Index to this Volume
Vegetable Physiology  page 1
Miasmata  4
Remittent Fevers  7
Turpentine Julep  15
Mercury & Spontaneous Salivation in Rem.  15
Hemorrhage from Bowels & Astringent Pills  32
Intermittent Fevers  35
Yellow Fever  41
Black Vomit  57
Treatment of Yellow Fever  58
Malignant Typhus Fever  63
Receipt for Spice Plaister  79
Receipt for Essence of Beef  82
General Observations on Fevers  92
Critical Days  101
Doctrine of Broussais  106
Pulse  116
Indigenous Cholera  126
Anodyne Mixture  128
Asiatic or Malignant Cholera  135


Dr James died July 5. 1835
Chief Justice Marshall – July 6. 1835


Lectures upon the Practice of Medicine 
delivered by Dr Joseph Parrish.
Introductory Lecture. April 22nd 1834.
The subject of this Lecture was Vegetable Physiology;
which, tho’ at first, may not appear as
connected with the practice of medicine, yet upon
consideration, we find it very intimately 
associated. The remarks tended to show the 
wisdom & goodness of Divine Providence in the 
relations existing between the Vegetable & animal
Kingdoms, and the various ways in which our 
health is promoted by the growth of plants. Their
systems appear to harmonise with our systems,
their roots constituting the Absorbents, & their
leaves, the Lungs; while Inhalation is effected on 
the upper surface of the leaves, & Exhalation, on 
the lower. It has been asserted too, that in their
circulatory system, the arteries run on the upper 
& the veins on the lower side of the leaves. 
Water is almost the sole food of plants. This has 


been proved by the experiments of Van Helmont 
and others, who planted a willow in a certain 
quantity of earth after watering it for several years
of its growth, the earth was again weighed & 
found to have lost but very little. It is also
proved from the fact which we frequently 
witness of the bulbous plants growing in a 
tumbler of water.
Knowing the property which plants have of eating 
up the noxious air during their growth, & also 
that this noxious gas is given out in large quantities 
from decaying vegetables, we may turn it
to practical advantage, if we were consulted by 
a farmer respecting the laying out of his farm.
With respect to Orchards etc. in which much 
decaying vegetable matter is found during the 
latter part of the summer, & from which a large 
quantity of unwholesome effluvia of rotten 
apples etc. is given off; we should remember to 
advise them to be placed on the Eastern side 


3
of the house, so that the prevailing winds of the 
summer from the West & South West, should
not sweep over this corrupted mass, & waft its
poisonous influence immediately into the
farmer’s dwelling. It may be well also to 
plant near the house, some vegetables which 
will flourish through the latter part of the season;
so that they may devour the noxious vapour 
prevalent at that period.
That plants do consume, the unwholesome and 
sickening air, is evident from the fact that during 
the early part of summer, when vegetation is flourishing,
it is a season of general health; but after
harvest, when plants begin to lose their vigour, to 
sicken and to die; disease appears & continues
until its progress is stopped by the cold, frosty weather.
In warm climates, Providence has compensated 
the inhabitants for the heat they sustain by placing
there the spices etc. & by continuing vegetation thro 
the whole year. The spices give a tone to the 



4
system, which would be lost under the continued 
influence of the heat. Just so it is here, when 
we find patients suffering from diarrhea etc. produced
from no other cause than mere heat, we
find great relief afforded by the administration
of strong Ginger Tea in the morning and 
salt meat about twice a week.
Second Lecture April 25th 1834.
Having given some account of the beneficial effect
of vegetables in their growing state, & also 
some remarks respecting the noxious vapour arising 
from their decay, we may now see why a 
new Mill-Pond is first to be dreaded. When it
is first made, such will necessarily be the decomposition 
of vegetable matter, that this same noxious
vapour will be produced & spread its poisonous
influence upon the surrounding neighborhood.
As an instance of this, he related the case of a 
party of young persons who went from the City to 
spend the Summer in such a vicinity, some of 
whom sickened and died.


5
Marsh Exhalations are influenced by mechanical
obstructions, as well as by the winds prevailing
in the summer. Instance of a circumstance noticed
by Dr Wistar, respecting a locality on the 
Schuylkill, whence by a high bluff etc. the air arising
from the decay of the docks etc. was carried 
thro’ a valley along up by Turner’s lane etc.
Knowing this fact, when a family applied to him 
respecting moving into the country in a house situated 
in the line of that valley, he advised them 
not to go. & that another family who afterwards 
occupied the same house, suffered by the loss of 
one or two of its members. From this very fact, 
we see how important it is that a physician
should be well acquainted with the vicinity in 
which he resides.
Thick woods interposed sometimes serve as a barrier 
to noxious exhalations. Instance. A County
seat of one Col. Howe, below Gloucester Point.
He related also the fact that a fever of a peculiar 
kind pervaded a family of millers in Bristol, Pa.



6
named Warner, & that upon examination it 
appeared that behind the house was a large 
marsh & between the marsh and the house was 
a large hog-stye containing a number of hogs.
From the mixture then of this vegetable & animal
effluvia being blown directly to the house, he accounted 
for this unusual kind of fever.
The consequences of Marsh Exhalations etc. are
Fevers in their different forms: but occasionally
Autumnal Fevers prevail in high and most healthy 
places, without any apparent cause. Thus it was 
in 1821 ’22 etc. when a general fever appeared to 
pervade the country, not only in low, marshy districts, 
but in high & generally health locations.
The pleasant situation upon Schuylkill & the 
upper & back parts of Pennsylvania, appeared
to suffer as much as any other localities, & even
Germantown, situated as it is upon a high eminence,
was equally afflicted, with the low lands
about Salem, Cohansey etc.


7
Third Lecture April 29. 1834.
Having mentioned the causes which operate in 
producing fevers, etc. we now proceed to consider the 
effects of these causes; and this brings us at once 
to the consideration of Remittent & Intermittent
Fevers. Remittent Fever is a very common
form of disease. It begins variously in different constitutions, 
but we will not consider a plain case to 
which a physician is called, unembarassed by 
the various little crooked circumstances, which 
may happen to change the form and treatment.
IT is sometimes preceded by a chill, nausea, 
bilious vomiting etc., then when reaction takes 
place, we have a dry, hot skin, and excited, febrile
pulse, restlessness, flushed face, thirst etc.
Suppose that this state of things commences in 
the morning, then these go on increasing thro’ the 
day & evening till the paroxysm arrives at its height,
then it again abates towards the ensuing morning,
& the patient is now in what is termed a 
state of remission.


8
This course of things will go on for 5, 7, 9 or
sometimes 11 Days, according to circumstances,
& then comes either a solution of fever, or it
runs into a protracted, tedious form.
Ordinary remittents are generally manageable
& so are intermittents, but sometimes we have 
a kind of mongrel of the two, which is more 
troublesome.
Treatment. If called to a case of common remittent,
within first 24 hours, and we find his 
stomach very irritable, continually attempting 
to throw off its contents, giving him much distress,
uneasiness etc. it strikes us at once that the
first indication is to clear out the Prima Via.
This is done very effectually by administering a
gentle emetic, consisting of good Pulv. Ipecac.
Take zi of it & divide it into two portions: mis
up ½ of it with a little water or other fluid & 
add one or two teaspoonfuls of Antimonial Wine,
& give to the patient: wait about ½ an hour and 



9
if no operation ensues, mix & give the remaining
half in a similar manner. This is generally 
sufficient to take hold of the stomach, & we may 
then give copiously warm diluent drinks, in order
thoroughly to wash out & cleanse the stomach.
Here we may give a caution to guard against
the violent effects produced upon some persons by 
an emetic. As an instance, he mentioned the 
Case of a family to which he was called to attend 
the mother labouring under a fever. He 
ordered her an emetic, but as soon as it was seen 
by her husband, he handed a paper written by 
Dr Wistar, stating that an emetic once administered
by him to the same person was attended with very 
serious consequences, & cautioning against a repetition
of it. This “voice from the grave” was attended to.
After the emetic has thus cleansed the stomach,
we next desire to purge & evacuate the bowels by a 
good purge. For this purpose the Comp. Cath. Pills may 
be given, or an infusion of Senna, Manna & Salts.


10
If the purge should not act in due time, take
about zi of Salts and zfs of Magnesia & mix
them up with Mineral Water, Syrup etc. so as to 
make a drink for the patient which will effect 
an operation. 
We may here state with respect to Bleeding,
that in general we do not approve of it, because
it is abstracting from the patient that which he 
needs for his support. Sometimes however in young
and vigorous subjects, it may be advantageous to 
bleeding the first stages of the disease. Local 
is preferable to General Bleeding.
When the skin is hot and dry, & the patient experiences 
great restlessness & thirst, another plan
which we have seen beneficially adopted is Cold
Ablution to the Whole Surface. (See Currie on the
Use of Cold Water in Fevers.) We have seen fevers subdued
by Cold Ablution as effectually as by the Lancet
& that without the loss of the blood. This should never
be used however, when the patient experiences a sense 


11
of chilliness. The head should be kept cook, by cold
applications, and by keeping the hair shortened. The 
use of Cold to head should be guided very much by the sensation 
of the patient, as the best test. Vinegar Water [illegible] Bladder
Contrary to the ancient theory, we think it absolutely 
necessary that the patient should be kept 
in a cool, well-aired apartment; & permit him to 
drink plentifully of good, pure, Cold Water.
After what has been already said, we have yet
other means for treating the fever. We may now
give a sudorific, & the one most preferred instead
of the old [antimonial] Nitrous Powder which consisted of [illegible]
& Tart. Ant. 1/6 gr. for dose, we take Sal Tartar zii & 
dissolve it in aq. ziv. Then to a tablespoonful of 
Lemon Juice and a tablespoonful of Water, add a 
tablespoonful of the mixture, which will make
a cooling & very pleasant effervescing draught.
Blisters may be employed in some cases with advantage;
as for example, we find some patients tossing about
in great restlessness, without having any particular 


12
local pain, and hence it is often very advantageous,
& tends to quiet them, by giving a local 
point upon which to fix their attention. For this
purpose a large pair of blisters applied to the inside
of the ankles often produces a happy effect.
[They] also promote tendency to the surface
Poultices to the feet are also useful.
[illegible] in small quantities, teaspoonful of solution [illegible]
Thus fevers progress, generally to a certain extent,
& run their course. But sometimes it becomes
necessary to change the treatment altogether.
We find the tongue loaded with fur, (& it 
is important to attend to the appearance of the tongue)
and the patient gradually growing weaker.
Then tonics may come in well during the remission 
We generally begin with the weaker as Serpentaria,
Chamomile etc. Their convalescence approaches, 
about the 7th or 9th day. The tongue commences 
cleaning gradually about the sides and top & becomes
red & moist. This is the most favourable appearance
then [nourishment], tonics etc. but if you find the tongue heavily loaded
& the patient affected with febrile symptoms, - and
the fauces also covered with a white coat of fur.



13
then you may consider that you have made, as
it were, a compromise with the disease, & though 
you may expect your patient to do well, yet his 
recovery will be slow & tedious.  This coat will 
clean off suddenly, sometimes 2 or 3 will come
and go in succession, leaving the tongue smooth,
red and moist, & tho’ the disease continues, it 
is generally manageable, but the recovery slow
& tedious. Slight tonics & gentle nourishment
may be given, being careful not to do too much 
but let Nature do her own work & aid her a little 
in her operations. The voice is sometimes changed
to a coarser sound, attended with sore throat, about 
the time when the tongue begins to clean,
but this may be considered as a harbinger of convalescence.
Another form of cleaning of the
tongue to which we should attend is, when the 
upper portion of the tongue cleans suddenly, leaving
the lower portion furred, & apparently gashed,
smooth, red and dry. This is an unpropitious 


14
state of things, and we may apprehend mischief.
(See Dr Wood’s Remarks in [illegible] & Surg. Journal Eclectic Repertory 
respecting the use of Turpentine in such
cases.) When the disease assumes this form,
we may meet also with a tympanitick belly.
This is not always fatal, but generally unfavorable.
It is connected with great debility,
& the ascribed cause is the loss of tone in the
muscular contraction of the fibres of the alimentary
canal. The primary object then, is, 
to maintain the peristaltic action of the intestines.
For this purpose, Dr Physick directs
the use of Tinct Rhei & Card. Seeds, a teaspoonful 
every hour. Dr Parrish has often given 
Warner’s Cordial, in quantity not sufficient 
to purge, but merely to excite a rambling action.
The Turpentine Julep comes in here remarkably 
well. Illustrated by the Case of a merchant
of this City, who was in this condition & restored
by its use. He had this tympanitic belly
following an attack of fever, and after the 


15
failure of other remedies, this was resorted to 
with success. The composition of the Julep 
is Spt. Terebinth m 120.
Sacch. Alb.
Gum Acac. zz zi or zii
Aqua Cinnam. f ziv
[illegible] Give a tablespoonful every one, two or 
three hours, according to the circumstances of the 
case. After this, we may resort to the milder
tonics, Serpentaria, Chamomile etc., and give good
nourishing soups together with some light cordials
as Wine [illegible] Claret & Water. then Mad. Wine, Porter, ale etc.
using these with due regard to the patient.
Fourth Lecture. May 2nd 1834
Mercury has been recommended to be used in 
Remittent Fevers, but it is the opinion of Dr Wister
confirmed by the experience of Dr Parrish that
salivation will not arrest the progress of fever. There
are cases, however, when purging & stimulants are inadmissible,
when the evacuations are dark, tarry etc. 



16
evidently indicating a derangement of the 
function of the Liver, that Mercury in very small doses of 
1/6, 1/8 or even 1/12 gr. may be very useful.
[illegible]
We must recollect here that Salivation sometimes
occurs in Fevers spontaneously, without
it is accompanied with Inflam. state of system, [requiring] [loss] of blood
the use of Mercury. so that the physician would
be censured for it, if he were not aware of this
fact. Dr Rush saw it happen in Pleurisy.
As we have before stated, Tonics may be advantageously 
employed. Porter, Bark infusion etc. & 
experience has taught us that in Remittent Fevers, 
in protracted cases, the Ark Cold infusion is better
than the Sulphate of Quinia.
[illegible]
We have thus far spoken of cases of ordinary 
occurrence, but it is our province in lectures 
to [??ention] such as are not usually found in 
books, & which may be considered as Anomalous
Either from constitutional difference or from 
some other cause, we find almost every season
some deviations from ordinary fevers, & some 


17
of these Anomalous Cases, which have come under
our own observation, we shall mention.
1. Case of Saml Middleton, a bricklayer, who 
was at the time engaged in building the Meeting
House in Twelfth St. below Market. That part of 
the city was then filled with brick ponds etc. so
that an unwholesome effluvia arose from them.
He, as well as his men, was exposed on the scaffold
to these miasmata, & became unwell. On
the day previous to the visit, he remained at
home, unable to work, & according to his own directions
was bled. ON the next day, Dr Parrish was 
called to him & found him complaining of dissiness
in his head pain in [illegible] with a feeble, irritable pulse etc.
The first thing to be done was to evacuate the bowels,
to ensure a free circulation of air thro’ the 
apartment, & cold ablutions when there was nothing
like chilliness. ON the second day, the disease assumed 
the appearance of Cholera, with bilious discharges
pulse sunk etc. Blisters, Sinapisms etc. were
then ordered & Chalk Julep to check the diarrhea.


18
In this way, he continued for 2 or 3 days, & on 
visiting him on an ensuing morning, there was
a great disposition to prostration & [illegible] violent symptoms.
Again the Sinapisms etc. were applied & 
in consultation with Dr Griffitts, cordials, wine etc.
[illegible] of Beef were given to support his system. He had a discharge
of black blood from his mouth, gums & 
nose & his stomach was so irritable that no remedy
could be taken into it. A decoction of Cantharides 
& Turpentine was used with friction so 
that it vesicated him from chin to the abdomen.
Oil was added to the mixture & rubbed on the 
extremities to prevent its blistering. The Ext. of
Quassia in Pill was given every 2 hours & Vol. Alk.
& [Illegible] Infus [with] [illegible] Ess. of [illegible] 
every hour. He began to convalesce & wine, Porter
etc. were administered & he gradually recovered.
2. In the same neighborhood, in 12th St. were
three patients of Remittent Fever, children of 
Mrs Elosa Fisher, who resided in a house open 
on the South Side to a lot [illegible], in which was a large
quantity of decaying vegetable matter.


