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                           MEDICAL INQUIRIES

                                  AND

                             OBSERVATIONS.

                        BY BENJAMIN RUSH, M. D.

         PROFESSOR OF THE INSTITUTES AND PRACTICE OF MEDICINE,
              AND OF CLINICAL PRACTICE, IN THE UNIVERSITY
                            OF PENNSYLVANIA.

                            IN FOUR VOLUMES.

                                VOL. I.

                          THE SECOND EDITION,

                  REVISED AND ENLARGED BY THE AUTHOR.

                             PHILADELPHIA,

   PUBLISHED BY J. CONRAD & CO. CHESNUT-STREET, PHILADELPHIA; M. & J.
CONRAD & CO. MARKET-STREET, BALTIMORE; RAPIN, CONRAD, & CO. WASHINGTON;
   SOMERVELL & CONRAD, PETERSBURG; AND BONSAL, CONRAD, & CO. NORFOLK.

              PRINTED BY T. & G. PALMER, 116, HIGH-STREET.

                                 1805.

                   *       *       *       *       *


                                PREFACE.

In this second edition of the following Medical Inquiries and
Observations, the reader will perceive many additions, some omissions,
and a few alterations.

A number of facts have been added to the Inquiry into the Effects of
Ardent Spirits upon the Body and Mind, and to the Observations upon the
Tetanus, Cynanche Trachealis, and Old Age, in the first volume; also to
the Observations upon Dropsies, Pulmonary Consumption, and Hydrophobia,
contained in the second volume.

The Lectures upon Animal Life, which were published, a few years ago, in
a pamphlet, have received no other additions than a few notes.

The phænomena of fever have not only received a new title, but several
new terms have been adopted in detailing them, chiefly to remove the
mistake into which the use of Dr. Brown's terms had led some of the
author's readers, respecting his principles. A new order has likewise
been given, and some new facts added, to the inquiry upon this subject.

In the Account of the Yellow Fever of 1793, many documents, interesting
to the public at the time of their first publication, are omitted; and
many of the facts and observations, which related to the origin of the
fevers of 1794 and 1797, now form a part of a separate inquiry upon that
subject, in the fourth volume.

The histories of the yellow fever as epidemics, and of its sporadic
cases, have been published in the order in which they have appeared
in Philadelphia, to show the influence of the weather upon it, and
the impropriety and danger of applying the same remedies for the same
epidemic, in different and even successive seasons. The records of
the first cases of yellow fever, which have appeared in each of the
twelve years that have been noticed, are intended further to show the
inefficacy of all the means, at present employed, to prevent its future
recurrence.

In the fourth volume, the reader will find a retraction of the author's
former opinion of the yellow fever's spreading by contagion. He begs
forgiveness of the friends of science and humanity, if the publication
of that opinion has had any influence in increasing the misery and
mortality attendant upon that disease. Indeed, such is the pain he
feels, in recollecting that he ever entertained or propagated it, that
it will long, and perhaps always, deprive him of the pleasure he might
otherwise have derived from a review of his attempts to fulfil the
public duties of his profession.

Considerable additions are made to the facts and arguments in favour
of the domestic origin of the yellow fever, and to the Defence of
Blood-letting.

The Account of the Means of Preventing the Usual Forms of Summer and
Autumnal Disease, appears for the first time in this edition of the
author's Inquiries. Part of the facts intended to prove the yellow fever
not to be contagious, were published in the sixth volume of the New-York
Medical Repository. The reader will perceive, among many additions
to them, answers to all the arguments usually employed to defend the
contrary opinion.

The Inquiry into the Comparative State of Medicine, in Philadelphia,
between the years 1760 and 1766, and 1805, was delivered, in the form of
an oration, before the Medical Society of Philadelphia, on the 18th of
February, 1804. Some things have been omitted, and a few added, in the
form in which it is now offered to the public.

If this edition of Medical Inquiries and Observations should be less
imperfect than the former, the reader is requested to ascribe it to
the author having profited by the objections he encouraged his pupils
to make to his principles, in their inaugural dissertations, and in
conversation; and to the many useful facts which have been communicated
to him by his medical brethren, whose names have been mentioned in the
course of the work.

For the departure, in the modes of practice adopted or recommended in
these Inquiries, from those which time and experience have sanctioned,
in European and in East and West-Indian countries, the author makes the
same defence of himself, that Dr. Baglivi made, near a century ago, of
his modes of practice in Rome. "_Vivo et scribo in aere Romano_," said
that illustrious physician. The author has lived and written in the
climate of Pennsylvania, and in the city of Philadelphia.

    _November 18th, 1805._

                   *       *       *       *       *


                         CONTENTS OF VOLUME I.

                                                                   _page_

  _An inquiry into the natural history of medicine among the
  Indians of North-America, and a comparative view of their
  diseases and remedies with those of civilized nations_               1

  _An account of the climate of Pennsylvania, and its influence
  upon the human body_                                                69

  _An account of the bilious remitting fever, as it appeared in
  Philadelphia in the summer and autumn of the year 1780_            115

  _An account of the scarlatina anginosa, as it appeared in
  Philadelphia in the years 1783 and 1784_                           135

  _An inquiry into the cause and cure of the cholera infantum_       153

  _Observations on the cynanche trachealis_                          167

  _An account of the efficacy of blisters and bleeding, in the cure
  of obstinate intermitting fevers_                                  177

  _An account of the disease occasioned by drinking cold water in
  warm weather, and the method of curing it_                         181

  _An account of the efficacy of common salt in the cure of
  hæmoptysis_                                                        189

  _Thoughts on the cause and cure of pulmonary
  consumption_                                                       197

  _Observations upon worms in the alimentary canal, and upon
  anthelmintic medicines_                                            215

  _An account of the external use of arsenic in the cure of
  cancers_                                                           235

  _Observations on the tetanus_                                      245

  _The result of observations made upon the diseases which occurred
  in the military hospitals of the United States, during the
  revolutionary war_                                                 267

  _An account of the influence of the military and political events
  of the American revolution upon the human body_                    277

  _An inquiry into the relation of tastes and aliments to each
  other, and into the influence of this relation upon health and
  pleasure_                                                          295

  _The new method of inoculating for the small-pox_                  309

  _An inquiry into the effects of ardent spirits upon the human
  body and mind, with an account of the means of preventing, and
  the remedies for curing them_                                      335

  _Observations on the duties of a physician, and the methods of
  improving medicine; accommodated to the present state of society
  and manners in the United States_                                  385

  _An inquiry into the causes and cure of sore legs_                 401

  _An account of the state of the body and mind in old age, with
  observations on its diseases, and their remedies_                  425

                 *       *       *       *       *




                            AN INQUIRY

                             INTO THE

                   _NATURAL HISTORY OF MEDICINE_

                             AMONG THE

                     INDIANS OF NORTH-AMERICA;

                               AND A

                         COMPARATIVE VIEW

                             OF THEIR

                DISEASES AND REMEDIES WITH THOSE OF
                        CIVILIZED NATIONS.

      Read before the AMERICAN PHILOSOPHICAL SOCIETY, held at
            PHILADELPHIA, on the 4th of February, 1774.


    GENTLEMEN[1],

I rise with peculiar diffidence to address you upon this occasion,
when I reflect upon the entertainment you proposed to yourselves from
the eloquence of that learned member, Mr. CHARLES THOMPSON, whom your
suffrages appointed to this honour after the delivery of the last
anniversary oration. Unhappily for the interests of science, his want
of health has not permitted him to comply with your appointment. I beg,
therefore, that you would forget, for a while, the abilities necessary
to execute this task with propriety, and listen with candour to the
efforts of a member, whose attachment to the society was the only
qualification that entitled him to the honour of your choice.

  [1] This INQUIRY was the subject of an Anniversary Oration. The style
      of an oration is therefore preserved in many parts of it.

