former practice, in gen-
eral, but have made a more free  use of opium as a stimulant, and
for the last fifteen  or twenty years, have made much  use  of the
infusion of capsicum, and believe it one of the best  of  stimulants
to produce reaction in the commencement of  some of the most
sunken  cases, and in cases of  sudden and great exhaustion  in the
course of the disease, and have found it particularly useful in some
cases in which the throat was much swollen and filled with can-
ker, or when the fauces were of a dark color and painful, andhave
known  it arrest the progress  of inflammation  in  its commence-
ment, when it  has been diffused and of  an erysipelatous appear-
ance.   In some of these cases, the infusion, so far from increasing
the pain in the throat, would make no sensible nor useful impres-
sion, unless  given  while hot or  with spirits.   My  patients have
been remarkably free  from that general edematous swelling of the
body so frequently affecting those who have recently  recovered
from this disease,  and believe  that no case of this kind has  occur-
red requiring any special attention, or for which I have made any
prescription,  but that of some  common diuretics, with  the contin-
ual use of tonics.
  But on the  1st of May, 1805, I saw a child which I had attend-
ed in a light case of this disease,  requiring but little medication,
making my last  visit on the  14th of March.  The  child  now,
after having been, as was said, well  for  about six weeks, had but
little pyrexia and  appeared but  slightly  indisposed ;  ^directed a
laxative only.  On the third day after I  was called to visit  it.  It
was now comatose, cold and nearly pulseless, with petechia} on
most parts of the body; there was an involuntary bloody discbarge
from the bowels,  and an oozing  of a bloody fluid from  the mouth,
nose and eyes.  On the next day the child died.
   In the evening  of the 22d of February, 1835, I visited a  female
aged about thirty.  She had complained of soreness of  throat for a
day or two,  her pulse was now very frequent and sharp ; her skin
was hot and covered with a rashy eruption.  At this lime she was
puking with an infusion of eupatorium perfoliatum which she had
taken.   She was  inclined to take no medicine through the night,
and I prescribed none, but she continued to puke  and also purged.
On  the 23d, without any sensible  change in the state of the pulse,
she was unable to swallow or attempt to swallow any thing, with-
out causing most  distressing efforts to  puke.   I could  get  neither
a pill of opium nor a dose of laudanum into the stomach, nor could
opium  be used in any other way.  She was disinclined to take any 
27
 medicine, food or drink, and swallowed nothing on this day nor the
 next.  On the  25th the pulse was less frequent, eruption had dis-
 appeared, and she was more comfortable, and in the course  of the
 day swallowed and retained a few teaspoonfuls of broth.  On the
 26th she was more comfortable,  and took  very  little broth, but
 was unwilling to take medicine, and took none.   In the evening,
 with  but  little  help, she for the first time got up from bed, sat for
 fifteen or  twenty minutes, with but little help got into bed and  im-
 mediately expired.   This patient, who, (with the exception of the
 emetic, which she took without advice,) died without medication,
 is the only one that I have ever  lost in this disease.  But  one child
 which died in 1794, which case has been noticed, I believe would
 have  died my patient, if it had not gone  into the  hands  of a root
 doctor.
   As indicating the commencement of an asthenic diathesis, notice
 has been taken of fevers preceding and accompanying scarlatina
 and dysentery;  but to give a more  connected account of typhoid
 pneumonia, that of all  other febrile diseases since the year 1805
 has been omitted.  From that  time  to the  present,  fevers have
 appeared  in various forms, not only in different  years, but have
 occurred at the same time in such forms as might have  been dis-
 tinguished by different appellations ;  but as  they all agreed in the
 same  general character, typhoid, requiring the same general treat-
 ment,  I shall comprise, under the  general term typhus, all idiopa-
 thic fevers, unaccompanied with  local inflammation,  which have
 occurred in my practice for the  last  thirty-two years, distinguish-
 ing more particularly those cases  only which I conceived required
 some  difference in treatment.
   Through the spring, summer and fall of 1806, fevers were very
 prevalent.   In most of these cases, the patients, after some days of
 predisposition, indicated by want of appetite, slight headache or
 pain in the  back or limbs, sense  of fatigue and  restless nights,
 would be  affected  with  some  slight chills,  soon succeeded with
 moderate heat,  and increase of pain  in the head, or a confused
 state of mind.   The pulse, now, seldom less  but often more than
 120 in the minute, and always small; the tongue being commonly
 soft and moist, covered with a thin, white fur, and seldom becom-
 ing dry and hard in the course of disease.  But in some cases,
 the patients, without  any previous  symptoms  of predisposition,
 would  be very suddenly  attacked with pain in the head, or dizzi-
 ness and  imperfect vision, accompanied, sometimes,  with slight
 nausea.  In these cases there commonly arose more heat, than in
 those  preceded  with symptoms of predisposition ; and some few
 of these patients were somewhat drowsy in the commencement of
 disease, but  in  general  the patients  were  watchful  through its
 whole course.