19
Sidney George Fisher, now an Attorney in the 
City, was the eldest of the three. He was a boy 
of delicate health, subject to diarrhea, from an attack 
of which he had just recovered when the 
fever seised him. For the first day or two, nothing
more than simple treatment was ordered, at
the same time taking care not to disturb the bowels
merely Rhub. Spts Mind. Ant. Wine etc.
let it might produce a return of diarrhea.
Shortly afterwards however the disease developed
itself in a very malignant form, the blistered
surfaces became dark and bloody & he was 
either in a delirious or comatose state continually,
his pulse was feeble, & he was apparently “within
the very jaws of death.” Stimulants were used,
Port wine, spiced & given at short intervals. given because both stimulant & astringent.
Dr Physic was called in consultation & he proposed 
to give also the Vol. Alkali, & that he should be prevented
from sleeping too long. Preparations of bark 
were also given, & contrary to almost all expectations,
by such treatment he was happily restored.
Two brothers had it less violent.




20
During the next season, he was again attacked
with fever, which was treated with a gentle emetic
of Ipecac, & with blisters. but it appeared to 
continue the same course & ran on till it was
nearly as bad as before. Under the use of bark,
Wine, Cordials, etc., he was, however, again restored.
In the next season, for the third time, he was 
attacked as before, but now knowing from former 
experience, the course which the fever would 
take, no delay was made in the treatment.
After gently emptying the Alimentary Canal 
with a little Rhubarb, he was ordered the use 
of Bark, Wine etc. to support his system, & thus
he passed this attack without any of those unfavourable 
appearances. The Bark infusion used
is prepared by adding together Bark Serpentaria & Sal
Tartar & making a hot infusion of them in Mad.
Wine. A teaspoonful to be given every hour.
& also every hour give 2 or 3 drops of Laudanum
This statement shows the necessity of a physician’s
attending to constitutional pecularities.


21
Remittents, whether of a mild or inflammatory 
nature at first, sometimes run into a very protracted, 
tedious form. Some practitioners are so 
fearful of exciting inflammation, that they will 
not give cordials to support the system, but permit
their patient to struggle hard against wind & 
weather, without offering them this support to 
buoy them up & enable them to reach the shore 
in safety. But such cannot be considered proper 
treatment, for sometimes they are absolutely necessary 
& may be given with much advantage.
Cases often occur, in which the patient suffers extreme
prostration very suddenly, and at such times 
a tympanitick belly may appear, which, though a 
very unpleasant, is not a fatal, indication.
Case of Oliver Sheppard in 1814. Who had a tympanitic
belly, with great tenderness & profuse, colliquiative 
sweats. Turpentine Julep was given for the Tymp. belly
& to check the sweats, it was directed to wash the body
with a saturated solution of Alum & Brandy about zi 
to Oi.


22
Fifth Lecture May 5th 1834
In this lecture we will first consider, whether 
very active treatment in the beginning will 
arrest the progress of fever. To show that it will 
not, we will state the Case of J. Gilliams, Dentist.
whom Dr Harlan saw in the beginning of the 
attack, & ordered him bled once or twice very 
freely. At first he seemed to bear the bleeding very 
well, but the fever ran on, until he became in 
a very low, sunk condition, with a tympanitic
belly & other unfavourable symptoms. The treatment
proper then of course was to support the system by 
the use of Bark, Wine etc. & by these means he lived
thro it & finally recovered.
The next case we shall mention was that of Pickering,
from Portsmouth N.H. in 1821, whom he 
attended with Dr Eberle & Mc Clellan. He had
a tympanitic belly & other symptoms so unfavourable
that his life was considered in imminent
danger. In such a case, great advantage arose from 


23
the use of about a wineglassful of the Decoction of
best Red bark with a teaspoonful of Huxhain’s Tinct.
once every two hours. Besides this, a tablespoonful
of the Turpentine Julep was given every 2 hours, & 
to support his strength, Ess. of Beef, Wine Whey & Mad. 
Wine; under the use of which he recovered.
Another case of this unusual low form of fever was 
that of Joshua Lippincott (Merchant). It commenced 
in a manner somewhat unusual, assumed the Mongrel
form, though apparently mild, but soon after he 
became extremely prostrated & dangerous, tympanitic, 
an almost imperceptible pulse etc. In this condition 
he took the Bark & Vol. Alk. with much benefit, & the 
use of the Turpentine Julep was decidedly advantageous
In order to keep up the peristaltic action, a teaspoonful
of Tinct. Rhei Arom was given every 2 or 3 hours.
After the fever had apparently reached its crisis,
a new form of action presented. He became loquacious
& evidently had a tendency to phrenitis. Seeing this,
it was, of course, proper to lay aside all the former 


24
treatment with stimulants & tonics, lest they might 
affect the brain, & purgatives were substituted
with mild nourishment to support his strength 
and he finally recovered.
Case of Saml Cooper. On Jersey side of Del.
For a few weeks before his attack, the weather had
been very wet, & the hay lying in his meadow
had become injured. When the Sun again made
his appearance, C. was engaged with his men 
spreading the hay, & the smell was so offensive
that he could scarcely endure it. He was attacked
on 7th day with chilliness etc. but on first day 
following, Dr Henry of Haddonfield was called in,
& saw him, evincing no striking or alarming symptoms.
He had been previously bled by his own direction, & at
last on the 6th day, Dr P. was called in & found him 
in a state of coma, with a very prostrate system.
On the next day, his countenance assumed the aspect
of a very malignant state of disease; his respiration 


25
was very laborious, disposed to coma & soon 
died. This peculiar form of fever was traced to 
the veg. decomposition taking place in the rotten hay.
Sometimes, however, these low forms of disease can 
be traced to no apparent cause, but must be attributed
to peculiarities of constitution. To substantiate
this we may mention 3 cases, children of the same
family, who were similarly afflicted, in the Autumn
of 1818. In Oct. Anna Kibler was attacked
with a fever, by which she was reduced to an extremely 
low state, with a peculiar delirium, in which her 
hearing became morbidly acute, & her sensibility very 
great; seeing this state of the brain, the stimulant
treatment was delayed, & a blister advised to the
head which was opposed by her parents. [So?es] soon 
began to collect about her mouth, her tongue became 
red and dry etc. Under these circumstances, it was 
resolved to use a little stimulant without regard to 
her brain, & weak Claret & Water was tried with advantage.
In consultation with Dr Dorsey, a blister 



26
was applied to her head, & 10 drops of Laudanum
given every 2 hours. Her convalescence commenced, 
& continued tho’ slow & tedious. The 
bark was used as in former cases with decided
advantage.
Mary, a sister of the former was attacked on the 
29th of the same month. It commenced with a 
chill & great pain in the head and bones. The 
first object was to clear the prima via by an
emetic & cathartic, which she seemed to bear very 
well at first. But this soon followed by great 
debility, & she was reduced to a very low condition.
Seeing this, resort was had to Sinapisms, Blisters, 
the free use of Wine etc. Bark, soups to nourish
her etc. were given, & under this treatment with 
cold ablutions whenever the skin became hot & 
dry, she finally recovered.
On the 3rd of November, another sister was attacked.
The prima via were first cleared as usual, but she
also passed to the same low & almost deathlike 


27
condition of the former. Her tongue became dark,
sordes collected about her mouth etc. Her hair was 
shaved & mustard plasters and blisters were applied 
to the head and extremities. Recourse
also was had to the free use of Wine & Huxhain’s
Tincture. Rhubarb was given to keep up the action 
of the bowels. She however continued low,
her respiration was at one time laborious, & she 
had involuntary evacuations. When these latter 
occur in an adult, we consider it a very unfavourable
& unpromising symptom, but not always 
fatal. By the use of Wine, Vol. Alkali, 
Blisters, Sinapisms etc. she revived, & under the
ordinary treatment for such cases, recovered.
A little boy, a brother, was attacked about
the same time & ran about the same course. Under
the use of blisters, sinapisms etc., and in fact, the same
general plan of treatment, he also recovered.
Another case was of a merchant named Albison,
in the fall of 1818. He had been ill for a 


28
few days before the first visit. The prima via
were cleansed, & the state of the system being
such apparently as to justify the use of the Lancet
he was according bled. But he soon run down
to a low state & blisters were resorted to. His tongue
blackened, sordes collected, his pulse was very 
low & feeble, & subsultus tendinum came on.
If then became necessary to reverse the depleting
plan, & substitute Wine, Huxhain’s Tinct etc.
His head was shaved, & blisters were applied to 
the scalp. Turpentine Julep was given, a tablespoonful 
every hour. His tongue suddenly 
cleaned, smooth & red, & of course, his recovery was
tedious. During his remaining in this low stae,
he was, for a time, unable to protrude the tongue,
which may always be considered as a very 
unfavourable, unpleasant circumstance. He 
was also covered with a profuse, colliquative sweat.
One morning upon visiting him, he was supposed 
by those around him, to be dying, his pupils 


29
were contracted, & he could neither speak or swallow.
Frictions were directed with Cantharides
& Turpentine; & he aroused from his lethargy.
After his tongue cleaned; his pulse remained at 
120 for several weeks & his convalescence was slow.
Turpentine is better to be given than Brandy, and 
it should be given in small doses frequently.
We have already stated that Mercury given
so as to salivate appears to exert no influence in 
arresting the progress of the disease. In proof of 
this, we will relate a case which occurred in the 
fall of 1817, of Dr Tyson, in which consultation 
was held by Dr Gebhard, Wister & Parrish.
Dr G. had seen the patient in the early part of the 
disease, had bled him & given him Mercury. The
mercury was continued after the consultation
until his mouth became touched, but it produced
no beneficial effect. On the subject of Mercury
read Dr Ayre on [Maras??s], & Dr Miller on minute
doses of Calomel, published in N. York Journal.


30
We, however, recommend in some cases the use
of Mercury in small doses of 1/6 or ¼ gr. every 2 
hours, so as to change the morbid action of the 
liver, and in order to see when this effect is 
produced or when it is needed, it is necessary 
to examine closely the evacuations. It is an 
humble office, but one from which much good 
results in the treatment of diseases, & therefore
we wish particularly to direct your attention 
to it, & induce you to practise it.
We now come to speak of spontaneous Salivation,
of which we have seen numerous instances. 
In the winter of 1817, occurred the cases of two 
children, who were affected with remittent fever,
& their gums presented an appearance like Salivation,
though Mercury had not bee given them.
They were treated with neutral & saline mixture etc.
Several other cases of the same, were mentioned.
After the close of the Epidemic of 1822, Dr
Parrish made a memorandum stating that a 


31
mongrel kind of fever had prevailed, which was
treated with purging, bark, neutral mixture, &
sometimes with the use of the Lancet. Also, blisters
Ice to the head, Cold Ablutions, with strict attention 
to the bowels. The tongue was generally 
red and dry, & some patients suffered very much 
from sickness of stomach, which was relieved by 
applying a Spice Plaster or a Blister to the Stomach.
There were also great pains of the Bones & Back.
Hemorrhages from the bowels sometimes occurred
& these are dangerous. Several cases.
In the summer of 1830, Dr Gebhard treated 
cases of hemorrhage from the bowels with Pills 
composed of Acet. Plumb. and [Ki??]. Blue Pill
was also used with advantage. Since that
time, the astringent Pills have been beneficially 
employed in numerous cases. Related one of 
Richard Gadson, who was a delicate man in a feeble
condition, & this hemorhhage occurred. He 
was much benefited by the use of the Ast. Pills 



32
They are composed of Sacch. Saturni
Pulv. [Kin?] aa grs XII
Divide into Pill no vi. Give one every 4 hours.
Also give 1/6 gr. of Calomel every 1 or 2 hours together 
with [illegible] vi Laudanum. A little Port Wine & Water
may also be given to excite the system.
Mentioned a case of a lady out of town, who 
was extremely ill, with a protracted fever. One
morning on examining the evacuations, hemorrhage
seemed to threaten: the nurse was informed
& directions given accordingly, & the pills
sent out. Before the evening visit, the hemorrhage
occurred & the pills were given with benefit.
In cases of tympanitic belly, we
have seen much good result from the use of 
the dry syringe introduced thro’ a tube, & also
for the purpose of evacuating the bowels, just 
as a Catheter is introduced for the purpose
of draining off the urine, both conducing much 
to the comfort of the patient.


33
Sixth Lecture May 9th 1834
Before closing the subject of Remittent Fevers, we may 
mention some cases of this fever of a most terrific 
character, which occurred in the family of Col. Howe
in Gloucester County N.J. (mentioned before, page 5)
This disease occurred in consequence of the opening
from the shore directly into a clearance of woodland
where the house was located. It was very fatal before
it was understood. When Dr P. was first introduced
there the disease had progressed for some time, & every 
room in the house appeared like a Hospital. Two 
of the family had died & a third followed in about 
1 ½ or 2 hours after his arrival. The treatment of
all the preceding cases had been that of general free
evacuation & depletion. The disease had that peculiar, 
irregular, mongrel form, which is so very unfavourable,
but generally no alarm was excited until about 
the 5th day, when the patient would commence 
a decline & sink rapidly to a low prostrate condition.
Col. Howe himself was attacked on the day Dr P. was 


34
first introduced, & having the advantage of knowing
what had been the treatment in former cases, he at 
once proposed to the medical attendant a different
course. Bark ab initio was the grand sheet-anchor & 
without hesitating, except perhaps for a little but very 
careful evacuations. The treatment proved happy; about 
the 3d day, his system appeared to be prostrated, but 
the bark was continued & worked well in this, & in 
some other instances which followed.
About 60 attacked from being [illegible] this house.
In conclusion, there is one subject to which we wish
particularly to direct the attention of practitioners, & 
that is to examine the Bladder in protracted Fevers.
During the progress of fever, when the mind may, sometimes
be affected, we find the urinary secretions very 
irregular, & the bladder may get into such a condition,
as to be unable to expel its contents. Whenever, then, 
we find the urine gradually distilling off, & even when 
this does not happen, we should examine the bladder
closely. If it be distended, introduce the Catheter, & 
great will be the relief given to the Patient.


35
We now come to the subject of Intermittent Fevers.
We shall say nothing respecting the common form,
found in Fever & Ague etc. but we will consider the
malignant forms, which this sometimes assumes,
with great danger to the patient. The first case of this
dangerous, malignant form which we shall notice,
occurred just across Schuylkill. McIlvaine.
He contracted the disease down in Del. while there
on business, & on his return was visited by Dr Parrish,
& it appeared like an ordinary Quotidian, for which 
bark was ordered. On the second visit, the disease
had assumed an alarming aspect, & the Dr arrived 
just in time to witness an attack of the paroxysm.
He was very much depressed, fainted, & his nervous
system appeared much affected, pulse feeble, with 
a continual desire to vomit, & his respiration, difficult.
Strong efforts were made to revive him by stimulants
both internally, and externally - & at last he did rally 
& recover. The difficulty of respiration, spoken off
above, which occurs in this form of fever, seems to depend 



36
upon a consciousness on the part of the patient, that 
something is wrong within him, which forbids the 
lungs performing their duty. The nerves appear to be 
so blunted that the blood in its passage thro’ the 
lungs is not oxygenated or decarbonised. It reminds 
one of the French Experiments upon Horses in the division 
of the Eighth Pair of Nerves. Respiration 
seems to be arrested in a similar way.
6/6-1815 Case of John Wood in Franklin Court.
He appeared to be attacked by a regular Quotidian,
& had been attended by another Dr [Ga?agh?] physician during Dr
P.’s absence for a few days from town. He had been 
bled by his attendant, but this not approved. Saw
him twice without any alarming symptoms. Afterwards
he had a chill, & became dangerously ill. He 
was affected with violent spasmodic pains, first on 
one side then on the other, sometimes extending
from the Clavicle, all down the side, so as to cause 
him to scream out with pain; his pulse was too 
frequent for enumeration, his respiration distressing, 


37
his skin, cold, countenance shrunk, & his 
stomach continually retching with much distress.
made use of Anodynes & [Sti??] and as he was a free
liver, to these were also added warm Brandy Toddy
Ginger Tea, Sinapisms etc. His feet were soak in hot
water with a little mustard etc. & he rallied.
We may here mention that in order to put a patient’s 
feet in hot water without the danger & inconvenience 
of lifting him out of bed, put a large tub in the bed
filled with the hot water & mustard or salt, & then direct 
the patient to draw up his knees & put in his feet.
This treatment occupied about 2 hours, when, seeing 
that his system did not rise as it was desired, frictions 
were directed to the extremities, blisters to the 
wrists & ankles etc. & bark was given, first in substance, until 
the stomach would not retain it in that way, & then 
in Decoct. & Tinct. with a little Laudanum. On the
8th he was very weak, his pulse frequent & feeble; the 
same treatment was continued with the bark every ½ hour, & 1 hour 
before the expected paroxysm, 2 grs. of opium were given, & 