The subject I have chosen for this evening's entertainment, is "An
inquiry into the natural history of medicine among the Indians in
North-America, and a comparative view of their diseases and remedies,
with those of civilized nations." You will readily anticipate the
difficulty of doing justice to this subject. How shall we distinguish
between the original diseases of the Indians and those contracted from
their intercourse with the Europeans? By what arts shall we persuade
them to discover their remedies? And lastly, how shall we come at the
knowledge of facts in that cloud of errors, in which the credulity
of the Europeans, and the superstition of the Indians, have involved
both their diseases and remedies? These difficulties serve to increase
the importance of our subject. If I should not be able to solve them,
perhaps I may lead the way to more successful endeavours for that
purpose.

I shall first limit the tribes of Indians who are to be the objects of
this inquiry, to those who inhabit that part of North-America which
extends from the 30th to the 60th degree of latitude. When we exclude
the Esquimaux, who inhabit the shores of Hudson's bay, we shall find a
general resemblance in the colour, manners, and state of society, among
all the tribes of Indians who inhabit the extensive tract of country
above-mentioned.

Civilians have divided nations into savage, barbarous, and civilized.
The savage live by fishing and hunting; the barbarous, by pasturage or
cattle; and the civilized, by agriculture. Each of these is connected
together in such a manner, that the whole appear to form different parts
of a circle. Even the manners of the most civilized nations partake of
those of the savage. It would seem as if liberty and indolence were
the highest pursuits of man; and these are enjoyed in their greatest
perfection by savages, or in the practice of customs which resemble
those of savages.

The Indians of North-America partake chiefly of the manner of savages.
In the earliest accounts we have of them, we find them cultivating a
spot of ground. The maize is an original grain among them. The different
dishes of it which are in use among the white people still retain Indian
names.

It will be unnecessary to show that the Indians live in a state of
society adapted to all the exigencies of their mode of life. Those who
look for the simplicity and perfection of the state of nature, must
seek it in systems, as absurd in philosophy, as they are delightful in
poetry.

Before we attempt to ascertain the number or history of the diseases of
the Indians, it will be necessary to inquire into those customs among
them which we know influence diseases. For this purpose I shall,

First, Mention a few facts which relate to the birth and treatment of
their children.

Secondly, I shall speak of their diet.

Thirdly, Of the customs which are peculiar to the sexes, and,

Fourthly, Of those customs which are common to them both[2].

  [2] Many of the facts contained in the Natural History of Medicine
      among the Indians in this Inquiry, are taken from La Hontan and
      Charlevoix's histories of Canada; but the most material of them
      are taken from persons who had lived or travelled among the
      Indians. The author acknowledges himself indebted in a particular
      manner to Mr. Edward Hand, surgeon in the 18th regiment,
      afterwards brigadier-general in the army of the United States,
      who, during several years' residence at Fort Pitt, directed his
      inquiries into their customs, diseases, and remedies, with a
      success that does equal honour to his ingenuity and diligence.

I. Of the birth and treatment of their children.

Much of the future health of the body depends upon its original stamina.
A child born of healthy parents always brings into the world a system
formed by nature to resist the causes of diseases. The treatment of
children among the Indians, tends to secure this hereditary firmness of
constitution. Their first food is their mother's milk. To harden them
against the action of heat and cold (the natural enemies of health and
life among the Indians) they are plunged every day into cold water. In
order to facilitate their being moved from place to place, and at the
same time to preserve their shape, they are tied to a board, where they
lie on their backs for six, ten, or eighteen months. A child generally
sucks its mother till it is two years old, and sometimes longer. It is
easy to conceive how much vigour their bodies must acquire from this
simple, but wholesome nourishment. The appetite we sometimes observe in
children for flesh is altogether artificial. The peculiar irritability
of the system in infancy forbids stimulating aliment of all kinds.
Nature never calls for animal food till she has provided the child with
those teeth which are necessary to divide it. I shall not undertake
to determine how far the wholesome quality of the mother's milk is
increased by her refusing the embraces of her husband, during the time
of giving suck.

II. The diet of the Indians is of a mixed nature, being partly animal
and partly vegetable. Their animals are wild, and therefore easy of
digestion. As the Indians are naturally more disposed to the indolent
employment of fishing than hunting, in summer, so we find them living
more upon fish than land animals, in that season of the year.--Their
vegetables consist of roots and fruits, mild in themselves, or capable
of being made so by the action of fire. Although the interior parts
of our continent abound with salt springs, yet I cannot find that the
Indians used salt in their diet, till they were instructed to do so by
the Europeans. The small quantity of fixed alkali contained in the ashes
on which they roasted their meat, could not add much to its stimulating
quality. They preserve their meat from putrefaction, by cutting it into
small pieces, and exposing it in summer to the sun, and in winter to
the frost. In the one case its moisture is dissipated, and in the other
so frozen, that it cannot undergo the putrefactive process. In dressing
their meat, they are careful to preserve its juices. They generally
prefer it in the form of soups. Hence we find, that among them the use
of the spoon, preceded that of the knife and fork. They take the same
pains to preserve the juice of their meat when they roast it, by turning
it often. The efficacy of this animal juice, in dissolving meat in the
stomach, has not been equalled by any of those sauces or liquors which
modern luxury has mixed with it for that purpose.

The Indians have no set time for eating, but obey the gentle appetites
of nature as often as they are called by them. After whole days spent
in the chace or in war, they often commit those excesses in eating, to
which long abstinence cannot fail of prompting them. It is common to
see them spend three or four hours in satisfying their hunger. This is
occasioned not more by the quantity they eat, than by the pains they
take in masticating it. They carefully avoid drinking water in their
marches, from an opinion that it lessens their ability to bear fatigue.

III. We now come to speak of those customs which are peculiar to the
sexes. And, first, of those which belong to the WOMEN. They are doomed
by their husbands to such domestic labour as gives a firmness to their
bodies, bordering upon the masculine. Their menses seldom begin to
flow before they are eighteen or twenty years of age, and generally
cease before they are forty. They have them in small quantities, but at
regular intervals. They seldom marry till they are about twenty. The
constitution has now acquired a vigour, which enables it the better to
support the convulsions of child-bearing. This custom likewise guards
against a premature old age. Doctor Bancroft ascribes the haggard looks,
the loose hanging breasts, and the prominent bellies of the Indian
women at Guiana, entirely to their bearing children too early[3]. Where
marriages are unfruitful (which is seldom the case) a separation is
obtained by means of an easy divorce; so that they are unacquainted
with the disquietudes which sometimes arise from barrenness. During
pregnancy, the women are exempted from the more laborious parts of their
duty: hence miscarriages rarely happen among them. Nature is their only
midwife. Their labours are short, and accompanied with little pain. Each
woman is delivered in a private cabin, without so much as one of her
own sex to attend her. After washing herself in cold water, she returns
in a few days to her usual employments; so that she knows nothing of
those accidents which proceed from the carelessness or ill management
of midwives; or those weaknesses which arise from a month's confinement
in a warm room. It is remarkable that there is hardly a period in the
interval between the eruption and the ceasing of the menses, in which
they are not pregnant, or giving suck. This is the most natural state
of the constitution during that interval; and hence we often find it
connected with the best state of health, in the women of civilized
nations.

  [3] Natural History of Guiana.

The customs peculiar to the Indian MEN, consist chiefly in those
employments which are necessary to preserve animal life, and to defend
their nation. These employments are hunting and war, each of which
is conducted in a manner that tends to call forth every fibre into
exercise, and to ensure them the possession of the utmost possible
health. In times of plenty and peace, we see them sometimes rising from
their beloved indolence, and shaking off its influence by the salutary
exercises of dancing and swimming. The Indian men seldom marry before
they are thirty years of age: they no doubt derive considerable vigour
from this custom; for while they are secured by it from the enervating
effects of the premature dalliance of love, they may insure more certain
fruitfulness to their wives, and entail more certain health upon
their children. Tacitus describes the same custom among the Germans,
and attributes to it the same good effects. "Sera juvenum venus, eoque
inexhausta pubertas; nec virgines festinantur; eadem juventa, similis
proceritas, pares validique miscentur; ac robora parentum liberi
referunt[4]."