  There  were  mild cases  of  typhus, the  treatment of which I
 commenced, if there were much heat and nausea,  with an emetic
of ipecac,  or  if there  were no  nausea, by evacuating  the bowels
with calomel and Dover's powder, or other  mild cathartic-   For
several of the succeeding days, making use of opium combined 
28
with ipecac, or if there were much heat,  with calomel or some
antimonial, omitting the calomel or  antimonials immediately on
the lessening of heat or the softening  of the pulse, continuing a
moderate  use of opium and other diffusible stimulants and infu-
sion of serpentaria, or  in  cases of more  debility, decoction of
cinchona, for the several last days of the first week.
  In most of these cases, about the close of the first week, there
would be an abatement of disease, and the  patient, with little or
no increase  of means of support, would recover in about another
week.  But in some cases, when,  as I conceived, there had been
too much evacuation, or calomel  or antimonials  had  been  too
loner or too  freely used, or sufficient support in the latter part of
thelfirst week had not been given, the patients would, in the com-
mencement of the second week, be in a state of muttering deliri-
um, with more or less of subsultus,  and very  watchful, the pulse
havino- become smaller and more frequent.   In this  state of my
patients, I made use of stimulants  and tonics much more freely.
  On the 13th of July, I visited a man  aged about  twenty-five.
His fever  had commenced  with slight rigors ; he  complained of
pain in the head, and of some nausea, his pulse was frequent and
his skin hot.  1  gave an emetic in  the evening, and directed an
opiate after  its operation.  On  the second day, directed calomel
in small  doses with opium and  infusion of serpentaria. This
practice was continued through the first week.   On the eighth
day, I found the pulse  more  frequent, and the patient watchful
and  delirious.  From this  time he took daily six  or eight grains
of opium, from half an ounce to an ounce of bark in decoction,
and about a half pint of spirits, until about the close of the second
week,  when the fever subsided, the patient  became rational and
soon recovered with a moderate use of tonics.
   On the 30th of October, in  the  evening, I visited a man aged
about thirty, who had been suddenly affected with dizziness  and
blindness, from which he,had nearly recovered, but said his mind
was confused, and complained of some nausea.   His pulse  was
small and frequent, with little febrile heat.   I gave a light emetic
and directed an opiate after its operation.   On the second day
there was more heat, and I directed opium, with tartar of antimo-
ny.  From  the third to the eighth day, he took opium, and was in
the use of infusion of serpentaria,  when I  found the pulse more
frequent, the patient delirious, much affected with subsultus and
very wakeful.  For two or three days he took daily from  eight to
twelve grains of opium, of bark, in decoction, from a half ounce
to an ounce, and  about one pint of spirits, and in the course of
this time, had taken several  doses of musk, each of about ten
grains, and had  continued in nearly the same state ;  but  now, on
visiting him on a morning, I  found him more delirious, and his
pulse more  frequent, and directed an increase of all his medicines,
and at night,  perceiving no sensible, change,  I  directed a still
further increase of medicine.  On the next morning found my
patient fast sinking, and  supposing him insensible to medicine,
despaired of his recovery : but the nurse, (who was a new one,) 
29
now told me that for the last thirty-six hours she had given only
about one-half of the quantity of medicine that I had directed, at
the commencement of this week, but would now follow directions.
The  use of medicines as at first directed, was now resumed.   In
the course  of a few days  the fever subsided,  the patient became
rational, and soon  recovered with a moderate use of tonics.
  Notwithstanding the difficulty of procuring sleep by  opium in
these cases, it was  effectually and beneficially  done in the case of
a colored female,  in the care of an ignorant nurse, in the month
of April.  The patient having  been in the second week of fever,
delirious and long  without sleep, I left, at night, a number of good
sized pills of opium, with directions that one should be given every
hour  until the patient should become sleepy.   The nextmornincr
the nurse told me  the  pills had  not operated, but that she gave
them hourly as long as  she could get  them down.   I however
found the patient in a profound sleep, with a pulse more full  and
less frequent.   She continued to sleep most of the time for twen-
ty-four hours, from which time she was more rational,  and event-
ually recovered.
   In  the course of this year the number of mypatients with typhus,
I believe could not have been  less than from  sixty to eighty, one
only  of which died.
   On the 31st of March,  I visited a young man who complained
of an excruciating  pain in one  side of the chest, and was in great
haste to be  bled.   Although he  had  but little pyrexia, and no
cough,  by the severity of pain  wlas induced to bleed him.   The
pain  was not removed by  the bleeding,  and I  directed  an emetic
and  epispastic.  The next morning, as the pain still  continued,
 although not so severe, I made another small bleeding.  On the
next  morning he  was free  from  fever and from pain,  but in the
afternoon was affected  with delirium tremens.   One pill of opium
 was all the  medicine that could be got  into his stomach, and he
died  in two or  three  days.  This patient was the only one that
was bled, and I have  since learned that these most excruciating
pain?, in the commencement of typhus,  when accompanied  with
 but  little heat, and with a  weak or soft pulse,  may be removed
 with  certainty, by  a free use, for a time, of diffusible  and  acrid
 stimulants,  opium, spirits and capsicum,  the last  article being
sometimes necessary to render the stomach  sensible  to any im-
 pression from the others.