38
he escaped the attack. On the 9th, he continued
the bark, & appeared a little better, & 1 hour before
the expected paroxysm, 4 grs. of opium were given.
& he again escaped the paroxysm. The bark was continued.
On the 10th bark was ordered every hour, he 
began to recover, & under the use of tonics he finally got well
In these cases of fever, there is no hot stage. They 
pass immediately from the cost stage to a state of 
depression. Dr. Henson had a case over in Camden,
which, altho’ he went over for the purpose of 
watching, died in a paroxysm.
The symptoms of this cold & dangerous stage, are, a 
cold skin, shrunk & ghastly countenance, low pulse,
retching, & distressing respiration.
Saw one lady die in the sweating stage. Some die
in spite of all efforts to save them in any stage.
This malignant form of fever was once epidemic on 
the banks of the Susquehannah. Dr. Worthington, attending
there, had one very interesting case which 
died in the cold stage. It was the case of a young 


39
man, on the very evening of his nuptial, just 
after the priest had tied the marriage-knot, & in the 
presence of the party assembled to enjoy the hilarities
of the occasion, this malignant fever attacked him, 
and in a few hours, he was a corpse.
It is a good plan in cases of Intermittents, to give
opium in anticipation of the paroxysm. & Bark
should always be given liberally, because it seems 
to be the only antidote which we possess for Intermitt.
At the present day, besides the Decoct. & Huxhain’s
tinct, we may at the same time give Quinia, of the 
very best quality. Here we must remark, however, 
that the Quinia is much inferior to what it formerly 
was. When first introduced, 8 or 10 grs. equalled 
zi of the Bark, but now we give 16 or 20 grs.
In the next lecture we shall take up the subject of
Yellow Fever, & previous to a description of the disease,
we shall notice the question of contagion or non-contagion
of foreign or domestic origin, which provoked in former
times, one of the most obstinate discussions, which ever
occurred among the Faculty. In 1793


40
Before leaving these protracted fevers, we may 
state that from long continued pressure by a patient
lying constantly in one position, when he has
become feeble and emaciated, sloughs often occur.
To prevent this it becomes necessary to watch when 
tenderness of any of the pressed parts appears, & endeavour
to relieve it. One case was much relieved by 
making a crucial incision in the Sacking Bottom
immediately under the exposed parts. It is well 
also to wash the parts with Brandy; & lay strips 
of adhesive Plaster over them. Air Pillows
We nay here also notice a case which occurred 
somewhat resembling Intermittent.
Dr. Gillingham & Parrish attending. Phsick was called
in. The patient was a gouty old man, who had 
been attacked with unusual, irregular intermitten
attended with great stupor in the paroxysms; Dr
Physick recommended the old practice of Hillary,
they gave small doses of Sulphate of Copper, 1/6 gr.
every 3 or 4 hours, with a very beneficial effect.


41
Dr Physick said he was in the habit of uniting it 
with 1 gr. Rhubarb & some Gum Water, about ¼ gr. of Sul.
Copper every hour without regard to the Paroxysm.
He said he had seldom known a relapse when the 
remedy had been fairly tried. The patient began 
to recover, & continued with the use of soup, calf’s foot
jelly, Milk Punch etc.
Seventh Lecture May 13th 1834
On Yellow Fever. Dr Parrish considers it as contagious
& holds that it may be imported see p.39
History informs us that in 1762 the Yellow Fever
appeared for the first time in Philadelphia & then 
it was universally admitted to have been imported 
fron the West Indies. A gentleman of this city, had
died of it there, & his clothes & effects were afterwards 
sent home. An inventory was made of them, & several
respectable gentlemen who made the examination 
were attacked with the Yellow Fever and died.
Dr Griffiths Grandfather died that [Death]
There is one fact universally admitted by contagionists
& now contagionists, that, whenever yellow 


42
Fever has appeared & spread through the City,
its origin could always be traced to somewhere
along the Delaware, in Water St. etc. The cases
could always be traced to some particular point 
of origin. Candour however impels us to state,
that in 1820, when the cases were few, that we 
found no instance of contagion out of the infected
district, & some cases occurred in Duke St. which 
some ascribed to the miasma arising from Peg
Run, but others with more plausibility, attribute
it to have been carried thither by a boy who had visited
the district affected.
Its progress is generally gradual, one person will 
died & then for a while, no more is heard of it, till in 
a short time a few more are affected; then they are’
followed by others & so on. In some neighborhoods 
In 1805, a [sm??ling] [gr???] introduced it from [illegible]
it may be traced, travelling from house to house.
The non-contagionists assert that it is nothing 
more than a high grade of the Bilious Fevers of our 
own country. But let us examine this point. 


43
If such were the case, those districts of country
which are most exposed to miasmata & the causes
producing ordinary bilious attacks, would have been 
more seriously affected, we might suppose, than 
the middle of our cities. But the fact is the very 
reverse, for “the Neck” was remarkably healthy, when 
the Yellow Fever prevailed to such an alarming
extent in the City.
Another fact connected with this is that Fevers arising
from Marsh Miasma affect the patient again 
& again, while such is not generally the case with 
Yellow Fever. We hesitate not to assert that 
Yellow Fever is directly the reverse of Bilious Fever,
& that persons affected with it, lose their susceptibility
of taking it, instead of having it increased. To 
prove this, we will take the body of medical men
from 1762, down to the present time, & see how it is.
At that period, it was a new disease, & but few of the 
physicians of the day had ever seen its like. Of these,
many were attacked & among them, Rush, Wistar,
James, Physick & many more, some of whom fell 


44
victims to the attack, but of those who withstood 
& struggled through that attack, not one of them 
have since died of the disease. Some of them Dr Physick say
however, that they have had attacks of it since.
Dr. Griffith was one of those who never flinched
from his duty or yielded up his post in the hour of
danger, & he said he thought he had never seen a 
secondary attack of the disease, & he was positively 
certain that he never knew a case of death from 
a secondary attack. A fact which proves this to 
be true also is that when the disease raged in Gibraltar,
there was a regiment of soldiers stationed 
there who had previously encountered the disease 
in the tropics, & of these, not one of them died, while 
their companions around them fell victims to the 
disease, like [rotten] sheep. Here too we may remark, 
in opposition to the now-contagionists that no filth
can be found on this elevated rock, from which a miasma
might arise to produce the disease; on the contrary 
the whole of this eminence was under strict military 


45
control, & was of course kept free from all filth.
Hence we see that even if we should grant that 
there might be a second attack, it only forms an 
exception to the general rule.
The opposition may use the objection that if it was 
contagious, why did it not spread into the country?
It is true, we must admit that generally it did not 
spread into the country, but sometimes it did. Related
Case of a very respectable old Friend in Bucks Co.
who came into the City to attend Yearly meeting, & 
when he returned home, he was attacked & died. 
His daughter, who was a faithful nurse, but which
had not been in the City, was afterwards taken & died.
Dr Wistar recorded several cases which occurred in 
German Town, & among the rest, some of his relatives,
the Johnson family, where the disease was referred 
to be caused by a dung heap; but upon inquiry,
it was found that this dung heap had been there for 
47 70 years, & had never before produced any such effects.
The fact that this disease seldom spreads in the Country 


46
can only be accounted for by supposing that
the pure atmosphere of the country is not a soil
congenial for its growth, just as we may acct.
for the fact that a seed which would not grow
in the sand, would, if planted in a rich loam
spring up & grow luxuriantly. From this, too, we
see the benefit resulting from Quarantine Laws.
If Yellow Fever were only a high grade of 
Bilious fever, why was it not understood in 1793?
They had been accustomed to attend cases of Bilious
Fever, but when this appeared, they knew 
nothing about it. If a physician was called to 
see a patient laboring under this disease, he would 
in a day or two suppose him recovering, & expect
soon to see him up & walking out, instead of which 
on paying him the next visit, he would find him 
dead. If Rush believed it to be nothing more
than Bilious, why did he in his Lectures, caution
his students to “beware of the natural tongue, the 
natural skin & the natural pulse,” for these occurring



47
in Bilious Cases never excite any alarm to require 
a caution.
A striking case showing that there is a difference 
occurred in the Hospital. An old French Doctor
visited there on one occasion, just after it was opened 
& but few patients had been admitted. He 
was a man, who had practised in the W. Indies,
in Madagascar etc. & knew all about Bilious fevers etc.
During his visit, attended by Dr Church he saw among 
the other patients one woman, & on retiring
from her bedside, he asked Dr C. whether he expected
she would recover, & he replied in the Negative, & 
his opinion was confirmed by that of Dr Wister.
This so much astonished the French Doctor, that 
he went back & again examined the patient, but 
discovering no apparent cause for alarm in any 
of her symptoms, he, with all due deference, dissented.
On the next day, he returned to the Hospital, 
to see the result of the case & found her dead,
proving that it was different from what he had seen 
of Bilious Fever.


48
The disease appears at present to be better understood,
but the mode of treating it, is yet unknown.
The black vomit must not always be considered as 
a certain diagnosis of this disease, though it generally 
is, & care must be taken to distinguish between
this & dark bilious vomiting which it resembles.
Another distinction between Bilious & Yellow Fever 
is what is termed the “walking cases.” In bilious 
attacks, the patient faces a languour & feebleness of 
the muscles, which is not so in Yellow Fever, for 
patients sometimes walk the streets pulseless, & drop 
down dead very suddenly. Dr Dorsey saw one in 
Market St. who was pulseless, he sent for a wagon 
to [convey] him to the hospital, where he died.
Eighth Lecture May 16th 1834.
To show that muscular power is not lost, he also related
the case of a man from “the Neck,” who walked
up to the Hospital carrying his bundle on his shoulder.
He felt unwell, his pulse was scarcely perceptible
and he died soon after his admission.


49
A sore throat and Red Eye are symptoms which 
generally mark the walking cases; and even though 
the individual may not know it, these symptoms prove
true. Case of a person at the Hospital in this situation
who was angry because the physicians & attendants
considered him ill. He had no pulse & felt well, but 
died soon afterwards.
These cases have been mentioned to show that there 
is a specific difference between Bilious & Yellow Fever.
It may be questioned whether there is any propriety
in this discussion & speculation concerning contagion, 
now contagion etc. but when we reflect that
physicians are considered as guardians of the Public
Health, it is proper for them to be able to give a just
opinion upon the subject of Quarantine Laws etc.
We now come to a description of Yellow Fever.
Like other fevers, it generally has a cold stage, ushered
in either with chilliness or cold, and followed generally 
by a reaction of the system, when the fever is fully 
developed. We may distinguish it into 3 grades


50
some cases are mild, & seem to recover without
much medical aid. some are more severe, 
while those of the third grade, appear to die gradually
from the very commencement of the disease.
At the early stage, as in other forms of fever, we
have the hot, dry skin, restlessness, pain in the 
head & back, but generally the eye of a practitioner
accustomed to the disease, immediately recognises
an indescribable expression of countenance which 
is not met with in other diseases. The reaction 
of the system is sometimes powerful, so as apparently 
to justify the use of the lancet. Emetics were 
always thought improper, & avoided, until lately they 
have been recommended by a physician [Dr Irwin] in Charleston
of this however we shall speak in the Treatment.
Yellow Fever in the first stage is less liable to Intermission
than other fevers. It generally continues for 
about 3 days, then a change occurs which is very 
deceptive to those unacquainted with it. The patient
who was before much distressed, tossing about with febrile
restlessness, now has a cool, natural skin.


51
his fever apparently subdued, no pain, natural
pulse & all seems well & prospects favourable, but an
experienced practitioner will immediately say, it is 
not so, & that this is the time of danger. On farther
inquiry, you find a tenderness at the pit of the stomach,
& a sense of weight there; then the breast assumes a 
yellow orange colour, and also the eyes. (We may 
here mention that in 1820, the tenderness at the pit of 
the stomach was not so great as formerly.) This calm
state is called the second stage, & from this the patient 
soon passed to the third stage, which is marked
by the Black Vomit, & Pus may be considered as
the Death warrant for the sufferer. This Vomit resembles
coffee-grounds, & is thrown up in large quantities.
Now the pulse completely disappears, & blood oozes out 
from the gums, tongue, kidneys in urine, & blistered surfaces,
& in a short time the individual dies.
Although this dreadful state occurs during the last
stage of the disease, yet the patient still generally retains
the most perfect clearness of intellect. To prove 


52
this, we can mention a number of facts. First was
Case of a widow with one child, who was brought into 
the Hospital, & soon seised with the Black Vomit,
knowing her condition, she requested the Doctor to 
write her will, which she would dictate & he did so,
she relating everything with a perfectly clear mind.
Another case, a whole family was brought into the
Hospital, the Father soon had Black Vomit, & requested
the Doctor to write his will. After he had done he asked
the Dr if he was married, he replied no; then he told 
him, that “if he were attacked, he would not leave a 
wife & six helpless children,” with perfect intellect.
Another case of a man who requested his will made
at 12 o’clock at night, & at the same time counted out
the precise sum of money he owed at his boarding house,
to be paid by his Executor, & died before morning.
A remarkable case of a Supercargo, from Hayti, who 
contracted the disease in the W. Indies & it developed
itself here. In 6 days after they left the port of Hayti,
they captured a pirate, & on that day he was taken 


53
ill; he was however smuggled up to the City & walked
to his boarding house & sent for Dr P. in the evening.
He went & could not see his countenance, but found 
nothing unusual; on the next morning, in entering 
the room, he immediately saw from his appearance,
a hopeless case of Yellow Fever, The man discovering
his situation, directed that no information should 
be sent to his Father in Maryland, because he knew 
he would neglect all his business to come & see him.
He however made a will, & when he was about to sign 
it, he called the nurse to come round & see him do 
it because he said she would be called upon after 
his death, to say whether she saw him or not.
We will relate another case showing the remarkable
clearness of intellect which patients had during 
the very last stages of the disease. Case of the Wharton
family, a shoemaker by trade in which were two 
brothers and a sister down at once, attended by Dr
Griffitts, Wood & Parrish. All of these had the black 
vomit and died. On the last visit paid to the elder 


54
brother, who died first, he was sensible of his situation
and sent for a clergyman, but he refused to come.
He then requested his sisters who were missing him
to sing a hymn which they did. The sick sister,
who lay in a room below with black vomit heard the singing, arose
from her bed, walked up stairs & sat on the side
of bed, joined them in the hymn, & when they 
had finished, leaned over & kissed her brother
& returned to her own room.
Next door to this family lived an English family,
who were attended by a young English physician,
on the same night that the abovementioned Wharton 
died, his patient next door also died. This appeared
to depress him very much & walking home he 
expressed some fears that he should take the disease
& his spirits were much depressed. In about 5 days,
from that, he was carried to the grave.
Almost all the cases above related go to show the 
decided clearness of intellect in the very last stages of the 
disease, & how well the Black Vomit etc. answer as 
the messenger of approaching death. But there were 


55
some patients who died without either the hemorrhage
or Black Vomit, as for instance, some walking cases.
The symptoms of these were however strongly marked,
as the malignant countenance, fiery, red eye, sore
throat, & no discharge of urine from the bladder,
when these appeared, the patient was almost
unconsciously inarticulato mortis.
Another case related in which death occurred in 
48 hours & on examination, no urine was found
in the bladder, showing a complete paralysis of the
kidneys, & no secretion of urine. He had also 
seen cases walking about, when the face would become
completely purple; death soon followed.
In some cases, however, the intellect does not retain 
its vigor till death. Some are seised with coma during
‘the last stages, while others are attacked with Coma
in the very first stage, & appear to sleep on till death.
We have sometimes the “natural pulse, tongue & skin,”
but no countenance itself discovers the danger before delirium
occurs. Case of a Sailor, so violently delirious in 
his last stage, that he was compelled to be fitted with 


56
a strait jacket & carried out into the outhouses
to die, so as not to disturb other patients
Walking cases without pulse were generally fatal,
but to this, one exception occurred; that of a female
who came to the Hospital pulseless. She was
placed on the bed, but resisted all the prescribed
treatment most violently. The Dr went to the Priest
who duly visited the house & requested his aid to 
quiet her, as she was of Irish race. The Priest
immediately brought her to order, & she submitted to 
treatment which proved useful, & at length restored her.
We have as yet said nothing of the different kinds 
of Pulse found in this disease. First then we shall
notice what Rush called the Gaseous Pulse. This
illustrated by case of a young man whose pulse 
appeared very full and violent upon first feeling
it, but it immediately dropped on pressure with the 
finger. A few ounces of blood were taken from him 
as seemed proper, but he fainted during the bleeding
& soon after died. The blood was in a dark, tarry 
mass, in the state called dissolved Blood. 