  [4] Cæsar, in his history of the Gallic war, gives the same account
      of the ancient Germans. His words are "Qui diutissimi impuberes
      permanserunt, maximam inter suos ferunt laudem: hoc ali staturam,
      ali vires, nervasque confirmari putant." Lib. vi. xxi.

Among the Indian men, it is deemed a mark of heroism to bear the most
exquisite pain without complaining; upon this account they early inure
themselves to burning part of their bodies with fire, or cutting them
with sharp instruments. No young man can be admitted to the honours of
manhood or war, who has not acquitted himself well in these trials of
patience and fortitude. It is easy to conceive how much this contributes
to give a tone to the nervous system, which renders it less subject to
the occasional causes of diseases.

IV. We come now to speak of those customs which are common to both
sexes: these are PAINTING, and the use of the COLD BATH. The practice
of anointing the body with oil is common to the savages of all
countries; in warm climates it is said to promote longevity, by checking
excessive perspiration. The Indians generally use bear's grease mixed
with a clay, which bears the greatest resemblance to the colour of their
skins. This pigment serves to lessen the sensibility of the extremities
of the nerves; it moreover fortifies them against the action of those
exhalations, which we shall mention hereafter, as a considerable source
of their diseases. The COLD BATH likewise fortifies the body, and
renders it less subject to those diseases which arise from the extremes
and vicissitudes of heat and cold. We shall speak hereafter of the
Indian manner of using it.

It is a practice among the Indians never to drink before dinner, when
they work or travel. Experience teaches, that filling the stomach with
cold water in the forenoon, weakens the appetite, and makes the system
more sensible of heat and fatigue.

The state of society among the Indians excludes the influence of most of
those passions which disorder the body. The turbulent effects of anger
are concealed in deep and lasting resentments. Envy and ambition are
excluded by their equality of power and property. Nor is it necessary
that the perfections of the whole sex should be ascribed to one, to
induce them to marry. "The weakness of love (says Dr. Adam Smith) which
is so much indulged in ages of humanity and politeness, is regarded
among savages as the most unpardonable effeminacy. A young man would
think himself disgraced for ever, if he showed the least preference
of one woman above another, or did not express the most complete
indifference, both about the time when, and the person to whom, he was
to be married[5]." Thus are they exempted from those violent or lasting
diseases, which accompany the several stages of such passions in both
sexes among civilized nations.

  [5] Theory of Moral Sentiments.

It is remarkable that there are no deformed Indians. Some have
suspected, from this circumstance, that they put their deformed children
to death; but nature here acts the part of an unnatural mother. The
severity of the Indian manners destroy them[6].

  [6] Since the intercourse of the white people with the Indians, we find
      some of them deformed in their limbs. This deformity, upon
      inquiry, appears to be produced by those accidents, quarrels, &c.
      which have been introduced among them by spiritous liquors.

From a review of the customs of the Indians, we need not be surprised at
the stateliness, regularity of features, and dignity of aspect by which
they are characterized. Where we observe these among ourselves, there
is always a presumption of their being accompanied with health, and a
strong constitution. The circulation of the blood is more languid in the
Indians, than in persons who are in the constant exercise of the habits
of civilized life. Out of eight Indian men whose pulses I once examined
at the wrists, I did not meet with one in whom the artery beat more than
sixty strokes in a minute.

The marks of old age appear more early among Indian, than among
civilized nations.

Having finished our inquiry into the physical customs of the Indians, we
shall now proceed to inquire into their diseases.

A celebrated professor of anatomy has asserted, that we could not tell,
by reasoning _à priori_, that the body was mortal, so intimately woven
with its texture are the principles of life. Lord Bacon declares, that
the only cause of death which is natural to man, is that from old
age; and complains of the imperfection of physic, in not being able
to guard the principle of life, until the whole of the oil that feeds
it is consumed. We cannot as yet admit this proposition of our noble
philosopher. In the inventory of the grave in every country, we find
more of the spoils of youth and manhood than of age. This must be
attributed to moral as well as physical causes.

We need only recollect the custom among the Indians, of sleeping in the
open air in a variable climate; the alternate action of heat and cold
upon their bodies, to which the warmth of their cabins exposes them;
their long marches; their excessive exercise; their intemperance in
eating, to which their long fasting and their public feasts naturally
prompt them; and, lastly, the vicinity of their habitations to the banks
of rivers, in order to discover the empire of diseases among them in
every stage of their lives. They have in vain attempted to elude the
general laws of mortality, while their mode of life subjects them to
these remote, but certain causes of diseases.

From what we know of the action of these powers upon the human body,
it will hardly be necessary to appeal to facts to determine that
FEVERS constitute the only diseases among the Indians. These fevers
are occasioned by the insensible qualities of the air. Those which
are produced by cold and heat are of the inflammatory kind, such as
pleurisies, peripneumonies, and rheumatisms. Those which are produced
by the insensible qualities of the air, or by putrid exhalations, are
intermitting, remitting, inflammatory, and malignant, according as the
exhalations are combined with more or less heat or cold. The DYSENTERY
(which is an Indian disease) comes under the class of fevers. It appears
to be the febris introversa of Dr. Sydenham.

The Indians are subject to ANIMAL and VEGETABLE POISONS. The effects of
these upon the body, are in some degree analogous to the exhalations we
have mentioned. When they do not bring on sudden death, they produce,
according to their force, either a common inflammatory, or a malignant
fever.

The SMALL POX and the VENEREAL DISEASE were communicated to the Indians
of North-America by the Europeans. Nor can I find that they were ever
subject to the SCURVY. Whether this was obviated by their method
of preserving their flesh, or by their mixing it at all times with
vegetables, I shall not undertake to determine. Their peculiar customs
and manners seem to have exempted them from this, as well as from the
common diseases of the skin.

I have heard of two or three cases of the GOUT among the Indians, but
it was only among those who had learned the use of rum from the white
people. A question naturally occurs here, and that is, why does not the
gout appear more frequently among that class of people, who consume the
greatest quantity of rum among ourselves? To this I answer, that the
effects of this liquor upon those enfeebled people, are too sudden and
violent, to admit of their being thrown upon the extremities; as we know
them to be among the Indians. They appear only in visceral obstructions,
and a complicated train of chronic diseases. Thus putrid miasmata
are sometimes too strong to bring on a fever, but produce instant
debility and death. The gout is seldom heard of in Russia, Denmark, or
Poland. Is this occasioned by the vigour of constitution peculiar to
the inhabitants of those northern countries? or is it caused by their
excessive use of spirituous liquors, which produce the same chronic
complaints among them, which we said were common among the lower class
of people in this country? The similarity of their diseases makes the
last of these suppositions the most probable. The effects of wine, like
tyranny in a well formed government, are felt first in the extremities;
while spirits, like a bold invader, seize at once upon the vitals of the
constitution.

After much inquiry, I have not been able to find a single instance of
FATUITY among the Indians, and but few instances of MELANCHOLY and
MADNESS; nor can I find any accounts of diseases from WORMS among them.
Worms are common to most animals; they produce diseases only in weak,
or increase them in strong constitutions[7]. Hence they have no place
in the nosological systems of physic. Nor is DENTITION accompanied by
disease among the Indians. The facility with which the healthy children
of healthy parents cut their teeth among civilized nations, gives us
reason to conclude that the Indian children never suffer from this
quarter.

  [7] Indian children are not exempted from worms. It is common with the
      Indians, when a fever in their children is ascribed by the white
      people to worms (from their being discharged occasionally in their
      stools), to say, "the fever makes the worms come, and not the
      worms the fever."