   In the next  four succeeding years,  1807 '8 '9 and '10, fevers
like those  of I80G were still  prevalent, and  among them  were
some few cases much more  malignant.   In the evening of the 8th
of February, 1809, a child  two  or three  years old,  while  very
playful, complained, at several times,  of severe but  momentary
pain  in one finger.  The  child became sleepy and was put in bed,
and  was supposed   to be  well.   After  several hours  of sleep, it
awaked, made efforts to puke and again fell into a sleep  from
which it could not be awakened.  Petechia?  were soon discover-
ed on its breast;  about two hours later  I  saw the  child; it was
cold, senseless and pulseless; its feet were of a* purple color, and 
30
 its body was very much covered with petechia?.  Nothing could
 begot  into the stomach, nor could the sensible contraction  of a
 single muscular fibre,  for voluntary motion,  be produced.  The
 child soon died without medication.
   On the 23d of March, 1810, 1 visited a male, aged about fifty,
 in the commencement of fever, with  some lung  affection.  He
 was purged and blistered, and on the second day was bled, and on
 this and the third  made use of some  nitrous medicines; on the
 fourth  commenced the use of bark  and opium.   Through the
 second week was in a low typhus state ;  continued the use of bark
 and opium perhaps too sparingly.   He died on the 1st  of April,
 on about the fourteenth of disease.
   I lost one other patient in 1807, a lad eight or ten years of age,
 in  a relapse  induced by a surfeit while in a  state of  convales-
 cence.
   I have  not  ascertained that I lost  any other patients by these
 fevers in these four years, but I probably did.
   Fevers were very prevalent  and  more  asthenic in 1811 ; many
 cases  commencing very suddenly with  faintness or epigastric
 sinking, requiring an  immediate and  free use of  diffusible and
 acrid stimulants, until  reaction was produced, heat restored, and
 this distressing sensation was  for the time removed.  By a con-
 tinued, but  more moderate use of  the  same remedies,  together
 with a free use of cinchona, the patient would often be convales-
 cing at the close of the first week, and  sometimes earlier.  But in
 other cases the fever would continue for two or three  weeks, with lit-
 tle febrile heat, the patient being often affected with epigastric sink-
 ings, unless constantly well supported by cinchona, opium, spirits,
 and capsicum.   As these would, almost with certainty, be induced
 by every evacuation from the bowels, neither cathartics  nor laxa-
 tives could be  used at any time in the  course of the  disease but
 with decided bad effects; I therefore made  use of no means  to
 procure an alvine  evacuation during the continuance of disease,
 whether this were one  or two weeks, or longer, unless the patient
 complained  of an inclination for an evacuation, without  ability to
 effect it, (an instance of which I have seldom seen.) In this case
 the evacuation was most safely procured by  an injection, the pa-
 tient taking at the time an extra dose of opium with spirits, or in-
 fusion of capsicum.
  There were many other cases of fever, in this year like those of
 former years;  but there was an unusual proportion  of cases com-
 mencing with vertigo and affection of vision, and in many cases,
 at or near the close of the  first week, the pulse would  suddenly
 become preternaturally slow and infrequent, the patient becoming
 more comfortable.  This slate of  fever required no  increase in
 the use of stimulants, but less opium and more of the acrid stimu-
lants.  Torpor of the bowels or of the urinary bladder  was also
 more frequent, requiring  the use of tinct.  guaic, tinct. lyttae,
epispastics,  and infusion of capsicum.  There may  have been
some deaths, but in the course of this year none has been ascer-
tained. 
31
  Fevers which were very frequent in the years 1812, '13, and '14,
were, like those of 1811, highly asthenic, bore evacuations  as
poorly in the commencement, and some cases required much sup-
port in an advanced stage  of disease ;  but the cases commencing
with epigastric sinking were not in so great proportion as in that
year.
  On  the 7th  of November, 1812, I visited a man  aged about
twenty-five,  who  had been indisposed  for several days, and had
taken a cathartic.   He had now much pyrexia, and  I prescribed
antimonials  in small  doses;  but on the  second or third day,  he
was using serpentaria and opium, and I  believe some spirits.  On
about  the  eighth  day, the pulse became smaller and more fre-
quent, and the  patient was in a state of low, muttering delirium,
with subsultus.  Bark was now prescribed, with more opium and
spirits.  This course was  continued until about the  close of the
second week, when  a laxative was given, which operated quite
moderately, but exhausted the patient.,   When  he had been sup-
posed dying for several hours, I found him cold and nearly sense-
less, with a  pulse very frequent and scarcely perceptible.   In the
course of the next twenty-four hours,  he took at  least twelve
grains of opium, a half ounce or more of bark in decoction, and
nearly a pint of  spirits.   He gradually  became warmer, with a
pulse  more full and  less  frequent.  The same medicines were
continued in nearly the same quantity for about two weeks longer,
 when the patient was convalescing with the use of little  medicine.
   In this case, in the course of the third week, the patient had a
 second sinking turn; a watcher, by way of experiment,  having
 omitted all medicine  for  four hours.  From this he was  again
 raised by the former medicines for  a time more sedulously used.