57
It is worthy of notice to remark the sympathy 
which existed between the head & the stomach. The
Black Vomit was relieved by Coma & vice versa; and
sometimes even in this black vomit stage, patients
have wished for food. It is attended with no nausea, 
but is thrown up in immense quantities, attended 
with acid but not better eructations. As in some
other diseases, violent convulsions sometimes close 
the last stage of the disease.
Recoveries from the Black vomit have been known
but they are exceedingly rare. Case in private practice 
he was put in a hot bath, his system seemed
to be stimulated to reaction, & his case flattering,
but the prospect again darkened, & he died at last.
Ninth Lecture May 22nd 1834
With respect to Black Vomit, for a description 
& remarks upon it, we refer to a paper published in 
“Coxe’s Medical Museum” of 1806, in which it is 
shown not to be bile, but rather dissolved blood, cast
out from the arteries of the stomach. The manner 


58
in which to test Black Vomit is to dip in it a
piece of white paper or rag, then holding it up, if 
it presents a reddish chocolate tinge, it is Black Vomit, but
if it presents a greenish tinge it is Bile.
But of this we shall speak farther hereafter.
We will now speak of the Treatment of Y. Fever.
In this, a very great difference prevails among practitioners.
Some thinking that violent diseases require
to be opposed by violent remedies acted on this
ground. This practice generally obtained in 1793,
when practitioners & Rush among the rest, made 
a very free use of the lancet & mercury. Subsequently, 
however, rush became mor cautious in 
the use of the lancet, alleging that the fever appeared 
to have changed its type, & to have a determination 
rather to the skin, consequently in 1802
he sweated his patients but bled less. The 
practice at the Hospital in 1805 was more simple.
Experience convinced that the lancet should 
be very seldom & very sparingly sued, & the large
use of Mercury seemed not flattering.


59
Wistar used Mercury very liberally both externally 
& internally in all the stages of the disease,
but his treatment was not very successful.
Griffit appeared to used it more rationally, & gave
it only in the first or febrile stage. His dose was 1 gr.
every 2 or 3 hours might & day; & if it purged a little,
no matter. This he would continue till the third 
day, after which he wished to use no more, then he
commenced purging, generally with a decoction of 
Senna, & his practice seemed more effectual. The
moderate use of the Lancet was sometimes advantageous, 
especially when the head seemed affected 
The general practice which obtained at the 
Hospital, when the patient was admitted in the 
early stage of the disease, was, to purge thoroughly
by either with Mercury or some milder purgative,
then to endeavour to produce sweating, use 
warm bath, sometimes Decoct. of Eup. Perfol.
also to drink freely of lemonade etc., & among
others the [illegible] or Effervescing Draught, which is
so grateful & pleasant in fevers. 


60
The Antimonial Preparations were never used.
Sometimes the patient would not sweat, & his skin 
would remain hot & dry; then it was proper to 
reverse the treatment, & instead of heating him, 
to use cooling applications, with cool air & drink.
Through every stage of the disease it is important
to attend to the state of the bowels, sometimes inject
small quantities of Magnesia. Avoid the
drastic purgatives. [M??ge?] resorted, with advantage 
to blisters over the stomach, but at the
present day, we should attend rather to the 
spine, the commencement of the nerves. 
In the low form of disease, the treatment should 
be directed to supporting the system. The second
stage seemed to be that which required most attention, 
for it was a fact that those patients, who 
had received no medical treatment during the 
first stage, & were brough in at the second, seemed 
to do as well as those who were brought into the
Hospital at the first stage of the attack.
Case of Bowman, who had fallen into a low state 


61
& Dr [S???] Duffield, and a practitioner who was not so fearful of Inf. Effusion etc. as P. was in his younger days.  ordered him Wine, which revived 
his system & he recovered. The bark was never
much used, but wines, malt liquors etc. etc.
Bowman afterwards expressed his gratitude with Easter Eggs.
Recovery, however depended very much upon 
good nursing. This, after all, is a grand desideratum
in the treatment of diseases, which should 
always be most sedulously attended to.
Watch nurses in Hospital, night & day
A great difficulty which must be encountered
in many cases arises from the irritability of the 
stomach, which will reject whatever may be given 
it, so that the system cannot be supported. To 
obviate this, Lime water & Milk may be used,
a tablespoonful of each for a dose. Dr Physick
used Sp. Turp. in the doses of 1 or 2 teaspoonfuls, but
the results did not seem to sanction its use, in so 
large doses, but it sometimes proved beneficial,
when given by injection so as to produce [strang??g]
& inflammation of the rectum Acts as counter irritant
to stomach
No practitioner was more successful in his treatment
that Dr [Ma??ee], & that was very simple.


62
sometimes he would use a little bleeding, give
the patient plenty of diluent drinks, chicken-water, & 
gentle laxatives Magnesia his favorite & injections, & sometimes apply 
blisters. These simple remedies appeared best
adapted to the cure of the disease.
From a summary view of what we have said, we
find that Yellow Fever is brought from a foreign
source, that it always begins in the Eastern part 
of the City, along the Delaware, that it is always
traced to Ships, whether from the air in the hold, or 
the infected clothes of those who have died, showing
the necessity for Quarantine Laws. that it 
seems like a species of Typhus occurring in hot
weather, & that it is specifically distinct from 
Bilious Fever etc.
With respect to Inflammations of the Stomach
we refer to a paper by Dr [Yellorby] of London in the
Eclectic Repertory. & to Seeds’ Experiments on the 
appearance of the stomach & brain after death


63
Tenth Lecture May 23 1834.
On Malignant Typhus Fever.
“Typhus Fever” is a very indefinite term & may be 
applied to low forms of disease arising from various causes, 
but now we are about to speak of what we consider
a specific character of disease, in which there is, ab
initio, a reduction of the system. It has been known
in our country for a few years past, & has been an 
epidemic. Some years ago, it first made its appearance
in New England under the title of Spotted
Fever, long before it was known here.
Our first acquaintance with it took place in the 
Winter of 1812 & ’13, when the disease raged in Camden,
N.J. & the attention of physicians was directed
to it. An opportunity soon presented for Parrish
to inqure into the nature of it, by his being called 
to see Saml Pool in consultation with Dr Hendry of
Haddonfield. The patient had been ill for several 
days & consequently a disadvantage arose from
not having been able to watch it from the beginning


64
Immediately upon entering the room, however, the
countenance presented a very malignant aspect, & 
evinced a disease of no ordinary character. He 
had been bled twice, & treated for a supposed case
of Inflammatory Rheumatism, since he had violent 
erratic pains, shooting thro’ his body. This case
died.
1/21-13 Called to see the widow Sarah Pool,
who was just attacked, & the messenger said she
had Quinsy. Here then was an opportunity for 
watching the disease from its commencement. 
On examination, it appeared that she had had 
a [illegible], & that the throat was somewhat sore, with 
an erysipelatous redness, but not like Quinsy. The
pulse was irritable but feeble, & yielded to pressure
like the Gaseous Pulse; the Eye assumed a dingy 
cast, & the disease was evidently of a very low form.
The treatment which had hitherto been tried in 
Camden, & found unsuccessful, was that for an 
inflammatory disease. From this circumstance


65
it seemed justifiable to pursue an opposite course
& finding that the disease was of a very low grade,
this course of supporting the system was adopted,
& the patient happily recovered.
Soon after this, a fresh crop of the same disease
broke out in Camden, & the treatment pursued
in the case of Mrs S. Pool was practised with success.
Not long after this, the disease crossed the Delaware,
& entered the city. It was first discovered 
along the water’s edge, & one of the first attacked
was Saml Clough in Water St. between Arch and 
Market, on Feb 11. called to see him on 16th
[illegible] ’13 visited Henry Fife, who kept now in Water St.
Soon after cases occurred along up Market & 
Arch St. to Front & Second, gradually creeping 
along up the streets, sometimes from house to house 
until it at length spread over the City. It being
that, at first, much in the neighborhood of Parrish’s
residence, he was the only one who saw it, while 
other physicians found more none of it in the City.


66
He invited Rush to see a patient with him in 
consultation, & as it was his first sight of it,
on retiring from the room, he expressed his surprise
at the malignant appearance of the disease
& prescribed for a low form. Soon after, he 
was attacked with the same disease & died.
The disease not only spread over the City, but
it also extended to some of the most healthy
places, north of the City. Case of the Shallcross
family above Frankford on the Bustleton
Turnpike. A poor family living on the Turnpike,
took in a soldier, who was sick & died of the 
disease. The family was taken sick & the neighbors
were afraid to visit them except John Shallcross,
who supplied with some things which were needed
John was soon after taken sick himself, & his
Father’s family was obliged to nurse him, he died
soon after this, then, the Shallcross family was
attacked, & 2 deaths occurred in it, before Dr Parrish
was called. In consultation in this case, he felt 


67
himself in a very awkward condition, because the
attending physician could not be convinced that
it was not an inflammatory disease, while P.
thought it was not. Two other physicians were
called to consult with them, & it was agreed to 
give the patients to P. treatment. He rode out to visit
them every morning & the whole people seemed to 
be watching the result, which was at last favorable,
& spread abroad the name of the physician.
Eleventh Lecture May 26 1834
We now proceed to speak of the symptoms which 
mark this disease. There is generally a great
prostration of the system; the patient is taken 
with a chill, & sinks into a state of debility; the 
reaction of the system is very slow, if at all.
Persons previously debilitated by disease or intemperate
habits, were more liable to be attacked.
The patients were generally marked with cold
extremities, countenance shrunk, pulse very 
feeble or sometimes absent, a great retching & 


68
attempts to vomit, & an almost insatiable thirst.
And here we may remark that as soon as the 
heat of the skin & the action of the pulse could 
be restored, the thirst declined in proportion to 
their increase.
By a little digression, we may remark, that exceeding
thirst occurs in 2 opposite states of the system
1. In fevers attended with high excitement.
2. In cold prostrate cases. In this latter it appears
to arise from the blood not being propelled
thro’ the extreme vessels. Hence in burns or scalds 
which are extensive, instead of the system become 
heated & febrile, it is cold & inactive.
[illegible] surface of body burnt or scalded, produces certain death.
Delirium sometimes marks the first stage of
Typhus, but when this occurs, it is less to be dreaded
in the early, than in the late stage. Case
of a young merchant who now lives in Canton, who 
was taken one day with a headache, & he thought 
he would take a ride out to his father’s country 
seat. On arriving there, he stepped out of the 


69
carriage, upon the piazza & was immediately seised
with violent delirium. Dr Parrish was sent for
& obeyed the summons, found him with a feeble
pulse, collapse state of system, & violent delirium
Footbaths, Sinapisms etc. were ordered as soon 
as possible, to bring about action in the system,
Evidence of the action of the Mustard Plaster from but [illegible]
first [illegible]
& these together with proper internal treatment,
aroused him & he finally recovered.
Some cases commence with erratic pains in the 
trunk & limbs, & seemed like an Inflammatory 
attack, but there was a marked difference; we 
must not always associate pain & inflammation 
Another form which was more common in some 
neighborhoods than others was what was called
Pneumonia Typhoides. This was thought to 
be very general but from examination of notes of 1813, it
appears that not more than 1/3 were of that form.
In these cases, there was pain in the chest, dyspnea 
dark, bloody e3xpectorations, with a dark orange secretion 
combined; when the expectoration was free, 


70
the danger seemed to be less The lungs appeared
to be disorganized, not directly from the 
disease, but from becoming engorged & filled up.
sometimes, however, they were doubtless inflamed.
Diarrhea attending the disease was a dangerous
symptom. Case of a young man, clerk in 
store of J. C. Wycoff. This was the first case
which Dr Physick had seen; he was now called in 
consultation. The patient laboured under diarrhea,
& the treatment was vigorous & supporting.
After much careful examination, he at length
took happily the same view of the case, & fully 
agreed in the vigorous plan adopted. The 
patient finally recovered.
Cholera was another form in which this
disease occurred in 1813. We shall speak 
of this at a future period: (see North on 
Spotted Fever).
In this as in other diseases which we have noticed,
there is a peculiar physiognomy, expressive
of the malignant nature of the disease.


71
The extreme torpor of the nervous system which 
sometimes occurs in this disease is very remarkable.
The surface of the body becomes insensible, & the taste
is completely gone. A striking instance of this 
occurred in Woodbury. Case of a lady, wife of 
Dr Ayre. She had been severely attacked by the 
epidemic, & her husband had remained at home 
with her, a constant attendant, when she began to 
recover, he left her to visit other patients, & during 
his absence, the nurse & herself thought it would be 
proper to have an evacuation from the bowels, & consequently 
an enema was given. The evacuation 
was effected, but it produced a “sinking spell.” On 
the husband’s return, he found her in a most alarming
condition. He resorted to the use of stimulants
both internally & externally, but her system would 
not respond to the means employed, until he finally
took a red-hot fire brand & applied it to her 
leg. This excited sensation & so far from being painful,
she afterwards told her husband, it was pleasant
She at last recovered.


72
The pulse is liable to much variation, but is generally 
weak, sometimes it is deceptive & yields
upon pressure, like the Gaseous Pulse. The most
dangerous pulse of all that which is small
feeble but tense, called by Rush, the Synocular.
The tongue is sometimes moist & natural, but
generally brown & dry.  There is much deception 
in the cleaning of the tongue in this fever. It appears 
sometimes moist & clammy.
Spontaneous & clammy sweats sometimes occur
also Hemorrhage from the Nose, lungs etc. of Dissolved
Blood.
The “Sinking Spells’ which take place in this
disease are well known The patient may be lying 
very comfortably, but for some reason may make
some exertion, which will produce at once apparent
syncope. In this disease then muscular exertion 
should be particularly guarded against. Case 
of man in N. Liberties, who died in the act of 
walking from his bed to the door. He was a poor 
man & he & his wife were both sick. The neighbors 


73
fearing the epidemic would scarcely enter the
house. The Dr attended him as a Dispensary
patient. He left him in the morning quite comfortable,
soon after, hearing the child crying at the 
door, eh got up & walked towards it, but fell 
dead before he reached the door.
The danger of these “sinking spells” increases in 
proportion to the length of time which elapses before
they are checked. Some of them are intermittent.
Pneumonic Symptoms in the latter stage are
terrific & generally fatal. Case of a young woman
residing in 8th St. near Vine, who went down in Pine
St to nurse her sister, & on her return was attacked 
with the Typhus Fever. At first nothing unusual in 
her case, but it appeared as one of moderate form.
One afternoon, however, about the third or fourth day,
on visiting her, Dr P. was struck with the change in 
her symptoms; her pulse was tense & she was evidently 
affected with Pneumonia, her breathing was laborious,
& pain like Pleurisy. The stimulating treatment 


74
was then abandoned, & she was bled a little
from the arm. She bore the bleeding very well
& the blood was set aside for examination. In the
middle of the night, visited her again, & found her 
with violent pneumonic inflammation. Her
blood appeared sisy; she was again bled freely,
& prescribed for an acute form of disease.
Next morning called others in consultation, found
that her system had changed, strength failed, & 
besides all this, as she was advanced in pregnancy 
miscarriage took place & she at last died.
Black vomit sometimes occurs. Case of a son 
of one House.
Also of Dr [Woolers] who, before his death became
[illegible] [illegible] Left being covered with yellow [illegible] lymph & [illegible] full of black vomit
as yellow as in yellow fever & had black vomit.
Pneumonic Inflammation generally occurred
between the third & fifth day.
Hemorrhages sometimes occurred in this disease.