The Indians appear moreover to be strangers to diseases and pains in the
teeth.

The employments of the Indians subject them to many accidents; hence we
sometimes read of WOUNDS, FRACTURES, and LUXATIONS among them.

Having thus pointed out the natural diseases of the Indians, and shown
what diseases are foreign to them, we may venture to conclude, that
FEVERS, OLD AGE, CASUALTIES, and WAR are the only natural outlets
of human life. War is nothing but a disease; it is founded in the
imperfection of political bodies, just as fevers are founded on the
weakness of the animal body. Providence in these diseases seems to act
like a mild legislature, which mitigates the severity of death, by
inflicting it in a manner the least painful, upon the whole, to the
patient and the survivors.

Let us now inquire into the REMEDIES of the Indians. These, like
their diseases, are simple, and few in number. Among the first of
them we shall mention the POWERS OF NATURE. Fevers, we said formerly,
constituted the chief of the diseases among the Indians; they are
likewise, in the hands of nature, the principal instruments to remove
the evils which threaten her dissolution; but the event of these efforts
of nature, no doubt, soon convinced the Indians of the danger of
trusting her in all cases; and hence, in the earliest accounts we have
of their manners, we read of persons who were intrusted with the office
of physicians.

It will be difficult to find out the exact order in which the Indian
remedies were suggested by nature or discovered by art; nor will it be
easy to arrange them in proper order. I shall, however, attempt it, by
reducing them to NATURAL and ARTIFICIAL.

To the class of NATURAL REMEDIES belongs the Indian practice of
abstracting from their patients all kinds of stimulating aliment. The
compliance of the Indians with the dictates of nature, in the early
stage of a disease, no doubt, prevents, in many cases, their being
obliged to use any other remedy. They follow nature still closer, in
allowing their patients to drink plentifully of cold water; this being
the only liquor a patient calls for in a fever.

Sweating is likewise a natural remedy. It was probably suggested by
observing fevers to be terminated by it. I shall not inquire how far
these sweats are essential to the crisis of a fever. The Indian mode of
procuring this evacuation is as follows: the patient is confined in
a close tent, or wigwam, over a hole in the earth, in which a red hot
stone is placed; a quantity of water is thrown upon this stone, which
instantly involves the patient in a cloud of vapour and sweat; in this
situation he rushes out, and plunges himself into a river, from whence
he retires to his bed. If the remedy has been used with success, he
rises from his bed in four and twenty hours, perfectly recovered from
his indisposition. This remedy is used not only to cure fevers, but
remove that uneasiness which arises from fatigue of body.

A third natural remedy among the Indians, is PURGING. The fruits of the
earth, the flesh of birds, and other animals feeding upon particular
vegetables, and, above all, the spontaneous efforts of nature, early led
the Indians to perceive the necessity and advantages of this evacuation.

VOMITS constitute their fourth natural remedy. They were probably, like
the former, suggested by nature, and accident. The ipecacuanha is one of
the many roots they employ for that purpose.

The ARTIFICIAL REMEDIES made use of by the Indians, are BLEEDING,
CAUSTICS, and ASTRINGENT medicines. They confine bleeding entirely to
the part affected. To know that opening a vein in the arm, or foot,
would relieve a pain in the head or side, supposes some knowledge of the
animal economy, and therefore marks an advanced period in the history of
medicine.

Sharp stones and thorns are the instruments they use to procure a
discharge of blood.

We have an account of the Indians using something like a POTENTIAL
CAUSTIC, in obstinate pains. It consists of a piece of rotten wood
called _punk_, which they place upon the part affected, and afterwards
set it on fire: the fire gradually consumes the wood, and its ashes burn
a hole in the flesh.

The undue efforts of nature, in those fevers which are connected with
a diarrh[oe]a, or dysentery, together with those hemorrhages to which
their mode of life exposed them, necessarily led them to an early
discovery of some ASTRINGENT VEGETABLES. I am uncertain whether the
Indians rely upon astringent, or any other vegetables, for the cure of
the intermitting fever. This disease among them probably requires no
other remedies than the cold bath, or cold air. Its greater obstinacy,
as well as frequency, among ourselves, must be sought for in the
greater feebleness of our constitutions, and in that change which our
country has undergone, from meadows, mill-dams, and the cutting down
of woods; whereby morbid exhalations have been multiplied, and their
passage rendered more free, through every part of country.

This is a short account of the remedies of the Indians. If they are
simple, they are like their eloquence, full of strength; if they are few
in number, they are accommodated, as their languages are to their ideas,
to the whole of their diseases.

We said, formerly, that the Indians were subject to ACCIDENTS, such as
wounds, fractures, and the like. In these cases, nature performs the
office of a surgeon. We may judge of her qualifications for this office,
by observing the marks of wounds and fractures, which are sometimes
discovered on wild animals. But further, what is the practice of our
modern surgeons in these cases? Is it not to lay aside plasters and
ointments, and trust the whole to nature? Those ulcers which require the
assistance of mercury, bark, and a particular regimen are unknown to the
Indians.

The HEMORRHAGES which sometimes follow their wounds, are restrained
by plunging themselves into cold water, and thereby producing a
constriction upon the bleeding vessels.

Their practice of attempting to recover DROWNED PEOPLE, is irrational
and unsuccessful. It consists in suspending the patient by the heels, in
order that the water may flow from his mouth. This practice is founded
on a belief that the patient dies from swallowing an excessive quantity
of water. But modern observations teach us that drowned people die from
another cause. This discovery has suggested a method of cure, directly
opposite to that in use among the Indians; and has shown us that the
practice of suspending by the heels is hurtful.

I do not find that the Indians ever suffer in their limbs from the
action of COLD upon them. Their mokasons[8], by allowing their feet to
move freely, and thereby promoting the circulation of the blood, defend
their lower extremities in the day-time, and their practice of sleeping
with their feet near a fire, defends them from the morbid effects of
cold at night. In those cases where the motion of their feet in their
mokasons is not sufficient to keep them warm, they break the ice, and
restore their warmth by exposing them for a short time to the action of
cold water[9].

  [8] Indian shoes.

  [9] It was remarked in Canada, in the winter of the year 1759, during
      the war before last, that none of those soldiers who wore mokasons
      were frost-bitten, while few of those escaped that were much
      exposed to the cold who wore shoes.

We have heard much of their specific antidotes to the VENEREAL DISEASE.
In the accounts of these anti-venereal medicines, some abatement should
be made for that love of the marvellous, and of novelty, which are
apt to creep into the writings of travellers and physicians. How many
medicines which were once thought infallible in this disease, are now
rejected from the materia medica! I have found upon inquiry that the
Indians always assist their medicines in this disease, by a regimen
which promotes perspiration. Should we allow that mercury acts as a
specific in destroying this disease, it does not follow that it is proof
against the efficacy of medicines which act more mechanically upon the
body[10].

  [10] I cannot help suspecting the anti-venereal qualities of the
       lobelia, ceanothus and ranunculus, spoken of by Mr. Kalm, in the
       Memoirs of the Swedish Academy. Mr. Hand informed me, that the
       Indians rely chiefly upon a plentiful use of the decoctions of
       the pine-trees for the cure of the venereal disease. He added,
       moreover, that he had often known this disease prove fatal to
       them.

There cannot be a stronger mark of the imperfect state of knowledge in
medicine among the Indians, than their method of treating the SMALL-POX.
We are told that they plunge themselves in cold water in the beginning
of the disease, and that it often proves fatal to them.

Travellers speak in high terms of the Indian ANTIDOTES TO POISONS. We
must remember that many things have been thought poisonous, which later
experience hath proved to possess no unwholesome quality. Moreover,
the uncertainty and variety in the operation of poisons, renders it
extremely difficult to fix the certainty of the antidotes to them. How
many specifics have derived their credit for preventing the hydrophobia,
from persons being wounded by animals, who were not in a situation to
produce that disease! If we may judge of all the Indian antidotes to
poisons, by those which have fallen into our hands, we have little
reason to ascribe much to them in any cases whatever.