   This case has been selected and thus particularly related, not
 as  a specimen of the best practice in  every  particular, but as
 showing the necessity of support and  danger from evacuations
 near the close of the  first  week, or near the approach of any other
 critical period, and the quantity of stimulants  and tonics neces-
 sary in an advanced stage of some of these cases.
   For the purpose of further showing, negatively, the necessity
 of such support in these cases, the following is adduced:
   On the 26th of December, 1812,1 visited a female aged about
 seventeen.   She was only moderately sick.  I puked  her with
 ipecac, and directed a moderate use of opium and of spirits.  In
 the course  of the first week,  her  pulse became preternaturally
 slow, and she was comfortable; but, at  the close of the week, she
 was affected with  epigastric sinkings-  These were suppressed by
 a more free use of spirits, opium, and bark; but by  a new nurse
 these were  used hi much  smaller doses, and, at the  close of the
 week, a severe cnse of sinking occurred, when I found the nurse
 (who supposed the patient was dying,  and unable  to swallow,)
 wetting the mouth of the patient occasionally with weak sling.
 I turned into the mouth of my patient a tablespoonful of brandy,
 with a small dose of laudanum, which was swallowed.  This dose
 I repeated a few times, and in the course of one hour ray patient 
32
 was again comfortable.   I  then  directed a more free use of the
 medicines, not doubting the recovery of the patient;  but my di-
 rections were not followed, and the patient, in a day or two, died,
 as I believe,  by neglect  of the nurse.
   This is the only patient I have ever lost in any case of fever in
 which the pulse became preternaturally slow.
   I have ascertained the death of only two patients besides this
 in 1812, '13, and '14, but there may have been others.
   From the  time that typhoid pneumonia commenced as an epi-
 demic in 1815, to  the close of the year 1816, typhus was less
 prevalent, and I believe  no case proved fatal.
   From Jan. 1st, 1817, to Jan. 1st, 1822, typhus was much more
 prevalent;  but during this time I lost only one patient with fever.
 A child which I visited  on the 14th  of August, 181S, had been
 sick but a short time, was comatose, much covered with petechia?,
 and died on the next day.
   In  1822, fevers were decidedly less asthenic than  they had been
 for many years. Of forty or fifty patients  which,  from the 26th
 of July to the 9th of November fell under my care, I bled six, and
 one  of these three times; but these bleedings were sparingly
 made.  These patients bore moderate evacuations  from the bow-
 els in the  commencement better than those of the  former years,
 but more or less use of  stimulants and tonics commonly became
 necessary  in  the course  of  the first week.   No case proved fatal
 during this year.
  In  1823, fevers were more prevalent and more asthenic, but I
 bled and purged one who recovered ;  but the case was a protracted
 one of four or five weeks.
  One case only proved fatal;  a female, aged about seventy-five,
 died on the 23d of June, after a sickness of about three weeks.
  In  1824, fevers were also prevalent, and were alike asthenic.
 Of these patients I lost two.
  One of these, a male,  aged about fifty, having so far recovered
 from a fever of two weeks continuance, that he rode in one day
 thirty miles, and a part  of this distance in rain, was again at-
 tacked with  fever,  and  died in about  ten  days, on the  14th of
 October.
  The other, a male, aged about twenty-one, I visited on the 30th
 of October.   He had  had, for  several days, a diarrhea, and had
 taken two doses of cathartic salts, by each of which he had been
 very drastically purged.   On  the 15th of  November he  had  a
 profuse hemorrhage from the bowels, and died on the  19th.
  In the years lb25,'6, '7. and '8, fevers continued to be very
prevalent,  many of which, and some of the worst cases, were in
the winter.
  In 1825, I lost two patients with fever.  One, a  female, aged
four  or five years, died on the  24th  of March; and the other, a
female,  aged  about  eighty.  Her  sickness  commenced with di-
 arrhea,  about the 20th of July.   After about two weeks she was
convalescing, but the diarrhea returned, and she died on the 19th
of August. 
33
  In 1826, I lost two patients.   One of these was a male, aged
about twenty-five.  His sickness commenced with diarrhea, about
the 20th of July, and he had taken a cathartic previous to my see-
ing him.  He died on the 9th of August.
  The other was a male, aged about twenty-five, whom I first saw
on the  evening of the  17th of September.  He  had been,  for
about a week  previous, somewhat unwell, in which time he had
been once excessively fatigued,  had been once freely purged with
Lee's pills, and again by cathartic salts.   He was  now delirious,
had severe transitory pain in the bowels, and spasmodic affection
of limbs ;  he was cold, sweating profusely, and his pulse was very
weak and very frequent.
  With a free use  of opium, spirits,  infusion  of  capsicum, and
decoction of bark, in two  or three  days the pulse had become
more full  and less  frequent, and he was only  slightly delirious.