75
Twelfth Lecture May 28 1834
Before mentioning the practice proper to be adopted
in treating Malignant Typhus, we will make a general
remark, that every epidemic when it first appears
has something peculiar in its character, & time is required
to become acquainted with the best mode of 
combatting it, & the proper remedies to be applied.
We will first suppose we have a case of Malignant
Typhus of ordinary form, unattended with 
any unusual or alarming circumstances, & that
the system, having passed thro’ the cold stage, has
sufficient power to react. The first indication, then, 
would be, to clear the prima via, by an emetic, either 
united or followed with Cathartics & Sudorifics.
Then we might probably give 8 or 10 grs Calomel & 20
grs. Ipecac. or first give the emetic, and follow it
with a Cathartic. Diluent drinks, to facilitate the 
operations. Pil. Cath. Comp. are now generally used
in preference to the old formula composed of 
Calomel
Jalap aa grs X
[Gold] Sulpht Amt. grs viii
[illegible] PUlv. no III
Give at intervals of 15 or 20 minutes.


76
Direct also that the feet should be steeped in 
warm water, give warm drinks of Eup Perfot & 
other similar substances to induce sweating.
also the Saline Draught every 1 or 2 hours; or if
Limes cannot be obtained give Sp. Mindereri,
a tablespoonful every hour if the stomach will 
bear it. If the head be affected, apply cups 
to the temples. Among the local applications
blisters to the neck & extremities are excellent.
Dover’s Powders sometimes given.
Opium gr ifs & Ipec. fri. given with warm drink
will often tranquillise the patient.
If sweating cannot be induced, the heating treatment 
must not be pushed, but stopped & cold [illegible]
As this is supposed to be no extraordinary case, 
in 2 or 3 days, we shall find the patient begin to 
flag under this course, & his system will call for a 
cordial, mild treatment, & about the 5th or 7th day
the fever will subside. The cordial treatment must
be attended with the utmost caution. The 


77
volatile alkali is well adapted to stimulate
in those cases, in order to prevent the prostration.
It may be given in the form of a Julep, a tablespoonful 
containing 5 or 6 grs Vol. [A???] or [B???]
Animal Diet has proved very beneficial in the 
treatment of this disease. [illegible]
But what must be done in those cold, prostrate
cases, when from the very beginning, the patient
seems to sink into a very low state, with a feeble
pulse, irritable stomach, cold skin & etc. etc. In these
Extremes in N.Y. State of [Depletiv] & Emetic
no emetics are requisite, the stomach is already 
irritated & making constant efforts to throw off its
contents. It then becomes proper to endeavour to 
tranquillise the stomach, to restore heat & action & 
if possible elevate the pulse. Reaction, then, being
in this place, the Polar Star to which all our efforts 
must be directed, we would first apply stimulants 
[illegible] internal [st??] when surface is [proper]
to the surface. For this, there are several ways. Flannels
soaked in Hot Brandy & Cayenne Pepper, may
be applied to the extremities & even to the trunk.


78
Formerly, Decoct. Cantharides & Spts. Turpent. were
used by friction, but not now, because it is too powerful 
& apt to produce vesication over the whole surface
to which it is applied Case of young woman. A hot bottle might
be useful, but it is generally so difficult to be obtained
as to render it impracticable.
Hemlock used in N England blocks steeped in hot water, or [Sal???]
Brick, heated in the same way & laid under the 
bed-clothes often prove advantageous Sometimes 
dry heat is applied in a similar manner.
The stomach may sometimes become so rebellious 
as to reject whatever may be given; then we must 
try opiates & if the stomach will not receive
them, we know that there are other modes in 
which they can be applied, so that the stomach
will feel their influence by sympathy. Hence 
then if they be rejected from the mouth, try it per [illegible]
& it will generally be successful. relative dose
The necessity of maintaining external heat & action 
is well worthy of attention.


79
Thirteenth Lecture June 2, 1834.
In the cases of Typhus which occur in the form 
of Cholera, the very powerful stimulants of Spirits
etc. are not so well adapted as pure Port Wine.
Spiced Mad. Wine. or Brandy, teaspoon or tablespoonful at a time
In these we may also use Blisters, Anodyne Injection
Spice Plaster over the stomach etc. and to support
the system, give Animal [soups] especially chicken
Broth. The formula for making the Spice
Plaister is, to take of Black Pepper or Cayenne
finely ground, 2 Tablespoonfuls, of Cloves and
Cinnamon, or Allspice, or Ginger, (any 2 of these)
ground fine each the same quantity, & mix them with Rye Meal
Brandy & Honey sufficient to form a good consistence
for a plaister. This applied over the stomach
is well adapted to sooth its irritability in a great
variety of diseases. [Grease] the part before applying it.
Pneumonia Typhoides is a form of this disease,
which is often greatly to be dreaded. In this, we
find a dark, bloody sputum, pain in the chest, etc.
but this pain does not always depend on Inflammation 


80
The practice recommended in treating this is as follows
If the system has reacted, the skin be hot & dry,
& the pulse admit of it, give an Emetic. This has
been of great service in relieving pain. Also Cathartics
to purge the bowels. If then there is much 
action, it may be necessary to abstract some blood,
this should be done locally by Cups. After this
we may make a speedy resort to extensive blistering
over the affected part & to the use of sudorifics, of 
opium gr ifs or gr [?ii] with Ipecac. gr I or gr sii, every 
4 or 6 hours. Diluent drinks may be freely given 
If no perspiration yet appears, give the Saline draught
or Spt. Mindereri every 1 or 2 hours. Also use
the warm applications about the patient with the
Salmon Bricks steeped in hot water. This will 
generally bring on diaphoresis & prove useful.
If the patient then becomes debilitated, with a languid
pulse, & evidences of prostration, then come in 
[vary] properly the vinous stimulants, or in intemperate
cases even brandy, but wine as a general rule 
is preferable to Ardent Spirits as a stimulant.


81
wine whey often produces a very happy effect.
Infus. of Serpentaria. Vol. Alkali either in 
Bolus grs v every 1 or 2 hrs. or Julep, if more agreeable.
After 3or 4 days, the patient will perhaps show
signs of great prostration, then common sense dictates
that we must lay aside the practice of sweating
purging etc. & adopt some other. Case of a young man
who passed very well until 5th day, when prostration
came on & he was very low. Bark Infus. & Tinct. were
given with stimuli, wine etc. & under this treatment
& close attention, with the blessing of Providence, he 
finally recovered.
There are some Pneumonic Cases, which, ab initio, 
seem to be beyond remedy.
When the patient has passed the first stage, & 
reaction has been completed, it becomes necessary, as
we have before said, to support the system by the
stimulant practice. But we wish the young practitioner 
to be guarded in his use of these stimuli,
as they are edge tools, which cannot be trifled with.


82
They should never be urged to excite the system
beyond its natural standard, & after it has attained
that height, less is necessary to keep it there,
than was to raise it up.
The effects of stimulants are transient, hence when 
we give the stim. we must also provide nourishment
to sustain the strength at the point to which we may 
raise it. Of the nourishing substances, none stands 
more prominent than the Essence of Beef, prepared
as follows. A Tablespoonful seems to be of
as much service as 1 pt. of Chicken Water.
Rx. Take a piece of young juicy beef, cut it 
in small slices, & put them in a porter bottle, 
so as to fill it to the neck, then stop it up, with 
a cork, thro’ the centre of which is passed a 
quill; there tie the neck of the bottle to the
pot-hook to keep it in a steady position, put it
in cold water, apply heat till it get to the 
boiling point, then boil for ¾ of an hour. We 
shall then have a pint tumbler about 2/3 


83
full of the essence. If there be any fat mixed
it can be skimmed off when the liquor cools.
This may be seasoned so as to be agreeable to 
the patient, & a teaspoonful or tablespoonful 
given at a time. It is an excellent, nourishing
substance, well calculated to strengthen
the system.
Calves’ feet jelly. Eggs with Wine or Brandy,
Oysters if in season, may be employed.
Another circumstance, to which we would direct 
attention, is, not to permit the patient to 
sleep too long at a time; for it is a fact well 
known to nurses, & should be to physicians, that
some sleep refreshes, and some exhausts. To 
distinguish between these is easy, because if we
see a patient in sleep, who is apparently distressed
moaning etc. we may know that he is not enjoying
the calm, refreshing influence of “nature’s 
sweet restorer, balmy sleep.” Then wake the sick, 
& give some kind of nourishment frequently.


84
Spts. Turpentine in small doses, frequently repeated, 
sometimes acts happily, if it do not 
offend the stomach, or prove ungrateful to the
patient. If pushed too far, it may purge, but 
this may be checked by a little Laudanum.
It sometimes happens that the system will 
not respond to the ordinary course of treatment
it then becomes necessary to endeavour to make 
some new impression. Case of a lad, upon 
whom stimulants produced no effect, but having
a slight evacuation from the bowels, he seemed to 
be better instead of worse after it, & consequently 
it was resolved to produce a slight discharge 
from bowels, & it had a very salutary effect.
By using stimulus too much, there is danger
of bringing the patient to a state similar to that 
in which a man is when “dead drunk.”
This disease is considered sui generis.
Closed with the injunction of constant attention to,
& careful watching of, patients, to obtain success 
in practice.


85
Fourteenth Lecture June 5, 1834
In speaking of Yellow Fever, we mentioned some
of the malignant appearances which sometimes
marked the last stages of that disease, & these
same marks we often find in this Malignant Typhus 
appear earlier. sometimes black vomit. 
such as petechial spots, sometimes black vomit, bloody sputum & urine, & [illegible] disorganisation
of the lungs. They seemed to be struck
with a death-blow from the very beginning.
In cases of disorganised lungs, we find a difficulty 
of breathing, heaving of the shoulders, & bloody expectoration,.
tho’ sometimes but slight. It is very rapid
in producing its fatal effects. Case of a young
man, somewhat intemperate, who was coming 
into the City, & was attacked with a chill at a [Fox-Blasé] tavern
about 3 miles distant, on the German Town
Road. Died the next day. His lungs were completely 
engorged, respiration difficult, & no reaction 
took place in his system.
This disease seems to anticipate the last stages of 
Yellow Fever in an extraordinary manner. Case 


86
of an only son of Wm J. Bell, who went out sleighing 
several miles in the morning, returned & ate
dinner, seemed a little drooping, but no alarm was 
excited until about 8 P.M. when Dr Wistar was 
sent for, but he being unwell, referred to Dr Parrish
He found him with very little pulse, comatose disposition
& when aroused, slight delirium accompanied 
This is unfavorable symptom
with a great dread of falling . Before 6 o’clock
on the next morning, he was dead & very spotted.
Taste could not distinguish wine from water.
Another case of Capt. Simmons in Arch St. who 
was in the habit of going down to his store in Water St.
every morning before breakfast. One morning, while
there, he was taken ill & with difficulty reached
home. Dr Dorsey was called in & found him very 
ill, & something peculiar in the nature of the disease.
He ordered him bled & a cathartic. The disease went
on & developed itself as Malig. Typhus. AT 10 P.M.
Parrish was called in consultation & while sitting
there, he died. Blood was proceeding from his nostrils,
& countenance very malignant. 


87
Sometimes the system would react & the patient 
struggle manfully with the disease, before death.
Various as human character.
For in some families, we find a great tenacity 
of life, while in others, it is just the reverse, & the
very moment disease attacks them, they yield
readily to morbid impressions & sink.
We may here offer some Reflections upon Disorganisation 
of the Lungs, which occurs in this disease.
Every practitioner knows that “determinations”
to certain organs take place at different seasons 
of the year, as in summer we have bowel comp. etc. 
& hence in the prevalence of an Epidemic, yellow
fever for instance, which prevails in hot weather,
the disease at last falls upon that part which 
seems to invite it & we have Black vomit etc. etc.
But in Winter & Spring, we know that the thoracic
or Pulmonary organs are more liable to 
disease, hence when this Pneumonia Typhoides 
prevails in Winter & Spring we have what might be, very properly,
termed “Black Vomit from the Lungs.”
Percolation of blood



88
The deceptive appearance of Inflammation may 
occur in the red eye which we often see in this
disease. But let us consider. Take a child, worn 
down by disease, (Cholera Infant. for inst.) to a state
of extreme prostration, & there you find a red eye, 
but instead of being a sing of excited inflammation,
it is a sign of death. It is a percolation,
for the vessels have become so weak, that they relax
& admit the red blood. So also in the last stage
of Malignant Typhus, it is not a sign of Inflammation 
The eye is a very important organ, it is the window 
of the brain & thro’ it we see the operations that
are going on within. When we see the dissolved blood 
oosing out at the corners of the eyes, the gums, or in 
petechial spots on the skin, can we expect any 
thing else than that the spongy structure of the
lungs will share the same fate?
Here the question arises, what is dissolved blood?
Some have asserted that is so, when the crasis is 
broken down by excessive action or inflammation, 


89
but this is not only incredible but a dangerous
doctrine upon which to found practice. It is 
true that this may sometimes be the case, as in 
death by lightning, when the blood is dissolved
by excessive action; but while we admit this, 
we believe that it may also be dissolved by the 
direct abstraction of the vital power. For instance
take a case of Scurvy, look at the causes operating 
to produce this disease & we ask if it is probable
that the oosing of blood from gums, ulcers, etc. is 
effected by an increased action. The disease 
[Anson??] Voyages.
occurs in ships on long voyages, with low diet,
hardships, mind depressed etc. & in besieged cities.
Siege of [illegible]
& can these privations bring on dissolved blood 
by excessive action? Reason & common sense answer 
directly in the negative. In those cases, we 
have not the full pulse found in Pleurisy etc. but 
a small gaseous, or none & even synocular pulse. An instance of 
this in the case of Jacob [Bill?ine], Manager of Alms
House Hospital, who died of Typhus & was spotted as a leopard.


90
Sometimes also we have a cold skin, showing no 
action on the surface, while at others we have
what is more to be dreaded, a hot skin & a 
feeble pulse. To prove that it differs from Inflammation,
we may mention a case Josiah Starky of Hemoptysis
which Dr Parrish once attended, the man
had thrown up a quantity of blood, but the hemorrhage
ceased, & just before his arrival, he had
drank a cup of hot coffee, which again excited
the hemorrhage Here pulse was no guide, for it was feeble. bled him several times. Suppose in this case Brandy etc.
had been given. the same hemorrhage would have 
occurred to a greater extent perhaps; but in dissolved
blood, the very reverse happened. In proportion 
as system is elevated, the hemorrhage diminishes.
When dissolved blood first appeared, it was treated
as an Inflam. by depletion, but physicians soon 
found that it would not do.
The results of dissections are not much to be depended
upon, because dure regard is not always paid to 
the gravitation of the blood, emptying of arteries into veins but with candour, we
acknowledge that sometimes these, do, most satisfactorily 


91
prove, the previous existence of Inflammation, as in 
the adhesion of the lungs Dr Woollens effusion of the lymph etc.
But admitting that it sometimes so happens,
must Inflamm. be always treated with the Lancet?
No: because Inflam. as well as Disease
inf. is not a [illegible]
differs in its nature & is sometimes specific & peculiar.
Carbuncle, for inst. is a specific inflam.
differing doubtless from ordinary inflam. because
instead of combatting it by depletion, we use the 
very reverse treatment op. Tonics & Cordials. to cure the patient.
This same specific inflammation may & 
does take place within as well as externally.
This Malignant Typhus then, we consider to be 
a disease of low action & that the patient sometimes
sinks from direct debility in the very beginning, but reaction dos 
ensue with sufficient strength, we may bleed very 
cautiously, topically rather than generally; use caution [illegible] emetics,
cathartics & cold ablutions sometimes etc. Sweating
also had a very happy effect, but must be limited.
Doctrine of excessive actions & suffocated excitement [very] hazardous


92
Premonitory Symptoms
Fifteenth Lecture June 9th 1834
We will now proceed to give some general views
respecting Fevers. First, we will notice some
Premonitory Symptoms, which generally indicate
an approaching attack of fever. The patient will 
generally complain of Lassitude Dulness, has an 
indisposition to exert himself, easily fatigued, loss 
or irregularity of appetite, nausea, disturbed
sleep, & perhaps constipation of the bowels. In addition 
to this, we often find a change of habits, as for 
instance, in a person who has been accustomed to his 
quid of Tobacco, he has no relish for it & leaves it.
The patient may also be frequently disposed to go to 
stool, but the passages are small & ineffectual. Some
times the attack is proceded by rigor or chilliness.
During the prevalence of the Typhus fever in the Prison,
Dr [Henson] said it was proceded by constipation.
In the Alms House it was directed to ventilate the 
room, watch the patients & when anyone complained
of nausea, listlessness, or other premonitory Symptoms