I have heard of their performing several remarkable cures upon STIFF
JOINTS, by an infusion of certain herbs in water. The mixture of
several herbs together in this infusion calls in question the specific
efficacy of each of them. I cannot help attributing the whole success
of this remedy to the great heat of the water in which the herbs were
boiled, and to its being applied for a long time to the part affected.
We find the same medicine to vary frequently in its success, according
to its strength, or to the continuance of its application. De Haen
attributes the good effects of electricity, entirely to its being used
for several months.

I have met with one case upon record of their aiding nature in
PARTURITION. Captain Carver gives us an account of an Indian woman in a
difficult labour, being suddenly delivered in consequence of a general
convulsion induced upon her system, by stopping, for a short time, her
mouth and nose, so as to obstruct her breathing.

We are sometimes amused with accounts of Indian remedies for the DROPSY,
EPILEPSY, COLIC, GRAVEL, and GOUT. If, with all the advantages which
modern physicians derive from their knowledge in anatomy, chemistry,
botany, and philosophy; if, with the benefit of discoveries communicated
from abroad, as well as handed down from our ancestors, by more certain
methods than tradition, we are still ignorant of certain remedies for
these diseases; what can we expect from the Indians; who are not only
deprived of these advantages, but want our chief motive, the sense of
the pain and danger of those diseases, to prompt them to seek for such
remedies to relieve them? There cannot be a stronger proof of their
ignorance of proper remedies for new or difficult diseases, than their
having recourse to enchantment. But to be more particular; I have taken
pains to inquire into the success of some of these Indian specifics,
and have never heard of one well attested case of their efficacy. I
believe they derive all their credit from our being ignorant of their
composition. The influence of secrecy is well known in establishing
the credit of a medicine. The sal seignette was supposed to be an
infallible medicine for the intermitting fever, while the manufactory of
it was confined to an apothecary at Rochelle; but it lost its virtues
as soon as it was found to be composed of the acid of tartar and the
fossil alkali. Dr. Ward's famous pill and drop ceased to do wonders in
scrophulous cases, as soon as he bequeathed to the world his receipts
for making them.

I foresee an objection to what has been said concerning the remedies of
the Indians, drawn from that knowledge which experience gives to a mind
intent upon one subject. We have heard much of the perfection of their
senses of seeing and hearing. An Indian, we are told, will discover
not only a particular tribe of Indians by their footsteps, but the
distance of time in which they were made. In those branches of knowledge
which relate to hunting and war, the Indians have acquired a degree of
perfection that has not been equalled by civilized nations. But we must
remember, that medicine among them does not possess the like advantages
with the arts of war and hunting, of being the _chief_ object of their
attention. The physician and the warrior are united in one character;
to render him as able in the former as he is in the latter profession,
would require an entire abstraction from every other employment, and
a familiarity with external objects, which are incompatible with the
wandering life of savages.

Thus have we finished our inquiry into the diseases and remedies of the
Indians in North-America. We come now to inquire into the diseases and
remedies of civilized nations.

Nations differ in their degrees of civilization. We shall select one
for the subject of our inquiries which is most familiar to us; I mean
the British nation. Here we behold subordination and classes of mankind
established by government, commerce, manufactures, and certain customs
common to most of the civilized nations of Europe. We shall trace the
origin of their diseases through their customs, in the same manner as we
did those of the Indians.

I. It will be sufficient to name the degrees of heat, the improper
aliment, the tight dresses, and the premature studies children are
exposed to, in order to show the ample scope for diseases, which is
added to the original defect of stamina they derive from their ancestors.

II. Civilization rises in its demands upon the health of women. Their
fashions; their dress and diet; their eager pursuits and ardent
enjoyment of pleasure; their indolence and undue evacuations in
pregnancy; their cordials, hot regimen, and neglect, or use of art, in
child-birth, are all so many inlets to disease.

Humanity would fain be silent, while philosophy calls upon us to mention
the effects of interested marriages, and of disappointments in love,
increased by that concealment which the tyranny of custom has imposed
upon the sex[11]. Each of these exaggerates the natural, and increases
the number of artificial diseases among women.

  [11] "Married women are more healthy and long-lived than single women.
       The registers, examined by Mr. Muret, confirm this observation;
       and show particularly, that of equal numbers of single and
       married women between fifteen and twenty-five years of age, more
       of the former died than of the latter, in the proportion of two
       to one: the consequence, therefore, of following nature must be
       favourable to health among the female sex." Supplement to Price's
       Observations on Reversionary Payments. p. 357.

III. The diseases introduced by civilization extend themselves through
every class and profession among men. How fatal are the effects of
idleness and intemperance among the rich, and of hard labour and penury
among the poor! What pallid looks are contracted by the votaries of
science from hanging over the "sickly taper!" How many diseases are
entailed upon manufacturers, by the materials in which they work, and
the posture of their bodies! What monkish diseases do we observe from
monkish continence and monkish vices! We pass over the increase of
accidents from building, sailing, riding, and the like. War, as if too
slow in destroying the human species, calls in a train of diseases
peculiar to civilized nations. What havoc have the corruption and
monopoly of provisions, a damp soil, and an unwholesome sky, made, in
a few days, in an army! The achievements of British valour, at the
Havannah, in the last war, were obtained at the expence of 9,000 men,
7,000 of whom perished with the West-India fever[12]. Even our modern
discoveries in geography, by extending the empire of commerce, have
likewise extended the empire of diseases. What desolation have the East
and West-Indies made of British subjects! It has been found, upon a nice
calculation, than only ten of a hundred Europeans, live above seven
years after they arrive in the island of Jamaica.

  [12] The modern writers upon the diseases of armies, wonder that the
       Greek and Roman physicians have left us nothing upon that
       subject. But may not _most_ of the diseases of armies be produced
       by the different manner in which wars are carried on by the
       modern nations? The discoveries in geography, by extending the
       field of war, expose soldiers to many diseases from long voyages,
       and a _sudden_ change of climate, which were unknown to the
       armies of former ages. Moreover, the form of the weapons, and
       the variety in the military exercises of the Grecian and Roman
       armies, gave a vigour to the constitution, which can never be
       acquired by the use of muskets and artillery.

IV. It would take up too much of our time to point out all the customs,
both _physical_ and _moral_, which influence diseases among both sexes.
The former have engendered the seeds of diseases in the human body
itself: hence the origin of catarrhs, jail and miliary fevers, with
a long train of other diseases, which compose so great a part of our
books of medicine. The latter likewise have a large share in producing
diseases. I am not one of those modern philosophers, who derive the
vices of mankind from the influence of civilization; but I am safe in
asserting, that their number and malignity increase with the refinements
of polished life. To prove this, we need only survey a scene too
familiar to affect us: it is a bedlam; which injustice, inhumanity,
avarice, pride, vanity, and ambition, have filled with inhabitants.

Thus have I briefly pointed out the customs which influence the diseases
of civilized nations. It remains now that we take notice of their
diseases. Without naming the many new fevers, fluxes, hemorrhages,
swellings from water, wind, flesh, fat, pus, and blood; foulnesses on
the skin, from cancers, leprosy, yawes, poxes, and itch; and, lastly,
the gout, the hysteria, and the hypochondriasis, in all their variety
of known and unknown shapes; I shall sum up all that is necessary upon
this subject, by adding, that the number of diseases which belong to
civilized nations, according to Doctor Cullen's nosology, amounts to
1387; the single class of nervous diseases form 612 of this number.

Before we proceed to speak of the remedies of civilized nations, we
shall examine into the abilities of NATURE in curing their diseases. We
found her active and successful in curing the diseases of the Indians.
Are her strength, wisdom, or benignity, equal to the increase of those
dangers which threaten her dissolution among civilized nations? In order
to answer this question, it will be necessary to explain the meaning of
the term nature.