In this  state  he  continued  through the first week, without any
evacuation from  the  bowels, when,  by an  injection, against the
use of which  I had  remonstrated, a single evacuation was pro-
duced of a perfectly natural appearance.  In the course of a very
few minutes, ihe patient was pale and cold, with  an  extremely
rapid pulse, and was very delirious.  By means of  opium, spirits,
and capsicum, in the course of an hour or two heat was restored,
the pulse became somewhat more full and less frequent, but con-
tinued rapid until the 27th, when the patient died, on the eleventh
day of my attendance, and about the fourteenth of fever.
  Fevers  were very common  in the years  1827  and '28,  and
among these were more cases than  usual of low or cold typhust
coinmencino- suddenly with  loss of strength, faintness, or nausea,
the skin being much colder than in health, and the pulse small
and frequent;  and  in some  of these cases there was tenderness of
bowels, and efforts to puke  from motion  or from swallowing.
  By a free use of diffusible and acrid stimulants, with external
application of heat, or of sinapisms, the pulse would become more
full and less frequent, the skin gradually  warmer, the patien,
more  comfortable, and commonly  convalescing  after the  first
week, during this time having had no evacuation from the bowels.
  In some of these cases, opium appeared to have  little or no ef-
fect, unless the stomach was previously warmed  by the  use  of
capsicum.
  I have never lost a patient with this form of fever.
  I have been consulted in two cases of this form of fever, which
had been under a different  mode of treatment.  A female, aged
about thirty, I first saw on the  14th of  September, 1827.   She
had been sick  about two weeks.  On  her first  indisposition, she
took a dose of jalap, without advice, and was  immediately con-
fined  to her  bed, and  mostly to a horizontal posture; could nei-
ther be raised nor turned, nor could she swallow  any thing, but
in very  small  quantity,  without retching to puke,  occasionally
ejecting a small quantity  of mucus,  of a blueish or green color.
She also occasionally voided the same appearing  fluid from the
bowels,  which were tender and sometimes painful,  but not tumid.
                  5 
34
Her pulse was small and frequent, and there was very little febrile
heat, and most of the time the temperature of the skin had been
much below that in health.
  Stimulants and tonics had been little used, but opium had been
administered to restrain the evacuations, but without any sensible
effect.   Calomel had been used in small doses to change the se-
cretions.  She  had also taken  a small  dose  of ipecac, the day
previous to my  seeing her, by which some evacuation was made
from the bowels, and she was very much exhausted.
  She now took, in  the course of about one  hour,  about a half
gill of spirits in hot sling, and  the same quantity of infusion  of
capsicum, while hot, which were  retained.   All inclination  to
puke, and a distressing sensation at the stomach, which had been
constant, were removed ; the bowels were  also free from pain and
from tenderness.   In this more comfortable state she continued
for four days without puking, with the use of about a half pint of
spirits, a half pint of infusion of  capsicum, about  six grains of
opium,  and six  grains sulph. quinine, when on the 18th an injec-
tion was used ;  she was sunken, and all her former complaints re-
turned.  I saw her again on the 19th, 20th, and 22d.  She con-
tinued,  during this time, the former medicines  somewhat more
freely, with the addition of decoction of bark; and in the forty-
four hours preceding my last visit on the 24th, she had taken one
quart of brandy, probably one  half that quantity of infusion of
capsicum, eight or ten grains of opium, as  much  sulph. quin. and
some decoction of bark;  was»now  sitting up in her chair, had ac-
quired some appetite for food, and from this time  continued to
convalesce under a more moderate use of the same remedies.
On the thirteenth day from the use of the injection, the patient
had her first evacuation from the bowels,  which was free, and in
all respects natural.
  It is worthy of remark, that with this very free use of spirits
and of opium, there was not the least sensible narcotic effect from
either, and this on  a patient who  in health had  never made any
use of spirits.
  The other of these patients was also a female, aged about thirty,
whom I visited on the 25th of September, 1827.  She had been
sick about a week or ten days.
   This case was too much like the other to need particular de-
scription;  buther complaints  were by no means so severe, nor
was she so much exhausted, but she had some little difficulty in
breathing, and  pain in the head ; she had also  been treated in
nearly the same  manner.  In the course  of one hour,  she now
took  a  half gill of spirits in hot sling, and several doses of tinct.
of capsicum.   All inclination to puke, a  distressing sensation at
the stomach, which had been constant, difficulty in breathing, and
pain in the head, were removed.
   One tablespoonful of  spirits in  hot sling every two hours, and
fifteen or twenty drops of alcoholic tincture  of capsicum every
two  hours,  alternately taken, with the  exception of one  pill  of
opium, were all  the medicines  afterwards used; but these were 
35
continued until  the  patient was well.   On  the eighth day there
was the first evacuation from the bowels, which was natural.
  In 1827,1 lost only one patient with fever, a female, aged about
sixteen.  I visited her first on the 28th of August.  She died on
the 11th of September.
  In 1828,1 lost but two patients  with fever.  One of these was
a child about five years of age, which I first visited on the 21st of
March.  It had  been sick about one week, and  had taken two
doses of cathartic salts, which had operated freely.  It died with
diarrhea on the 23th.