93
give an emetic of Ipecac, & the plan seemed to succeed.
It is always proper to attack fever in its founding
stage, & then it may sometimes be arrested, but 
when once formed, it runs its course. Case of two 
patients, who were attended in a low Nervous fever, but 
they at least recovered. Sometime after, they had the 
symptoms of another attack, which would carry 
them to the same low state, but at the very commencement,
blisters were applied to the wrists, & the
fever was checked in its progress.
We will next give some general principles respecting
the treatment of Fevers.
We have endeavoured to show the necessity of evacuating 
the prima via, and if the circumstances
require it, use general & topical bleeding, then
come sudorifics, & if they fail to produce their effects
after a reasonable application, resort to the 
cold ablutions & drinks, & these if properly employed according
to the direction of Currie, when the skin is
hot & dry & no chill, are often beneficial. If 


94
cold water be not suitable, tepid may be used.
Blisters for local affections often produce very happy 
effects, as for instance, to the back of the neck,
for delirium, also to the legs, & to the breast for 
Pneumonia Typhoides. When there may be no 
local pain, but the patient is very restless, continually 
tossing about & sighing, blisters often act
happily in apparently calming the nervous irritation
And if we were called upon to name the most
powerful remedy for arresting the progress of fevers,
we would place blisters at the head of the 
list. Tonics & stimulants may be used according 
to the directions inculcated in the previous lectures, 
remembering that there is a possibility of exciting 
too much, & that they are only transient
in their operation, hence nourishment must also
be given to maintain the effect which they produce.
There is one thing to which we would particularly 
invite the attention of the practitioner, viz. that the 
patient in a low fever, may sometimes become 


95
insensible to the calls of Nature, & the urine
may collect & extend the Bladder to an extent
for greater than one might be aware of. Hence
we see the importance of always looking to the Bladder, 
& using, if necessary, the Catheter.
In children, the limbs sometimes become contracted 
by long remaining in one position; & in 
them as well as in adults, sloughs may arise
from long continued pressure upon the parts in 
contact. Hence it becomes necessary to change the 
position & take off the pressure by pillows [airpillows] or by 
making a crucial incision in the [Sacken] bottom 
[illegible] Alleviator.
We next speak of the Symptoms of Convalescence.
The tongue is generally a good index by which 
we may be guided as to the probable result. It is
generally furred in fever, & its cleaning is the first
evidence of convalescence. There are two ways of its
cleaning, smoothly & naturally, when we may expect
a speedy restoration, or slowly, when, tho’ it 
may result favorably, yet it will be slow & tedious 


96
And in these latter cases, the fauces also are covered
with a fur. When the tongue cleans
rough, dry & chopped, it is a bad sign. Bu t
if it cleans smooth, red & moist, tho’ convalescence
is pretty certain, yet it will be long & tedious.
When the tongue cleans in part, then stops & the
belly becomes tympanitic, we may regard it as
a dangerous symptom. In such cases, Dr Wood
recommends the free use of Turpentine
[P??] of Bark of [Peru]
Case of Jos. P. Norris, an exception to the rule of the 
cleaning of the tongue. He was very low, but when 
other symptoms became decidedly favourable, his 
tongue remained furred. Soon after, however, it 
assumed a healthy appearance. Critical [Sweats]
this occurred in fever which Parrish contracted at Col. Howe’s
A reduction of frequency of the pulse, if attended
with other favorable symptoms, may be considered
as a good sing, but if the attending symptoms
do not coincide, we cannot rely upon it, as for inst.
in Yellow Fever, when during the last stage, the 
pulse comes even to its natural standard, & often 
When convalescence with frequent pulse – watch for [illegible]
deceives an inexperienced practitioner.


97
The condition of the bowels must be attended to,
for the passages are frequently not natural or healthy.
Healthy-looking passages are not always a sing of
They show merely the state of the [Lung] etc.
recovery. The urine also should be observed, more
so perhaps than it is, but it is apt to be fallacious.
The expression of countenance, often serves as an 
infallible criterion for those accustomed to long
& constant observation. A great deal depends 
upon it, & an experienced man will notice it.
We mentioned (p92) a change of habits, as one of the 
signs of approaching fever, but when we see a return to 
former practices, as for instance to the use of Tobacco
after it has been suspended, we may consider it as 
a good evidence of convalescence. Case of a black 
woman, in Yellow Fever Hospital, who sat one morning
smoking her pipe, considered it a good sign.
A desire for Bread , is a very good sign. Once
noticed a remark made by an old black nurse in the 
Yellow Fever Hospital in 1805 that all who wished for & 
ate bread, got well, & the remark was a true one.


98
Once knew a patient, who was in a very los
condition from an attack of Nervous Fever, & 
delirious, but he called constantly for Milk,
which was given him & he recovered.
When delirium subsides, it is a good sign, unless
it should be that deceitful calm, which precedes
a more violent storm. This delusive calm
is probably owing to the effusion in the brain.
We will next notice some of the Unfavourable
symptoms appearing in Fevers.
If the pulse be much accelerated, it is unfavourable
Dr Heberton considers 160 in adults a fatal pulse, & it generally 
is so, but not always. The danger is also greater,
when, in addition, we have subsultus [tendinum],
which we must be careful to distinguish from voluntary
contractions of the muscles. Case of young
lady, in whose case, a true but unfavorable opinion 
was formed from the circumstance that
while he was feeling her pulse, he felt a sudden 
twitching of the tendon, & upon inquiry, found
it was involuntary.


99
A brown, dry & chopped tongue, and in old
people, we sometimes see a mucous, brown, moist
dirty tongue, like currant jelly, these are very ad.
The blood is often a good criterion, hence C.
Rieburgher, cupper etc. often predicts with great
accuracy the death of the patient. Thus it was
in the case of Dr Wistar, he said after cupping 
him that he would die, because he had “Blue 
Blood.” & so in other cases.
Delirium, in the latter stages, especially if of the 
maniacal kind is a dangerous symptom.
Convulsions generally fatal sometimes happen in the last stage Yellow & Typhus
[Wistar] died in a violent convulsion.
Pneumonic Inflammation, which occurs
in the last stage of Typhus, is often fatal.
Torpor of the system is very unfavorable; thus when 
a patient, who hitherto, has been very careful & 
modest, now becomes heedless of exposure, & can [be]
rolled about in any direction in bed, slip downwards in bed, we may consider
his disease approaching a fatal termination;
such was the case of Dr Wistar.


100
We next come to the Dying Stage. Whatever 
may have been the preceding symptoms, here
they are very similar. There is sometimes a condensation 
of the fluids of the eye, & a film forms
over it, so that a fly may settle upon it, without 
causing a wink.
The patient becomes unable to prevent the apparent
difficulty of respiration, he loses the control 
of the muscles, & it goes on in this way, uneasy & 
distressing, until sometimes we have, what are
called the groans of death.
The projection of the lower jaw is an evidence 
that life will close in from 15 to 20 to 40 minutes.
Case of a girl, subject to Epileptic attacks.
Also of Randolph of Roanoke. about 20 minutes


101
Sixteenth Lecture June 12 1834
On Critical Days. Hippocrates taught, during
his time that there were certain critical days in 
fevers, & that after the disease had run to that
period there was usually a change took place.
Since his time, this doctrine had not been without
its followers. Dr Rush taught the same, & though
he often employed active measures in the treatment 
of fevers, yet it was not with a view of cutting off
the disease at once, but of preventing serious consequences
following the critical periods.
In order to arrive at a fair view of this subject,
let us consider the operations of Nature, & see
how the Vis Medicatrix exerts itself in disease.
Suppose a patient labouring under a common Intermittent
Fever and Ague; we find it generally comes
on about the middle of the day, he has first the rigor,
coldness etc. afterwards his teeth begin to chatter with 
cold etc. pulse frequent, after this stage the symptoms
change, & a sense of burning, heat etc. appears, which marks 


102
this stage, runs a certain course, & is then succeeded 
by moisture etc. which stage will terminate with 
profuse sweating. This order of things will occur
without the aid of art. The patient returns to his 
avocation till the time for the next attack.
If this, then, is true with intermittents, why may 
it not be so with remittents? We maintain that
it may & that in these also, Nature makes an effort
at Resolution, but does not succeed, & they continue
running till 3, 5, 7, or 9, or more days, before the 
crisis arrives, depending on Constitution etc.
If this doctrine be true or not, we here are led
to the question whether we can cut short fever?
We answer that when a fever has once been fully 
and fairly developed, it cannot be cut short in a 
great majority of cases, but by proper treatment,
violence may be [illegible] local determinations [prevented] etc.
may generally be brought to a favorable issue.
If fever can be cut short, it evidently follows
that the most vigorous remedies must be applied 
to the most vigorous diseases; is this true in 


103
practice? Do we find that in severe attacks, the
most violent measures operate most favorably?
Certainly not, take the Yellow Fever for instance;
it was first thought that this could not be treated
too vigorously. Mercury, Bleeding etc. were used 
very extensively, but physicians soon found that 
this would not do, & we recollect that the mild 
simple treatment of Dr [M????] p.62 was most successful.
In 1805, the practice in the City Hospital was
more simple than in former years & equally successful.
Now let us descend from the Yellow Fever, to 
our common Autumnal Fevers, & see the treatment 
best adapted for their cure. Some practitioners
have pushed boldly forward, & acted very vigorously 
with a view of cutting up the fever. Case of a
gentleman in Lancaster Co. of fine talents, who 
wrote a Thesis of the Unity of Disease & sat down
to practice on the borders of the Susquehannah.
A fever prevailed in that neighborhood, which, in 
his hands became one of extreme mortality. He 


104
seemed to consider it as an epidemic of a very 
malignant character, & demanding violent treatment,
& he resorted to profuse bleeding at every 
carried to the very last paroxysm
paroxysm. Two medical men of judgment & 
common sense, who practised in the same disease
& same locality, said that it was merely a disease
which usually prevailed there at certain 
seasons, & that it yielded to the common treatment.
[illegible] [illegible] very requisite in Practice of Medicine
This shows the danger of carrying into operation 
practice founded upon such false theory.
We have seen instances failing in the attempt
to cut off fevers. Case of J. Gillingham, Dentist, 
(p.22) who was a lusty stout man, & active measures
were resorted at the beginning by Dr Harlan,
but he ran down to a very low state, before he recovered.
Dr Dorsey was a striking instance of active
treatment, but it was incapable of arresting
the fever, which at last carried him off.
These remarks confirm the position that fevers,
once fully developed, will run a determinate
course.


105
We do not pretend to say, however, that Fevers
should be left to themselves, as requiring no 
medical aid, far from it, our previous lectures
evince something very different.
Here, however, we are compelled to mention a
fact, which tho’ humiliating is no less true. A
Surgeon Dr [Trovil] in the army during the Late War Revolution
mentions that during one period, Fever prevailed
extensively in the army, & among the rest, 30 or
the sick were so situated that they could receive
no medical attendance or advice. These, however, 
he said, seemed to do as well as those who received
medical aid, & as many of them survived. This
is a humiliating fact, but it shows us that before
using violent measures, we should be certain that’
they are needed; but so far from doing nothing,
much may be done by a judicious practitioner, to 
alleviate both local & general affections.
There is one great mistake apt to be committed
by young practitioners against which we would give 


106
a caution, & that is to introduce active treatment
in anticipation. The patient may be doing 
well, but the practitioner imagines that 
some serious affection of the brain, or stomach etc.
may possibly come on, & introduces treatment in 
anticipation, now, instead of doing this, we 
must wait till there is need, & not endanger
the life of the patient for evils, merely imaginary.
For further remarks upon Critical Days etc. we
would refer to a Paper by Dr Boure in Duncan’s
Annals of Medicine vol 7. p.293. Also to Fordyce
on Fever, an old but valuable book.
There have been many speculations started 
at different times respecting the causes of Fevers,
& among those, one which holds a prominent place
at the present day is that of Broussais.
HE teaches that all Fevers arise from & depend
upon intestinal irritation, & that the mucous coat
is in a state of Inflammation; & some others say 
that it is owing to congestion of venous system which is the same 


107
thing as was considered by Rush as “Suffocated
Excitement,” and is nothing new. Some maintain
that the Liver, others that the Brain is the 
primary cause in producing fever.
To a certain extent, Broussais’ theory & others may be
correct, but so far from considering these as the
certain causes of fever, we hesitate not to say 
that they are often consequences & not causes.
We have known fever without any inflammation
we have known it to occur from a very profuse
evacuation of blood. To illustrate we will state
a case of a lady whose accoucheur was Dr 
James & family physician Dr Parrish. When 
she was delivered at one time, she was seised with 
profuse uterine hemorrhage, so great that for one
day her pulse was scarcely perceptible & cold; on the next
day, she had a fever, with a hot skin, & pulse sufficient
apparently to justify the use of the lancet,
if her former history had not been known.
Dr James then remarked that while he was in 
London, attending the lectures of Dr Denman, he 


108
recollected that the Dr said he had seldom lost
a patient from uterine hemorrhage, but from 
the fever which followed. The lady, however,
recovered after a protracted illness.
Another position which we assume is that starvation 
may bring on Fever. Scripture informs us 
that famine & pestilence go hand in hand,
Typhus fever shows the same thing; the History 
of Ireland a few years since, when crops were 
scarce & food scarce, confirms the position.
In opposition to the Broussais’ theory of intestinal
irritation, we may take a case of our 
own Intermittent Fever, (such as described p. 101)
where we find the Patient after the attack walks,
eats, drinks etc. till the next attack. Can we conclude
then, that if this occurs so regularly, he 
will be able to pursue his avocation, if labouring
under intestinal irritation as the cause of his disease?
And if it depends upon that, Wine etc. so
far from being serviceable, would rather exasperate
the mucous membrane already excited.


109
Seventeenth Lecture June 16 1834
It has been said that dissection gives evidence
of intestinal irritation, & in proof of it, we are told 
that post mortem examinations exhibit a red appearance
of the vessels & a suffusion of the mucous 
surface, but this is no evidence that the inflammation
has taken place, because this same appearance has 
been found in persons who have passed immediately 
from health, to eternity, as in executed
criminals; on this subject see Dr [Yello?die’s] paper
in the Eclectic Repertory, also Seeds’ Experiments 
on Animals, in bleeding them to death in various
ways, & our dissection, redness & [server?] effusion were 
found in them. In concert with Winlen & Gebhard,
Parrish pursued these experiments on hogs etc. & found 
the statements true; they exhibited not only the
red appearance but even red stellated spots.
Dr Davy[illegible] to Dr McGregor of G Britain concluded from some experiments that
he made, that the blood percolated thro’ the vessels
causing the redness of the stomach.
[Illegible] found this by experiment [illegible] at Med. Soc.


110
Lesions of the stomach may sometimes take
Dr [Hewson’s] son died of Hydrocephalus stomach perforated by gastric lesions
place, appearing as if from inflammation or erosion
With this subject it is important for a physician 
to be acquainted, if called upon for legal evidence
Recent trial of [illegible] in Canada gave [illegible] & 2 
in a trial. Referred to the trial of the murderer 
med men pronounced it poison [illegible] 1835
of a Miss [Burns], in one of the Court of Assises.
A post mortem examination of her showed lesions
of the stomach, & even holes in it. The volume is
very interesting, because the trial brought up the
doctrine respecting the gastric juice, whether it 
would produce lesion etc. & a vast number of 
experiments were made. We have no doubt but 
that it will do so, and also destroy the stomach
itself, for in the stomach of a child of Dr Hewsons’s
we find a hole made by the gastric liquor after death.
In a Review of Broussais’ book by Johnston of
London, he extracts a case in which the patient
was starved for 20 days & died. The intestines 
were contracted, & [calibre] much diminished,
showing that the absorbents had been feeding on 
them in order to sustain life.


111
Pressure upon the Epigastrium is by no means
new, or belonging to the Broussais Theory. It 
is an old practice, & one which we showed was
extensively practiced in the time of Yellow Fever.
But we must give a caution to discriminate between  
the feeling of the patient when he flinches
on acct. of inflammation, & when it arises from 
nervous irritability, in which he would do the
same if pressed on any other part of the body
as well as the pit of the stomach.
We are told that serous effusions prove the 
existence of inflammation before death. We 
will admit that this effusion & even dropsy may 
happen, but this is often the consequence of debility.
If we take a patient worm out by disease
with a feeble pulse, a cold, clammy surface, & 
evidently in the last stage of his existence, we find
that the cold sweat of death is upon the 
surface; if this takes place, then, upon the exterior
surface, can we deny that the living membrane


112
of the stomach & bowels may also secrete a 
fluid, & that the absorbents partaking of the general
debility, will not & take it up?
Case of a lad, apprentice of Gall in Front St.
who recd an injury from a fall, causing concussion 
of brain & death. At first, the trephine was
applied, but there was no abatement of the stupor,
the pulsation of the brain was suspended, no reaction 
ensued & he died in a few hours. A post
mortem examination showed a serous effusion 
& in this case, it certainly could not take place 
from excessive action, because there was no reaction 
at all, the patient died without it.
A change of structure by Induration etc. is said
to be an evidence of Inflammation. This may occur
in the progress of disease, for the secretions may continue 
in their natural state, but the lymphatics 
may be unable to remove them & consequently enlargement 
or induration may occur from the lymph 
secreted thus, not being taken up.