By nature, in the present case, I understand nothing but _physical
necessity_. This at once excludes every thing like intelligence from
her operations: these are all performed in obedience to the same laws
which govern vegetation in plants, and the intestine motions of fossils.
They are as truly mechanical as the laws of gravitation, electricity,
or magnetism. A ship when laid on her broadside by a wave, or a sudden
blast of wind, rises by the simple laws of her mechanism; but suppose
this ship to be attacked by fire, or a water-spout, we are not to call
in question the skill of the ship-builder, if she be consumed by the
one, or sunk by the other. In like manner, the Author of nature hath
furnished the body with powers to preserve itself from its natural
enemies; but when it is attacked by those civil foes which are bred by
the peculiar customs of civilization, it resembles a company of Indians,
armed with bows and arrows, against the complicated and deadly machinery
of fire-arms. To place this subject in a proper light, I shall deliver
a history of the operations of nature in a few of the diseases of
civilized nations.

I. There are cases in which nature is still successful in curing
diseases.

In fevers she still deprives us of our appetite for animal food, and
imparts to us a desire for cool air and cold water.

In hemorrhages she produces a faintness, which occasions a coagulum in
the open vessels; so that the further passage of blood through them is
obstructed.

In wounds of the flesh and bones she discharges foreign matter by
exciting an inflammation, and supplies the waste of both with new flesh
and bone.

II. There are cases where the efforts of nature are too feeble to do
service, as in malignant and chronic fevers.

III. There are cases where the efforts of nature are over proportioned
to the strength of the disease, as in the cholera morbus and dysentery.

IV. There are cases where nature is idle, as in the atonic stages of the
gout, the cancer, the epilepsy, the mania, the venereal disease, the
apoplexy, and the tetanus[13].

  [13] Hoffman de hypothesium medicarum damno, sect. xv.

V. There are cases in which nature does mischief. She wastes herself
with an unnecessary fever, in a dropsy and consumption. She throws a
plethora upon the brain and lungs in the apoplexy and peripneumonia
notha. She ends a pleurisy and peripneumony in a vomica, or empyema. She
creates an unnatural appetite for food in the hypochondriac disease.
And, lastly, she drives the melancholy patient to solitude, where, by
brooding over the subject of his insanity, he increases his disease.

We are accustomed to hear of the salutary kindness of nature in alarming
us with pain, to prompt us to seek for a remedy. But,

VI. There are cases in which she refuses to send this harbinger of the
evils which threaten her, as in the aneurism, schirrhous, and stone in
the bladder.

VII. There are cases where the pain is not proportioned to the danger,
as in the tetanus, consumption, and dropsy of the head. And,

VIII. There are cases where the pain is over-proportioned to the danger,
as in the paronychia and tooth-ach.

This is a short account of the operations of nature, in the diseases
of civilized nations. A lunatic might as well plead against the
sequestration of his estate, because he once enjoyed the full exercise
of his reason, or because he still had lucid intervals, as nature be
exempted from the charges we have brought against her.

But this subject will receive strength from considering the REMEDIES of
civilized nations. All the products of the vegetable, fossil, and animal
kingdoms, tortured by heat and mixture into an almost infinite variety
of forms; bleeding, cupping, artificial drains by setons, issues, and
blisters; exercise, active and passive; voyages and journies; baths,
warm and cold; waters, saline, aërial, and mineral; food by weight and
measure; the royal touch; enchantment; miracles; in a word, the combined
discoveries of natural history and philosophy, united into a system of
materia medica, all show, that although physicians are in speculation
the servants, yet in practice they are the masters of nature. The whole
of their remedies seem contrived on purpose to arouse, assist, restrain,
and controul her operations.

There are some truths like certain liquors, which require strong heads
to bear them. I feel myself protected from the prejudices of vulgar
minds, when I reflect that I am delivering these sentiments in a society
of philosophers.

Let us now take a COMPARATIVE VIEW of the diseases and remedies of the
Indians with those of civilized nations. We shall begin with their
diseases.

In our account of the diseases of the Indians, we beheld death executing
his commission, it is true; but then his dart was hid in a mantle, under
which he concealed his shape. But among civilized nations we behold
him multiplying his weapons in proportion to the number of organs and
functions in the body; and pointing each of them in such a manner, as to
render his messengers more terrible than himself.

We said formerly that fevers constituted the chief diseases of the
Indians. According to Doctor Sydenham's computation, above 66,000 out of
100,000 died of fevers in London, about 100 years ago; but fevers now
constitute but a little more than one-tenth part of the diseases of that
city. Out of 21,780 persons who died in London between December, 1770,
and December, 1771, only 2273 died of simple fevers. I have more than
once heard Doctor Huck complain, that he could find no marks of epidemic
fevers in London, as described by Dr. Sydenham. London has undergone
a revolution in its manners and customs since Doctor Sydenham's time.
New diseases, the offspring of luxury, have supplanted fevers; and the
few that are left are so complicated with other diseases, that their
connection can no longer be discovered with an epidemic constitution of
the year. The pleurisy and peripneumony, those inflammatory fevers of
strong constitutions, are now lost in catarrhs, or colds, which, instead
of challenging the powers of nature or art to a fair combat, insensibly
undermine the constitution, and bring on an incurable consumption. Out
of 22,434 who died in London between December, 1769, and the same month
in 1770, 4594 perished with that British disease. Our countryman, Doctor
Maclurg, has ventured to foretel that the gout will be lost in a few
years, in a train of hypochondriac, hysteric, and bilious diseases.
In like manner, may we not look for a season when fevers, the natural
diseases of the human body, will be lost in an inundation of artificial
diseases, brought on by the modish practices of civilization?

It may not be improper to compare the PROGNOSIS of the Indians, in
diseases, with that of civilized nations, before we take a comparative
view of their remedies.

The Indians are said to be successful in predicting the events of
diseases. While diseases are simple, the marks which distinguish
them, or characterize their several stages, are generally uniform and
obvious to the most indifferent observer. These marks afford so much
certainty, that the Indians sometimes kill their physicians for a false
prognosis, charging the death of the patient to their carelessness, or
ignorance. They estimate the danger of their patients by the degrees
of appetite; while an Indian is able to eat, he is looked upon as free
from danger. But when we consider the number and variety in the signs
of diseases, among civilized nations, together with the shortness of
life, the fallacy of memory, and the uncertainty of observation, where
shall we find a physician willing to risk his reputation, much less his
life, upon the prediction of the event of our acute diseases? We can
derive no advantage from the simple sign, by which the Indians estimate
the danger of their patients; for we daily see a want of appetite for
food in diseases which are attended with no danger; and we sometimes
observe an unusual degree of this appetite to precede the agonies of
death. I honour the name of HIPPOCRATES: but forgive me, ye votaries of
antiquity, if I attempt to pluck a few grey hairs from his venerable
head. I was once an idolater at his altar, nor did I turn apostate from
his worship, till I was taught, that not a tenth part of his prognostics
corresponded with modern experience, or observation. The pulse[14],
urine, and sweats, from which the principal signs of life and death
have been taken, are so variable, in most of the acute diseases of
civilized nations, that the wisest physicians have in some measure
excluded the prognosis from being a part of their profession.

  [14] Doctor Cullen used to inform his pupils, that after forty years'
       experience, he could find no relation between his own
       observations on the pulse, and those made by Doctor Solano. The
       climate and customs of the people in Spain being so different
       from the climate and customs of the present inhabitants of
       Britain, may account for the diversity of their observations.
       Doctor Heberden's remarks upon the pulse, in the second volume of
       the Medical Transactions, are calculated to show how little the
       issue of diseases can be learned from it.