  The other was a female, aged about thirty, whom I first visited
on the 12th of September.  She had been sick about one week,
during which time she had kept up a constant catharsis with ca-
thartic salts and aloes.   She was much exhausted, and was  hav-
ing frequent and  copious  liquid evacuations from  the bowels
which 1 was able only partially to  suppress, and she died  with
diarrhea and tumid bowels on the 21st, and about the fifteenth
of fever.
   For the last eight years, from the 1st of January, 1829, to Feb.
1837, fevers  have been much less  frequent than  for many years
previous, and in the  year 1835 there were very few cases.  During
this time fevers  were also, in general, less asthenic, more partic-
ularly  in the year 1834; the patients in this year bearing, and in
some instances requiring more evacuation from the bowels  than
in former years,  and requiring  less support in  the progress of
disease.
   In these eight years I lost  only one  patient with fever.   This
patient,  a  female, aged  eighteen, I first visited  on  the 11th of
September, 1836.  She  had  been much unwell for about a week,
during which time she had had very restless nights, and had com-
plained of constant noise in the head,  and for several weeks pre-
vious had at times had some  diarrhea.   Her pulse was weak, but
not very frequent, and she had little febrile heat.  I considered
the patient in a state of predisposition to, rather than in the actual
state of fever, and, considering her previous state of bowels, was
induced to give her, at night, two or three grains of calomel with
Dover's powder.  This, contrary to my intention, operated two or
three times, her pulse became smaller and more frequent, and she
was somewhat delirious.  I  was  unable to obtain control of the
bowels as I wished, and  she died  on  the seventh day from my
first visiting her, and, as I believe, on about the fourteenth of fever.
   In my account of fevers from 1805 to Jan.  1st, 1817, I  have
noticed only a few deaths, not supposing I have noticed the whole
number.  But from the  10th of March, 1816, to the present time,
(Feb.  1837,) it has been my intention  to ascertain the number of
deaths, and have made a list of only twelve fatal cases, which  I
confidently believe is the whole number.  Seven of these  have
been related.  Of the twelve patients who died, one  was a child,
which died on the second or third day with petechia:! fever.  One
died of a relapse, induced by excessive fatigue and riding in rain.
One had excessive diarrhea, took two  doses of cathartic salts 
36
without advice, and had hemorrhage from the bowels.   One was
eighty years of age, the disease commencing with diarrhea.  One
was much fatigued in the commencement, was twice drastically
purged  before I saw him, and injudiciously used an injection in
the course of disease.  One was a child, which was twice purged
with cathartic salts  in the first week  of disease, with  no other
medication.  One kept up a constant  catharsis through the first
week (without advice,)  by cathartic salts and  aloes.  The other
five were perhaps under as favorable circumstances  for recovery
as many others who did  recover.
   The number of my patients with typhus in these last twenty-one
years cannot now be ascertained nor computed  with any good de-
gree of accuracy;  but as under this term I would be understood
to include  all  fevers which have occurred in my practice which
were unaccompanied with local inflammation, and as most of the
time of the first fourteen  years was remarkably sickly, and also
some part of the last seven, I am  of opinion that the number can-
not fall  much short of one thousand.
   Among these cases may have been many which by some would
not have been considered typhoid; but  I believe  that  I have in
this time treated no  case of  continued  fever,  through  its whole
course, on a plan which could be considered strictly antiphlogis-
tic, although there were many in which evacuations were made,
not only in the commencement, but later in the disease, but gen-
erally more for the purpose of removing irritation than for reduc-
ing excitement;  in some of which  cases very little  medicine was
afterwards used.  These patients I believe might have recovered
under a light  and inefficient stimulant, or antiphlogistic treat-
ment, and perhaps as well without  either,  and  of course are not
cases on which to found an opinion of the  propriety or impropri-
ety of any mode of practice that is much more efficient than these
cases required.  It is only in the more dangerous and fatal dis-
eases, or in  a dangerous state of diseases of less fatal tendency,
that the happy effects of an efficient practice are  evident.  That
such cases require an efficient practice, all will admit.  It must
also be admitted that these cases  furnish the best  opportunity for
judging not only of the propriety or impropriety of any efficient
means of cure that may be adopted, but also of the character of
the disease.
   During a general asthenic  diathesis, I have thought that various
membranous inflammations  were more common  than at other
times, and that there are then asthenic.
   In the years 1825'6, and '7, there were many cases of erysipe-
las, in which the pulse was small and very frequent, or full and
soft; in some of which cases the patients were delirious in the
commencement of disease.   These cases  I  treated successfully
with  bark, spirits, and opium.
   Some cases of typhus commenced with severe rheumatic pains.
In these, after making some evacuation from the bowels with cal-
omel and Dover's powder, I have made use of spirits, infusion or
tincture of capsicum, and of opium combined  with ipecac, or with 
37
tincture of actea, or of sanguinaria, for some of the first days, or
until there was some remission of fever with sweating, and some
alleviation of pain, when I have commenced the use of bark or of
sulph.  quinine, continuing that of spirits and of capsicum, making
use of opium alone, or combined with Fowler's solution, in such
doses  as were  found  necessary to control the pain,  in  a great
measure.