113
Engorgement of Veins, commonly called congestion 
is said to be the result of Inflammation 
by Armstrong. But this doctrine is equally 
preposterous with the others. If a man be killed
instanter by the falling of a brick as he
passes, & be examined soon after, the blood veins vessels
will be found engorged; this certainly 
cannot be an effect of inflammation, hence
this subject is scarcely worthy our notice. Let
us look a little farther & ask when is the state 
of the circulation natural? It is when the balance
between the arteries & veins is maintained?
But in death, by the last act of expiring nature,
the blood is pushed out of the arteries, & the
veins consequently possess more than their natural
quantity. This is the dying state, & this is
nothing more than venous congestion.
But we must look rather to the nervous system,
as the primary cause of the mischief, for if there be
less nervous energy, the heart acts with diminished 


114
vigour, & when the nervous power is cut off, the
heart ceases to act not from congestion, but from 
want of nervous energy. This also is proved by 
the effect of cutting off the 8th pair of nerves.
A further evidence that death arises from an 
imperfection of nervous power, is its surgical
operations, when the system sometimes receives 
such a shock, that it never reacts.
These facts are brought forward to show that
medical men are too apt to confine their views 
to one side of the question.
We do not deny that in fevers, inflammation,
congestion etc. may sometimes occur, but we do 
call in question the universality & unity of inflammation.
Dr Isaac Snowden when in the Almshouse, was 
attacked with a fever, which was attended with 
excitement amounting to Phrenitis. Here the
Inflammation was unequivocal, & he required very 
copious bleeding, before he recovered.
DR Ab. Cox of N.Y. appeared to show the same determination, 
& recovered under similar treatment


115
But to suppose that all fevers depend upon 
inflammation, & require rigid starvation, depletion 
etc. is absurd.
The patients of Broussais were literally 
starved to death. The authors of this rigid system,
seem to forget the [absorbents] of the system, for
if no food is given them, they will prey upon 
the universal matter of the system, the most
unwholesome nourishment. Surgeons appear
to understand this, hence when a patient has 
a large tumour to be absorbed, they place him 
on the most rigid diet, in order to render the 
absorbents hungry & active.
The success of Broussais etc. was highly 
lauded in France, but a comparative result
of the cases reported does not prove its merits.
(See Revue Medicale Vol 3. P. 143 for 1824)


Eighteenth Lecture June 19 1834
On the Pulse. The knowledge of this is a very 
important part of medical attainment. Dr Rush
inculcated the necessity of studying the pulse, & said
if he should erect a temple in honour of medicine, 
over its door should be inscribed, “Let no mat enter
here, who does not understand the pulse.”
But let us here ask the question, May not too 
much reliance be placed upon the Pulse abstractly 
considered? We answer in the affirmative & shall 
proceed to show it in the present lecture.
We would first remark upon feeling the pulse.
For this purpose, we generally select the radial artery,
because it is most convenient. We should remember 
however that this artery, sometimes divides,
& while a small branch pursues the usual course, 
the larger branch roles over the lower end of the radius,
& one may be somewhat embarrassed by 
finding no pulsation in the usual place; in such 
cases, turn the finger over on the outside, near the 
end of the radius, & you find, a fine bounding pulse.


117
Another matter worthy of notice, is, when it is
desirable to feel the pulse of children, who have 
been frightened about the Doctor by [improvident] 
threats etc. you cannot approach them & 
lay hold of the arm, but first let the mother or 
nurse rub the leg a little & by degrees, introduce
your hand & feel the Anterior or Posterior Tibial
Artery in the Foot.
In old people, Radial artery may feel like a long tube. Ossified arteries.
The Pulse is very various in different persons.
In some it is slow, in others frequent & very irritable,
& we think may be aptly compared with 
the human passions. We see that some person s
are quickly exited to anger, & easily appeased,
while others are aroused with difficulty, but not 
easily allayed. Just so with the pulse. In some 
it is easily excited, in others, not. Some have
a very strong susceptibility of excitement, while
others have it in a very feeble degree.
We must distinguish between irritability & inflammatory action of System
Frequency of Pulse is increased by the Emotions
of the mind. Case of a young lady, who 


118
was remarkably modest, so that whenever the 
Doctor entered, he found rapid pulse.
Being on one occasion out of town, & she taken
sick, Dr Wood was sent for, & knew the circumstances
respecting her pulse. Another physician was called 
in consultation, who was very much astonished
at the pulse until it was explained by Dr Wood.
Some are excited by very slight causes, & it is
stated of Dr [illegible] of London, who had a very frequent hard
pulse, that one of the gates of the heart had an 
ossified point in it after death producing irritability 
In the Sacred Scriptures it is said that “a 
soft word turneth away wrath.” so mild treatment
may quiet an irritable pulse. Nourishment
will often change its frequency, thus we 
find that in some persons, before dinner, they 
have a frequent pulse, but after dinner, it becomes,
slow, full & natural.
As in some persons, we find a disposition to 
sink under affliction, & in others, none, so in the 



119
pulse, life often appears strong in the arteries 
& blood vessels, while death reigns over other parts 
of the body. Hence Persons may be led into error
by constant efforts to reduce the Pulse. Thus in 
some cases of Phthisis [Pulsuo] we fin a tense 
pulse to the very last, & sometimes even the 
Synocular pulse of Dr Rush in Chronic cases.
Much mischief has often resulted from ignorance
of, or inattention to, this fact. Some 
pulses can never be reduced, & may be compared
to the story of the Gipsy Queen, Meg Merrilies,
whom the Scots endeavoured to make change
her politics by ducking. Every tie she arose to  
the surface, she cried out “Charley yet,” until 
death terminated her powers of utterance. So
the pulse will cry out notwithstanding every 
attempt to reduce it, until it is silent in death.
Case of an old lady, who was attacked with 
an epileptic fit, about 2 miles out of town, & the
Dr was sent for. He soon arrived at the spot, & found 


120
that death was stamped upon her countenance
in legible characters, & tho’ every symptom foretold
that she was then in articulo mortis, yet
she had a violent pulse, which would seem to 
warrant bleeding. Seeing this condition, I sat
down & adopted an advisable plan, when on e
knows not what to do, to call for a mustard
plaster, which takes some time to prepare & 
gives a person time for thinking. The mustard
Plasters were prepared, but she expired before
they were applied. 
Rebecca Dickerson, aged 72, died of Atrophy
of old age in 1821. For some days before her death,
very little food passed her lips, yet in the dying state,
her pulse possessed great force, & her skin much febrile
heat, so that a Chinese Doctor from feeling her 
arm, would have ordered her bled.
Soothing measures will sometimes reduce a pulse,
when vigorous depletion will not. Some persons have 
naturally a tense pulse, & if upon inquiry, their 


121
general health appears good, it will be most
safe to consider it a natural one, & guard strictly 
against mistaking it for a morbid pulse.
Once knew a patient at the Alms House, who 
had been bled, & taken Digitalis freely to reduce
the pulse, but no diminution occurred, showing
clearly that it was natural.
Case also of an old Aunt, who had a very 
strong pulse, when at the same time in good health.
A curious circumstance occurred in 1821;
a member of the class, Chevalier from Geo. 
after hearing this lecture upon Pulse, approached
& requested the Dr to feel his. It was very powerful 
& he stated that he had been subjected to 
rigorous treatment for it in Savannah, confined
to the house for 2 months, bled excessively 
etc., but all to no purpose. He was permitted
to omit the medical treatment & escaped.
He afterwards died of Consumption.
The most distinguished practitioners are sometimes 



122
deceived by the Pulse. Dr Wistar used to 
relate a striking instance which occurred whilst
he was a pupil at Edinburgh. They were engaged
in performing some experiments upon 
animals, & when they were bleeding a dog to 
death, a distinguished practitioner entered the 
room, & upon being asked to feel the pulse of the 
dog, & pronounce whether it was sthenic or asthenic,
he said it was Sthenic, when in reality 
it was the last act of expiring nature.
There are some diseases of great debility, as 
dyspepsia, in which the heart will palpitate
more frequently as the debility increases.
Dr Anderson said that while he was afflicted 
with indigestion, his pulse was so irritable, that
a drink of milk increased its frequency.
Thus we must always remember, that a Palpitation
of the Heart is met with in 
diseases accompanied with extreme debility,
and may be mistaken.


123
Thus much for the deception in a Strong Pulse,
we will now show that mistakes may also be 
made by relying solely upon a weak pulse.
When upon Typhus Fever, we mentioned the 
case of a gentleman p.90 who was attacked with 
hemorrhage from the lungs. His constitution 
was strong, blood florid etc. but his pulse was 
very weak. The hemorrhage was active & not
passive, so much so that it was excited by
drinking warm coffee. In this case, blood 
was taken from the arm with advantages,
showing that we must not rely on pulse
Inflammation of the bowels & peritoneum 
may be attended with a pulse very 
deceptive to the young practitioner. Instead
of relying upon this, we must notice the tenderness
of the stomach. When we find pain & tenderness
upon pressure, (tho’ distinguished from nervous irritability), 
we may expect much internal mischief.
Case of a young lady, afflicted with these 


124
symptoms. Directed her to be bled, but very little, 
on the next visit, finding her still restless, with 
pain etc., but with a low pulse, Dr P. determined
to bleed her himself & see how she would bear it.
She bore it well, appearing much stronger than 
he had expected, at the same time stimulants 
& frictions were used, & under this treatment
she finally recovered.
Another case, wife of a French Merchant, who 
was a patient of Dr [Mongs] but he being ill, P.
was called to see her. He found her with great 
pain in the abdomen, & restlessness,
but with very little pulse. Before taking any decisive
measures, he went & stated the case to Dr M.
who knowing her natural constitution, stated that
it was an inflammatory disease & required the
lancet. From this statement, he returned & bled her,
 several times & she bore it well & recovered
Since the death of Dr M. he has been called in consultation
upon the same person, stated the case, Her 
physician adopted the plan & was successful.


125
In some cases of Opthalmia of a purulent character, 
the pulse must not be a guide for treatment.
Rush says pulse does not quickly sympathise with smaller vessels. that
the “time is not readily [illegible] thro’ smaller branches”
Case in 1818, of a nurse, who had an attack
of this species of Opthalmia. Dr P. was called in 
consultation with the accoucheur, a respectable
practitioner, but unaccustomed to Surgery. He was 
not aware of its true character, & one of her eyes was 
already destroyed, & the other on the High Road to 
Ruin. Experience had shown him that bleeding
was the remedy proper in such cases, & notwithstanding
her pulse was very feeble, the lancet was 
resorted to, & by copious depletion, the eye was saved.
Hence we perceive that however valuable the
pulse may be in estimating the character of disease,
it should be considered only in connexion with 
other symptoms.


126
Nineteenth Lecture June 23 1834
Indigenous Cholera consists in a vomiting
and purging of bilious matter, accompanied
with gripes, spasms & sometimes cramps in the 
limbs & muscles. From being apparently in 
good health, a person will sometimes be suddenly 
attacked, but generally a predisposition exists
for a short time previous. The spasms sometimes
are so very severe, that even a man of strong
nerve & temperament, will have to utter the cry of 
distress in pretty strong language.
In the more advanced stage, sometimes in a few hours, the practitioner 
will be astonished at the extreme prostrations exhibited
in the countenance, & more especially in the 
sunken eyes of the patient, strident voice attended with exhaustion 
feeble pulse, cold clammy sweats
& a desire for cold drink, which, however
is often improper in this disease.
In this disease, “what thous doest, do quickly”
is the maxim we should take four our guide.
IN the commencement of the disease while pain [illegible] & copious bilious discharges the first 



127
indication is a free dilution with mild drinks.
Sydenham recommends, what we consider
an admirable remedy & have employed in very 
numerous instances, simple Chicken Water.
[Illegible] also recommends free dilution
Obtain a chicken as soon as possible, cut it
in pieces, mash the bones; pour on about 1 Gal. 
of Water & boil it a little till it [gives] a little [taste] then it may be salted
a little to be more agreeable. Give it freely 
to the patient, even tho’ it be vomited up again.
Also give at intervals some Herb Tea, as Peppermint
etc. But when pain & vomiting become
very distressing, use also external applications, 
flannel wrung out of Hot Spts. & Pepper, & renewed 
before it is cold. If the extremities be cold,
apply sinapisms, or rub them with warm Spt.
After fomentations have been continued for a 
while, apply the Spice Plaister extensively over 
the abdomen.
When the symptoms are very violent, it may 
be proper to resort to opiates in the early stages, & 


128
Laudanum may be given by the mouth or injection.
This practice, however, is not recommended
if it is possible to do without it. Dr Wistar
was opposed to it & preferred giving small doses
of Spiced Brandy, a teaspoonful every hour till 
the spasms should cease.
A mixture which Cr Parrish has frequently 
employed is Sal Tartar zi
Tinct. Opii gtt LXXX
Aq. Menth. fziv
Give a tablespoonful every hour or two according 
to circumstances.
The Spasms in the Bowels, have by some practitioners
been referred to Inflammation. But this
theory will lead to some sad mistakes in practice.
We may safely say, that we have rarely, if ever,
met with Cholera in any other form, than such 
as was manageable by proper treatment. We do 
not mean, when it has occurred, succeeding other
diseases, but when it has attacked a person at once
who was apparently enjoying good health. And 


129
we may say also, that we never saw a case 
which required the use of the lancet. We do
not believe the lancet is necessary, because 1st
no inflammation exists; if we associate pain 
with infl. it will often lead into error in practice.
Thus for inst. in [retrocedent] gout, where there
is violent pain in the stomach & the patient dies 
in so short a time, that there is no inflammation’
at all. But why may we not suppose that the 
pain is the result of spasm in the muscular fibres
of the intestines? we see these spasms occurring 
in other muscular fibres, & why should they not here?
2d The disease is accompanied with bilious 
evacuations, producing great depletion & prostration, 
why should the physician deplete still more by 
the lancet, & draw off the last remnants of life
instead of cherishing & sustaining it?
The prostration is generally extremely great & hence
while supporting the system by internal means, we 
must also use frictions, sinapisms etc.