I am here insensibly led to make an apology for the instability of the
theories and practice of physic. The theory of physic is founded upon
the laws of the animal economy. These (unlike the laws of the mind, or
the common laws of matter) do not appear at once, but are gradually
brought to light by the phænomena of diseases. The success of nature in
curing the simple diseases of Saxony, laid the foundation for the ANIMA
MEDICA of Doctor STAHL. The endemics of Holland[15] led Doctor BOERHAAVE
to seek for the causes of all diseases in the FLUIDS. And the universal
prevalence of diseases of the NERVES, in Great-Britain, led Doctor
CULLEN to discover their peculiar laws, and to found a system upon them;
a system, which will probably last till some new diseases are let loose
upon the human species, which shall unfold other laws of the animal
economy.

  [15] "The scurvy is very frequent in Holland; and draws its origin
       partly from their strong food, sea-fish, and smoked flesh, and
       partly from their dense and moist air, together with their bad
       water." Hoffman on Endemical Distempers.

       "We are now in North-Holland; and I have never seen, among so
       few people, so many infected with the leprosy as here. They say
       the reason is, because they eat so much fish." Howell's Familiar
       Letters.

It is in consequence of this fluctuation in the principles and practice
of physic, being so necessarily connected with the changes in the
customs of civilized nations, that old and young physicians so often
disagree in their opinions and practices. And it is by attending to
the constant changes in these customs of civilized nations, that those
physicians have generally become the most eminent, who have soonest
emancipated themselves from the tyranny of the schools of physic; and
have occasionally accommodated their principles and practice to the
changes in diseases[16]. This variety in diseases, which is produced
by the changes in the customs of civilized nations, will enable us to
account for many of the contradictions which are to be found in authors
of equal candour and abilities, who have written upon the materia medica.

  [16] We may learn from these observations, the great impropriety of
       those Egyptian laws which oblige physicians to adopt, in all
       cases, the prescriptions which had been collected, and approved
       of, by the physicians of former ages. Every change in the customs
       of civilized nations, produces a change in their diseases, which
       calls for a change in their remedies. What havoc would plentiful
       bleeding, purging, and small beer, formerly used with so much
       success by Dr. Sydenham in the cure of fevers, now make upon the
       enfeebled citizens of London! The fevers of the same, and of more
       southern latitudes, still admit of such antiphlogistic remedies.
       In the room of these, bark, wine, and other cordial medicines,
       are prescribed in London in almost every kind of fever.

In forming a comparative view of the REMEDIES of the Indians, with those
of civilized nations, we shall remark, that the want of success in a
medicine is occasioned by one of the following causes:

First, our ignorance of the disease. Secondly, an ignorance of a
suitable remedy. Thirdly, a want of efficacy in the remedy.

Considering the violence of the diseases of the Indians, it is probable
their want of success is always occasioned by a want of efficacy in
their medicines. But the case is very different among the civilized
nations. Dissections daily convince us of our ignorance of the seats
of diseases, and cause us to blush at our prescriptions. How often are
we disappointed in our expectation from the most certain and powerful
of our remedies, by the negligence or obstinacy of our patients!
What mischief have we done under the belief of false facts (if I
may be allowed the expression) and false theories! We have assisted
in multiplying diseases. We have done more--we have increased their
mortality.

I shall not pause to beg pardon of the faculty, for acknowledging, in
this public manner, the weaknesses of our profession. I am pursuing
Truth, and while I can keep my eye fixed upon my guide, I am indifferent
whether I am led, provided she is my leader.

But further, the Indian submits to his disease, without one fearful
emotion from his doubtfulness of its event; and at last meets his fate
without an an anxious wish for futurity; except it is of being admitted
to an "equal sky," where

               "His faithful dog shall bear him company."

But, among civilized nations, the influence of a false religion in good,
and of a true religion in bad men, has converted even the fear of death
into a disease. It is this original distemper of the imagination which
renders the plague most fatal, upon his first appearance in a country.

Under all these disadvantages in the state of medicine, among civilized
nations, do more in proportion die of the diseases peculiar to them,
than of fevers, casualties, and old age, among the Indians? If we take
our account from the city of London, we shall find this to be the case.
Near a twentieth part of its inhabitants perish one year with another.
Nor does the natural increase of inhabitants supply this yearly waste.
If we judge from the bills of mortality, the city of London contains
fewer inhabitants, by several thousands, than it did forty years ago. It
appears from this fact, and many others of a like nature, which might be
adduced, that although the difficulty of supporting children, together
with some peculiar customs of the Indians, which we mentioned, limit
their number, yet they multiply faster, and die in a smaller proportion
than civilized nations, under the circumstances we have described.
The Indians, we are told, were numerous in this country, before the
Europeans settled among them. Travellers agree likewise in describing
numbers of both sexes who exhibited all the marks of extreme old age. It
is remarkable that age seldom impairs the faculties of their minds.

The mortality peculiar to those Indian tribes who have mingled with the
white people, must be ascribed to the extensive mischief of spiritous
liquors. When these have not acted, they have suffered from having
accommodated themselves too suddenly to the European diet, dress, and
manners. It does not become us to pry too much into futurity; but if we
may judge from the fate of the original natives of Hispaniola, Jamaica,
and the provinces on the continent, we may venture to foretel, that, in
proportion as the white people multiply, the Indians will diminish; so
that in a few centuries they will probably be entirely extirpated[17].

  [17] Even the influence of CHRISTIAN principles has not been able to
       put a stop to the mortality introduced among the Indians, by
       their intercourse with the Europeans. Dr. Cotton Mather, in a
       letter to sir William Ashurst, printed in Boston, in the year
       1705, says, "that about five years before there were about thirty
       Indian congregations in the southern parts of the province
       of Massachusetts-Bay." The same author, in his history of
       New-England, says, "That in the islands of Nantucket and Martha's
       Vineyard, there were 3000 _adult_ Indians, 1600 of whom professed
       the christian religion." At present there is but _one_ Indian
       congregation in the whole Massachusetts province.

       It may serve to extend our knowledge of diseases, to remark, that
       epidemics were often observed to prevail among the Indians in
       Nantucket, without affecting the white people.

It may be said, that health among the Indians, like insensibility to
cold and hunger, is proportioned to their need of it; and that the less
degrees, or entire want of health, are no interruption to the ordinary
business of civilized life.

To obviate this supposition, we shall first attend to the effects of
a single disease in those people who are the principal wheels in the
machine of civil society. Justice has stopt its current, victories have
been lost, wars have been prolonged, and embassies delayed, by the
principal actors in these departments of government being suddenly laid
up by a fit of the gout. How many offences are daily committed against
the rules of good breeding, by the tedious histories of our diseases,
which compose so great a part of modern conversation! What sums of money
have been lavished in foreign countries in pursuit of health[18]!
Families have been ruined by the unavoidable expences of medicines and
watering-places. In a word, the swarms of beggars which infest so many
of the European countries, urge their petitions for charity chiefly by
arguments derived from real or counterfeit diseases, which render them
incapable of supporting themselves[19].

  [18] It is said, there are seldom less than 20,000 British subjects in
       France and Italy; one half of whom reside or travel in those
       countries upon the account of their health.

  [19] Templeman computes, that Scotland contains 1,500,000 inhabitants;
       100,000 of whom, according to Mr. Fletcher, are supported at the
       public expence. The proportion of poor people is much greater in
       England, Ireland, France, and Italy.

But may not civilization, while it abates the violence of natural
diseases, increase the lenity of those that are artificial, in the same
manner that it lessens the strength of natural vices by multiplying
them? To answer this question, it will only be necessary to ask another:
Who should exchange the heat, thirst, and uneasiness of a fever, for one
fit of the colic or stone?