   With this treatment,  all recovered  in the  ordinary time of
typhus.
   I have seen two young  persons thus  affected, which, under a
moderate antiphlogistic  treatment, died; one, I  believe,  in the
year 1814, and one only  a few years since.  And on Jan. 19th,
1825,  I visited, in consultation, a young man, who had been af-
fected  with  rheumatic pains for  a week  or  ten  days.  He had
taken  a cathartic,  and early in  the disease had  been sparingly
bled and  fainted.   In two or three days after, his  pulse becoming
remarkably  full, and, as was said, hard, he was more freely bled.
The blood drawn was said to have been uncommonly black, ex-
hibiting, on cooling, a buff of  very uncommon thickness, which
was separated with great ease ; the pulse  then  became small and
more frequent.  On the day previous to my visiting him, petechias
appeared  on various parts of the body,  and now the skin on most
of the  forehead, on one temple, over the pubes, groins, and nates,
the whole of the scrotum, and most of the penis,  on the inside of
one thigh, and on part of the  calf of one leg, was sphacelated;
the skin surrounding the sphacelated parts, for a small distance,
was of a  light pink color.  The  patient was without sleep and
was delirious.
   In the  course of the next twenty-four hours, he took from ten
to twelve  grains of opium, one-third  of  a  grain of arsenic, ten or
twelve grains of sulph. quinine, some decoction of bark, and one
quart of spirits.   On the next day his pulse was more full and less
frequent; he  had had but  little sleep, but  was  more rational;
sphacelation was arrested, and the pink  color of the skin had dis-
appeared.   With the omission of the arsenic, and  some reduction
of the  quantity of  spirits, (about one half,) this treatment was
continued until the dead skin, together  with  the  subjacent cellu-
lar membrane, sloughed off, and granulations of  flesh appeared,
when,  by the obtrusive interference of a physician, more despised
for his quackery than esteemed for his  virtues,  by his medical
brethren,  one half of the opium was exchanged for ext.  stramon.
and  the quantity of bark and  spirits was  reduced.  The patient
became much more delirious, the secretion sanious, and in a few
days the patient died.
   Two other cases of this character, treated more or less on an
antiphlogistic  plan, I have more lately seen, which terminated fa-
tally after five or six weeks continuance.
                         MEASLES.
   Measles, in the early part of my practice, was a highly sthenic
disease, which I treated on a free antiphlogestic  plan.  And since, 
38
while other febrile diseases were in general, asthenic, this has so
far sustained  its common sthenic  character, that in most cases,
little medication has  appeared necessary, most  patients requiring
very little  more than exposure to  cool  air, and  abstinency from
hot and stimulating drinks.   I have directed such patients as were
able, to keep the open air, and have known many able to do this
through the whole course of  disease; and have never known the
eruption repelled,  or the patient  injured by exposure to cold air
or by washing with cold water, neither previous to, nor during
the eruption ; but by these  means the  patient  has  been much
relieved when  febrile heat  had been much increased, and pain
induced by heat or other stimulants.
  Those patients  which  have had the most febrile heat and the
fullest eruption, have, more commonly, at the time of crisis, been
affected with  puking and purging, or  have needed  the  use of
cathartics  soon after, to remove the continuance of a febrile state;
also,  with hoarseness  and cough  to  which they are  peculiarly
liable.  In this state of  the lungs,  cold air is injurious ; and nar-
cotics, with perhaps, a mild antiplogistic treatment, are decidedly
useful.
  Those patients which have had the least eruption and of course,
less fever, have, commonly,  had  the most speedy and most per-
fect recovery.
  From this  history of febrile diseases, it  would appear that in
my practice they  were  in general sthenic from 1789 to 1799.
That from that time to  1806, febrile diseases were more of an
asthenic character ;  and that from 1806 to 1830, with perhaps
the exception of some cases in 1822, they were not only decidedly
asthenic,  but in general highly so.  That from 1829  to the pres-
ent time,  they have been of the same character, but in general not
so highly  asthenic.  So that  it may be said that,  within the limits
of my practice, there has been a general asthenic diathesis  pre-
vailing from the year 1805 to the present time, 1837.
  Typhoid fevers have a strong tendency  to  a crisis on the sev-
enth day; and when a crisis does not take place at that time,  a
favorable  one will  not until the fourteenth or twenty-first day ; and
during the continuance of fevers, every seventh day will be marked
by some change in the state of the patient.
  A most favorable crisis is marked only by a subsiding of febrile
heat, the  pulse becoming less frequent, more free, and  natural,
the patient becoming free from every uneasy sensation,  without
purging, and with little sweating,  and  recovering under a mod-
erate use  of tonics necessary to prevent a relapse.
   But when, on a critical day, the crisis is only partial, the pa-
tient becoming only more comfortable, with a less frequent pulse,
which has lost nothing of its strength, if the same unremitted use
of tonics  and stimulants be continued, a favorable crisis  may be
expected  on the next critical day.