130
Here it is necessary to give a caution against
the use of Cold Drinks, for though Nature
generally is remarkably true, yet not always.
Like a child, she sometimes permits inclination
to rule over reason, and if followed in 
this instance will frequently be found to be 
Cold increases spasm Tepid water is [illegible]
a “bad Doctor.” When the patient has a hot,
febrile skin & pulse, it may be proper to allow a 
little cold drink, but in cases of extreme prostration,
with a cold, clammy skin, feeble pulse etc.,
cold drinks should not generally be allowed,
& in these instances, experience has taught that 
stimulants are beneficial, for in proportion as 
the system revives & strengthens, thirst diminishes.
Sometimes we may give small quantities of 
Soda Water, [illegible] Saline Draught, etc. [illegible]
We wish to impress strongly upon the student’s 
mind, the necessity of free dilution, as before
directed, in the early stage of the attack.
If [illegible] prematurely arrested by [illegible] more fever apt to follow.
Sometimes if medical aid be not properly
but sometimes we must make a choice between two evils


131
& seasonably applied, extreme prostration and
death ensue in a very short time Case of 
an old Dr Hang in Lancaster Co. who was attacked
in the privy, fell from his seat, & lay 
till he was carried to the house, where he died.
Also of an Gnelishman, tenant on Dr Parrish
farm at Burlington, a strong, robust fellow,
who was attacked one night while he was
on a visit there from the City, & he was called
to him about day-break, & found him extremely 
cold [illegible] [studulous] voice.
prostrated, so much so that he discharged
his faeces involuntarily; but under
proper treatment, he, in a few days, recovered.
Afte rthe first symptoms of the disease have
passed, it then becomes necessary to prevent
any accumulations of bile in the intestines
& at the same time guard against weakening 
the patient too much. Hence, we see that 
Rhubarb comes in here admirably, & it is 
used in various forms, as the Syr. Rhei Arom


132
Rhubarb combined with Magnesia, or the
following preparation which Dr P. usually orders 
in a family. Take 2 Teaspoonfuls of best Rhubarb 
grated, & 1 Teaspoonful of grated Nutmeg,
& put them in a ½ pt. Tumbler about 2/3 full of boiling
water, little [drop sugar] & of this Tea, give a Tablespoonful 
every 1, 2 or 3 hrs. according to circumstances.
The diet should be plain & nutritious, without
[teas] [illegible] New [illegible]
any [illegible] food, & also give some tonics, as Columbo
& Ginger, Quassia & Ginger, Cascarilla etc.
This treatment is adapted to the common form 
of the disease, but as it may be much diversified,
the treatment also must vary; & in some 
cases, it may even be proper to administer Calr
but it should be in minute doses. [illegible]
There is yet another remedy which is sometimes
of very great advantage, when others fail. It was
applied once in a case resembling Cholera of extreme prostration,
young Naval officer
with cold, clammy sweats, feeble pulse, & the
young man seemed to be influenced by none 


133
of the ordinary remedies, when Dr Physick, being
called in consultation, recommended the 
Spt. Terebinth. 15 drops upon Sugar frequently repeated,
& it had a very happy effect. Recovered
Port Wine also may be used, diluted, & blisters
have a very happy effect when a more
not so much for [illegible] as [illegible] & then they may 
often be removed early
permanent excitement is delivered than Mustard.
Mischief is often done by mistaking the
character of this disease. Dr Wistar used to 
mention a consultation to which he was once 
called by a young practitioner, who had a lady 
under his care, whom he had been treating by 
evacuants etc. Her life seemed to be in great
jeopardy under this treatment, & the few words
which put the physician right in his practice,
so that the woman recovered, were that the 
“Disease was Cholera, not Dysentery.”
Before concluding the lecture, we may remark
that Cholera sometimes appears as a Prophylactic.
This may seem stranger & perhaps induce 


134
a smile, but if we reflect upon it, perhaps we
shall find it true. We know that in the 
Summer Season, there is a strong tendency to 
bilious secretions & consequently to febrile action,
now it would seem as if Cholera was 
an effort of nature to avert impending danger,
by throwing off the bilious accumulations.
Compare this with the operations of art, for we
know that in the commencement of Fevers, the
first thing a practitioner does, is to produce an 
artificial Cholera, by the use of Emetics, Cathartics
etc. & so it is with Nature, though she performs
in a rather mor rough way, & when she
makes the effort, instead of checking her at once,
we should watch her, aid her, & check her 
at a seasonable period.


135
Twentieth Lecture June 26 1834
On Asiatic Cholera. This we consider as especially 
distinct from our Indigenous Cholera, & 
our reasons for this belief will be found in 
the ensuing remarks.
This disease has received various names, such 
as Asiatic, from that quarter of the Globe, in which 
it proved so great a scourge. Spasmodic, from 
the spasms accompanying it, but this is improper 
because our own Cholera might receive the same 
name for the same reason. But we think a 
better term for is Malignant Cholera, because
it is truly malignant in every sense of the word.
This disease, is marked by peculiarities, well]
worthy of notice, in its description.
The first & very important part of the history of 
it is that it is preceded by marked premonitory
symptoms. (refer to a work by Dr Kirk in England)
When this disease prevailed in this City in 1832
we had the premonitory symptoms, sometimes, indeed, 


Dysenteric form here, is less dangerous than the [other]


136
the premonition being very short, only 
a few hours, and at others, several days.
There were 2 forms of these premonitory 
symptoms, Diarrhea or Dysentery, & it seems
as if almost every one you met, complained
of either one or the other of these. Diarrhea]
was most to be dread, & those patients were
most liable to danger, who had naturally 
delicate bowels. A striking instance of this 
was an old French Gentleman, whom Dr P was 
often called to see with the bowel complaint, & he 
had marked him as one to whom the Cholera 
would prove fatal, should it attack him. He 
was a delicate, feeble man, & one day he ate some
green figs that grew in his garden. That night he 
was attacked, Dr P. saw him about day-break,
in 3 or 4 hours, he was dead.
The fact that premonitory symptoms appear,
robs Cholera of many of its terrors; like the rattle
snake, it sounds the warming-note, before it inflicts 
the poisonous wound.





137
The symptoms of a severe attack are, after
the premonitory symptoms, the person is seised 
with vomiting & purging; the discharges from the 
bowels are different from those in Indigenous
Cholera, instead of the Bilious, we have the Rece
water discharges. Of this, however, Dr P. saw 2 exceptions
in which they were bilious. Sometimes
the discharges were as Limpid as Spring Water,
& often involuntary
& run out very fast. These were more dangerous 
than the Rice Water disch. Case in Hospital
in which these limpid discharges passed from 
him by quarts, & life too ran out with equal 
rapidity.
As the disease advanced, great debility ensued
with a cold surface, cold tongue, shrivelled fingers,
livid colour of the hand, sunk countenance
sunk & half-closed eye (which was a very unfavorable
symptom), weak stridulous voice, feeble
pulse, sometimes insatiable thirst, suppression 
of urine, & sometimes, but not always, severe 


Half-closed, everted eye, sure sign of Death


138
cramps and spasms. This state of things ran on 
& the patient was soon reduced to a state of
collapse, which may be described to be an aggravation
and concentration of the former
symptoms, as a cold, clammy sweat, inelastic
skin, complete death like surface & death smell sometimes, generally a
dark-brown, or a blue shrivelled hand, creeping
pulse, total suppression of urine, & sometimes
the sweats were profuse and colliquative,
as was evinced in one awful case brought from a 
Wilmington Packet, who looked as if he had 
been just picked from the Docks as a drowning 
man. Some, on the contrary, have no sweat,
as in an Irishman, who was brought from the 
Rail Road, who sweat none, but was as blue 
as Indigo, all over, & skin cold & dry.
Some were perfectly clear in their intellect, till 
the very last moment of their existence. Dr P. has
read & heard much about congestion in this disease,
but at length, laying aside other books, he determined 


Mistake made in preparation of Apparatus for applying
external heat.
This morbid sensibility sometimes occurs in Malignant
Typhus & Yellow Fever in last stages etc.
The Cases would not bear removal for 
Prostration or “Sinking Spells” immediately come on


139
carefully to study the Book of Nature. He look 
for congestion in the brain, but the clear intellect
showed that it was not there. He then looked
for it in the lungs, but not find it there. It is true
that some had great distress of breathing, but we
shall snow presently that this was not from congestion.
Some had exquisite nervous sensibility, so that
they could not for a moment endure even a mustard
plaster, & this does not look much as if the 
brain was impaired by congestion.
As for the Laborious Respiration, we can readily 
account for it by supposing that altho’ the nervous
system was much excited, yet the morbid
condition of the nerves which supply the lungs,
caused this respiration, for instead of the rattling
noise which we might expect from congestion, we
found the breathing resembled that described in 
the case of the French Experiment Dupuytren etc. upon Horses, of
cutting the 8th Pair of Nerves; the nervous power
being diminished, the patient exerted himself for breath


It was the last effort of expiring Nature


140
Before death, as in Yellow Fever, a train of very 
delusive symptoms occur, which were deceitful.
One case of a man, who was cold & shriveled,
with a feeble pulse, but at length he began to grow 
warmer, his pulse filled, & his color seemed to be 
much improving; but this was only delusive, & the
man instead of recovering, soon died.
There was one thing however which occurred in 
this disease, which we never saw in any other,
& that was the continuance of the spasms after
death. Saw one man in N. [illegible] who at the time of his death, 
held a porter bottle filled with warm water in 
his grasp, & he continued, drawing it about after 
his death, for half an hour.
Another very unpleasant case of muscular exertion 
at the very termination of the disease, was
that of a young practitioner from the country, who 
upon visiting a Hospital, saw one just expiring with 
his mouth open, & being desirous of feeling the cold
tongue, put in his finger, when the mouth suddenly 
closed, like a snapping turtle & lacerated the finger.




141
IN some cases, it happened, as in other diseases,
that there was much confusion of intellect.
An opinion seemed to prevail that every thing
about a body, dead from this disease, was putrid,
& sooner liable to decomposition than other bodies
but such was not the case, & we doubt not many 
have been sent to a premature grave, & buried
alive, from this very fear. Physicians, as a body, 
should discourage premature interment.
The spasms, in the very worst cases were sometimes
slight, in others, violent. Some had very violent 
spasms in the beginning, & these generally were the 
most favourable. They were ushered in with a 
hot skin, active pulse, & slight evacuations. Case 
brought from Ferry with violent spasms, who required 
the use of the Lancet. [recovd] Also, of a Dutchman
from Easton, who came down the river on a raft,
living on green apples, he had violent spasms, so 
that he roared lustily, & had a hot skin & active
pulse [illegible] bore bleeding recovd Saw one case with apoplexy, but not
with a creeping pulse a very powerful pulse. It was a Captain of a ship 


Weak & delicate persons from any cause, & these
subject to bowel affections, were subject to Cholera 


142
he admitted of free bleeding, sinapisms to the stomach 
etc. & the violent symptoms soon passed, in a 
day or two he recovered
There were a few cases who rose from the Collapse
state, sufficiently to have febrile heat & action,
but it was a low, malignant fever, with a foul 
tongue, confused head etc., which soon carried off
the patient. Reaction sometimes took place in 
fever. Case of a man who was much shrivelled etc.
who was placed under the use of mercury by friction.
He appeared evidently convalescing, so that 
Dr Hudson gave a certificate for his admission
into the convalescent Hospital, but soon after he 
was seised with diarrhea, which carried him off.
Among the exciting causes of the disease was,
irregularity of diet. We shall endeavour to show
however, that vegetable diet should not be too rigidly 
restricted, as it was here in 1832
It was at one time considered, that if a man died
of his disease, he must have been intemperate, & so 
dreadful was this state of things, that almost the 


Case produced by Fear. Dr from West ([former] pupil of P.) was sent
to Wheeling to observe disease, saw a patient or two & [illegible]
off, & after riding a few miles, stopped at [List???]
was taken & died.


143
first object, the friends of the deceased had to 
accomplish, was to prove his correct moral character.
It is true that Intemperance subjected persons
to less chance of recovery from that, as well as from 
other diseases, but it was not true, that none 
but the Intemperate were attacked.
Fatigue & over exertion brought on the disease.
A striking example of this in the case of two young Childs.
men, who had both had the disease, but recovered 
Soon after they went across the Del. to see an old
friend whose son had died with the disease, & on returning,
they were compelled to return in a small 
ferry boat, & with a high, rolling surge. They had
to walk a mile or more to their homes, where
they arrived much fatigued. One of them was
attacked, & walked up, right past his Father’s door 
to the Cholera Hospital, which he had been influential 
in establishing in spite of prejudice, & requested 
a bed. Dr P. saw him in about 2 hrs. in a 
complete collapse, & in 5 hrs. he was dead.
The other was attacked & died in a few hours, at home.


144
Distinguishing Symptoms.
Twenty-First Lecture June 30 1834
When speaking of our Indigenous Cholera, we remarked
that it prevailed always in hot weather, & 
that the Fever which occurred in that, was not of 
the malignant type, that the crasis of the blood was
not completely broken down, but that the system 
had sufficient power to react, & generally recover.
But how is it with respect to the Malignant Cholera?
Can we say that this prevails only in hot weather?
No; it spreads without regard to temperature, having
no such limits; it has carried off its thousands in 
the frozen regions of Russia, & in the heat of an equatorial 
sun, alike in Summer & in Winter.
The Fever too, which follows is very malignant, so 
that the patients die in it. As to the secretions,
instead of an increase, we generally find a suspension,
not only in the hepatic system, but also in 
the Kidneys.
The subjects predisposed to Cholera are those whose 
constitutions are broken down or weakened from 
any cause. Scanty & impoverished diet breaks 


Sometimes in Indigenous Cholera, we have the 
secretion of bile much increased, & debility extremely 
great, but the patient has a recuperative
power remaining


145
down the crasis of the blood, as we see evinced 
in the production of scurbutic affections, in 
long voyages, in besieged & reduced cities etc.
“Famine & Pestilence,” saith Scriptures, “go hand
in hand.” Instance of Ireland, a few years since.
Excessive evacuations from any cause tend to 
produce the disease, any irregularity injures the
alimentary canal, & hence we conceive that a 
rigid diet is improper, & we think that vegetables 
were too much excluded in 1832.
The intemperate are ill able to bear an attack
of any disease, because the system is already somewhat 
exhausted, & consequently if attacked by 
cholera, they fall victims. But it is not the Intemperate
alone that suffer so severely, for we know 
that there is not place where so many died in so 
short a space of time as in India, & these, Religion 
prevented them from indulging either in Liquor
or Animal Food. Those with weak and irritable 
bowels were subjected to attacks as we
have already stated.




146
We now come to another part of the subject, & this
we shall commence with a text from Scripture.
“The life of the flesh is in the blood.,” Livit. 17.11 & hence the
question arises. Is it possible to lessen the vitality 
of the blood? We answer in the affirmative & 
according to the old Hunterian Doctrine. We
have already alluded to the state of the blood which 
produces Scurvy; & in our malignant Yellow Fevers, we
have “dissolved Blood,” where the Crasis is broken
down & brings it to that peculiar condition.
Now in this disease, the Crasis is so broken up 
that Disintegration takes place, that Cohesion 
which is necessary for the natural Coaptation of 
the parts is lost, & the serous particles separate from 
the others, so that a patient may bleed almost to 
death by the serous evacuations. We have already 
spoken of the Limpid & Rice Water Discharges, & 
we think they can be readily accounted for upon 
these principles, & at the same time, we may 
bear in mind the colour of the body from those
portions of the blood which remain.


Danger is in proportion to Disease of Blood


147
The danger appeared to be proportional to 
the diseased state of the blood, & we view
a case of recovery from collapse in Cholera, in 
a similar light with a case of recovery from 
Asphyxia by drowning. Now & then in drowned
persons, we may meet with a man “as tough
as a terrapin,” who will recover after he has 
been apparently dead, but in a great majority 
of cases, after they remain under water a 
few minutes, they cannot be resuscitated,
after the blood has once become disintegrated, 
vital action will not ensue. “It is done” & we
cannot mend it. Just so in Cholera, some, (but
they are very few) will revive after collapse,
but in most cases the blood becomes dissolved
& they pass the dreaded boundary.
We next come to the interesting & important
question, what are the best means of prevention?
We may, before going farther, notice the analogy 
between the effects of exertion in this & in the 




148
Malignant Typhus & Malignant Intermittent of which we have before spoken 
So striking was the analogy that some of the 
New England Physicians, who were accustomed
to seeing the spotted Fever said that the Diseases
were of the same family & that in Cholera, the patients
all died in the cold stage.
One of the best methods of prevention is to 
maintain an equable state of the system:
to partake of proper nutrition, & to avoid excesses of 
every kind, keeping the alimentary canal always 
in a proper tone, by using a due proportion of aromatics 
We know that during the summer season, there is 
a peculiar tendency of disease to the bowels; & when 
we look abroad upon Creation & see where every thing
has been placed by an All Wise Providence, we find 
that in hot climates, the aromatics are abundant to 
give tone to the alimentary canal & counteract the
effects of heat. So also in this, we consider it a good 
Prophylactic, to intersperse our food with aromatics,
nor must we push the restriction of vegetables 
too far, as we are convinced was done in 1832.


The Nervous System is injured
Goodwin’s Experiments about Life & Death
& other observations upon Drowning & Hanging etc.


149
Bust most of all, should we protest against
drenching patients with medicines as preventives,
& especially large doses of Calomel, by the teaspoonful
instead of by the grain. Of this we shall
speak more fully in the Treatment.
Among some of the remedies which were 
used, during the excitement & alarm which prevailed,
was the injection of the veins with saline
substances, because it was said that the 
saline & serous portions of the blood run off,
& could be thus renewed. Had it not been 
for the alarm which existed, Anatomy, Physiology,
& Medical Common Sense would all 
have opposed such a course. The very student 
of Physiology would have know, that these substances
thus thrown in without undergoing the
process of assimilation etc. would prove injurious.
Happily, however, for the credit of the 
Profession, the plan was soon abandoned, with 
a full conviction that it was injudicious.



This practice is carried to an unwarrantable extent 
in the Western Country & in many parts of the Land.
but no Sound Medicine principle can justify it.


[His] students do


Elmer
W. Elmer.