   But if  on the  contrary,  the patient at the end of the first or
second week,  becomes  more restless, and watchful, or delirious,
with a smaller and more frequent pulse, or comatose, with a pulse 
39
       not less  frequent but  weaker, or Jess  frequent  and  more full
       if very soft, the patient will probably fail on the next critical day'
       without  a more  free  use of tonics and stimulants, especially of
       opium.
          If an effort for a crisis  be accompanied with diarrhea or profuse
       sweating, although the patient may feel  relief at  the time, the
       pulse will soon become smaller and much more frequent, the
       patient perhaps  delirious, and unless well supported by a  more
       free use of tonics and stimulants, will probably die, if not at this
       juncture, on the next critical day.
          In all cases commencing with much diarrhea, its continuance is
       to be  prevented by the use of opium by the mouth and by way
       of injection; and  if these prove  not effectual, the  use of a few
       doses of  acetate of lead.   If this  diarrhea cannot be entirely sup-
       pressed, the bowels will  become tumid  in  the course  of disease,
       with  an  increase of diarrhea,  and the patient will probably fail.
       But although the bowels are much tumid,  if the diarrhea be effec-
       tually stopped and no evacuation  from the bowels be allowed, the
       tumefaction will gradually subside and the patient, if well sup-
       ported, will probably recover, having passed one or two weeks, or
       longer, without any evacuation from the bowels, and without un-
       easiness from the want  of  it.  In recommending  this course in
       these  cases, I speak advisedly, having tested its salutary effects
       in very many cases.
          Those patients who  have been  drasticially purged  in the com-
       mencement, or have been more moderately but repeatedly purged
       in the course of the first and second week, are disposed to diarrhea
       at the close of the second or third, with tumid bowels, requiring
       then the same  treatment as if the  disease had commenced with
       diarrhea.   To prevent this  accession of diarrhea, an early and
       more free use of tonics  and of opium is necessary, than under other
       circumstances the symptoms would appear to indicate.
         In all cases of epigastric sinking,  and those in which the tem-
       perature of the  skin is  much  below that in health, whether the
       patient be inclined to puke on  motion or on deglutition or not, or
       has pain or tenderness of bowels  or  not, all evacuations from the
       bowels are to be avoided.   These cases require a free use of stim-
       ulants, more particularly acrid stimulants,  without which tonics
       and opium in some cases, will have but little effect.
         Very seldom indeed, can an evacuation  from the bowels be, by
       any means,  procured with safety, very near the approach of a
       critical period.
         Drastic purging  in  the  commencement,  not  only disposes to
       diarrhea more late in the  disease,  but also to hemorrhage from the
       bowels.
         The use of emetics, cathartics,  and other reducing agents in the
       first week of typhus, will often render necessary, a  very free use
I      of tonics and stimulants  in the after treatment,  but  when these
       have not been  injudiciously used, nor the  patient reduced  by
       diarrhea or other  debilitating  discharges,  only moderate support
       will generally be required.   If, in the  course of the disease, the 
40
patient becomes suddenly much more affected by the medicines
used, although not increased in quantity, it is an evidence, not only
that they are" used in over proportion to the  present exciteability,
but that, if they are now adapted to it, the patient will recover.
  In predisposition to typhus,  I have often seen the fever com-
mence in the course of the twenty-four hours after the operation
of an emetic or a cathartic, and think I have often seen the fever
prevented in  like state of predispositon, by rest and  a moderate
use of diffusable stimulants.
  I have seldom, if ever, seen a dry and hard tongue  or the teeth
covered with sordes in typhus of the  nervous type, unless when
drastic purges had been used, or the patient  had been reduced by
a too free and injudicious use of mercurials, or had been in the use
of antimonials.   This dryness  and hardness of the tongue, may
often be much lessened by an infusion of capsicum.
  By the same  debilitating practice, the patient is also rendered
unable to take  that quantity of food  which he otherwise  might
have taken, and which would have been an important  means of
support, and the stomach is brought into a  state unfit to receive
the usual impression from medicines, and to  extend  their usual
and salutary effects to the rest of  the  system.
  Among my patients who have  recovered from typhus, I can
recollect no instance of any permanent injury, neither organic or
functional,  that  could be attributed either to  the disease or method
of cure.  And,  indeed, can now recollect  no recovery which has
not been perfect.
  In this communication, intentionally avoiding all theory, I have
endeavored to give a correct account of  the  diseases noticed,  and
also of my treatment of them.  And I have  been careful to notice
particularly, not only such cases as were successfully  treated, but
every fatal case in which I thought 1 could see, or others might
see, some  mistake or error in practice;  for  such cases  cannot
be without their use.   I have also inserted some facts which I
thought might be of use to  the practioner, or afford matter for the
speculations of  the theorist.
  This communication is the  result of my  own experience and
observations, unshackled by existing theories, and uncontrolled by
the opinions  of men, justly esteemed for their talents and knowl-
edge, when these have  appeared founded,  more on  theory than
on experience.   And  if my mode of treating these diseases  should
not accord with the practice of some of  my medical brethren in
this Association,  it may, as I sincerely hope it will, call forth the
communication of better practice from other  members.
East Windsor, Feb. 14th,  1838.