The history of the number, combination, and fashions of the remedies
we have given, may serve to humble the pride of philosophy; and to
convince us, that with all the advantages of the whole circle of
sciences, we are still ignorant of antidotes to many of the diseases of
civilized nations. We sometimes sooth our ignorance, by reproaching our
idleness in not investigating the remedies peculiar to this country.
We are taught to believe that every herb that grows in our woods is
possessed of some medicinal virtue, and that Heaven would be wanting in
benignity, if our country did not produce remedies for all the different
diseases of its inhabitants. It would be arrogating too much to suppose
that man was the only creature in our world for whom vegetables grow.
The beasts, birds, and insects, derive their sustenance either directly
or indirectly from them; while many of them were probably intended,
from their variety in figure, foliage, and colour, only to serve as
ornaments for our globe. It would seem strange that the Author of
nature should furnish every spot of ground with medicines adapted to
the diseases of its inhabitants, and at the same time deny it the more
necessary articles of food and clothing. I know not whether Heaven has
provided every country with antidotes even to the _natural_ diseases
of its inhabitants. The intermitting fever is common in almost every
corner of the globe; but a sovereign remedy for it has been discovered
only in South-America. The combination of bitter and astringent
substances, which serve as a succedaneum to the Peruvian bark, is as
much a preparation of art, as calomel or tartar emetic. Societies stand
in need of each other as much as individuals; and the goodness of the
Deity remains unimpeached when we suppose, that he intended medicines
to serve (with other articles) to promote that knowledge, humanity, and
politeness among the inhabitants of the earth, which have been so justly
attributed to commerce.

We have no discoveries in the materia medica to hope for from the
Indians in North-America. It would be a reproach to our schools of
physic, if modern physicians were not more successful than the Indians,
even in the treatment of their own diseases.

Do the blessings of civilization compensate for the sacrifice we make
of natural health, as well as of natural liberty? This question must be
answered under some limitations. When natural liberty is given up for
laws which enslave instead of protecting us, we are immense losers by
the exchange. Thus, if we arm the whole elements against our health, and
render every pore in the body an avenue for a disease, we pay too high
a price for the blessings of civilization.

In governments which have departed entirely from their simplicity,
partial evils are to be cured by nothing but an entire renovation of
their constitution. Let the world bear with the professions of law,
physic, and divinity; and let the lawyer, physician, and divine yet
learn to bear with each other. They are all necessary, in the present
state of society. In like manner, let the woman of fashion forget the
delicacy of her sex, and submit to be delivered by a man-midwife[20].
Let her snatch her offspring from her breast, and send it to repair the
weakness of its stamina, with the milk of a ruddy cottager[21]. Let art
supply the place of nature in the preparation and digestion of all our
aliment. Let our fine ladies keep up their colour with carmine, and
their spirits with ratifia; and let our fine gentlemen defend themselves
from the excesses of heat and cold, with lavender and hartshorn. These
customs have become necessary in the corrupt stages of society. We must
imitate, in these cases, the practice of those physicians who consult
the appetite only, in diseases which do not admit of a remedy.

  [20] In the enervated age of Athens, a law was passed which confined
       the practice of midwifery only to the men. It was, however,
       repealed, upon a woman's dying in childbirth, rather than
       be delivered by a man-midwife. It appears from the bills of
       mortality in London and Dublin, that about one in seventy of
       those women die in childbirth, who are in the hands of midwives;
       but from the accounts of the lying-in hospitals in those cities,
       which are under the care of man-midwives, only one in a hundred
       and forty perishes in childbirth.

  [21] There has been much common-place declamation against the custom
       among the great, of not suckling their children. Nurses were
       common in Rome, in the declension of the empire: hence we find
       Cornelia commended as a rare example of maternal virtue, as much
       for suckling her sons, as for teaching them eloquence. That
       nurses were common in Egypt, is probable from the contract which
       Pharaoh's daughter made with the unknown mother of Moses, to
       allow her wages for suckling her own child. The same degrees of
       civilization require the same customs. A woman whose times for
       eating and sleeping are constantly interrupted by the calls of
       enervating pleasures, must always afford milk of an unwholesome
       nature. It may truly be said of a child doomed to live on this
       aliment, that, as soon as it receives its

                                              ------"breath,
             It sucks in "the lurking principles of death."


The state of a country in point of population, temperance, and industry,
is so connected with its diseases, that a tolerable idea may be formed
of it, by looking over its bills of mortality. HOSPITALS, with all
their boasted advantages, exhibit at the same time monuments of the
charity and depravity of a people[22]. The opulence of physicians, and
the divisions of their offices, into those of surgery, pharmacy, and
midwifery, are likewise proofs of the declining state of a country. In
the infancy of the Roman empire, the priest performed the office of a
physician; so simple were the principles and practice of physic. It
was only in the declension of the empire that physicians vied with the
emperors of Rome in magnificence and splendour[23].

  [22] "Aurengezebe, emperor of Persia, being asked, Why he did not build
       hospitals? said, _I will make my empire so rich, that there shall
       be no need of hospitals_. He ought to have said, I will begin by
       rendering my subjects rich, and then I will build hospitals.

       "At Rome, the hospitals place every one at his ease, except those
       who labour, those who are industrious, those who have lands, and
       those who are engaged in trade.

       "I have observed, that wealthy nations have need of hospitals,
       because fortune subjects them to a thousand accidents; but it
       is plain, that transient assistances are better than perpetual
       foundations. The evil is momentary; it is necessary, therefore,
       that the succour should be of the same nature, and that it be
       applied to particular accidents." Spirit of Laws, b. xxiii. ch.
       29.

       It was reserved for the present generation to substitute in the
       room of public hospitals private DISPENSARIES for the relief of
       the sick. Philosophy and christianity alike concur in deriving
       praise and benefit from these excellent institutions. They
       exhibit something like an application of the mechanical powers
       to the purposes of benevolence; for in what other charitable
       institutions do we perceive so great a _quantity_ of distress
       relieved by so small an expence?

  [23] The first regular practitioners of physic in Rome, were women and
       slaves. The profession was confined to them above six hundred
       years. The Romans, during this period, lived chiefly upon
       vegetables, particularly upon PULSE; and hence they were called,
       by their neighbours, PULTIFAGI. They were likewise early inured
       to the healthy employments of war and husbandry. Their diseases,
       of course, were too few and simple to render the cure of them
       an object of liberal profession. When their diseases became
       more numerous and complicated, their investigation and cure
       required the aids of philosophy. The profession from this time
       became liberal; and maintained a rank with the other professions
       which are founded upon the imperfection and depravity of human
       institutions. Physicians are as necessary in the advanced stages
       of society as surgeons, although their office is less ancient
       and certain. There are many artificial diseases, in which they
       give certain relief; and even where their art fails, their
       prescriptions are still necessary, in order to smooth the avenues
       of death.

I am sorry to add, in this place, that the number of patients in the
HOSPITAL, and incurables in the ALMSHOUSE of this city, show that we are
treading in the enervated steps of our fellow subjects in Britain. Our
bills of mortality likewise show the encroachments of British diseases
upon us. The NERVOUS FEVER has become so familiar to us, that we look
upon it as a natural disease. Dr. Sydenham, so faithful in his history
of fevers, takes no notice of it. Dr. Cadwallader informed me, that it
made its first appearance in this city about five and twenty years ago.
It will be impossible to name the CONSUMPTION without recalling to our
minds the memory of some friend or relation, who has perished within
these few years by that disease. Its rapid progress among us has been
unjustly attributed to the growing resemblance of our climate to that of
Great-Britain. The HYSTERIC and HYPOCHONDRIAC DISEASES, once peculiar
to the chambers of the great, are now to be found in our kitchens and
workshops. All these diseases have been produced by our having deserted
the simple diet and manners of our ancestors.

The blessings of literature, commerce, and religion were not
_originally_ purchased at the expence of health. The complete enjoyment
of health is as compatible with civilization, as the enjoyment of
civil liberty. We read of countries, rich in every thing that can
form national happiness and national grandeur, the diseases of which
are nearly as few and simple as those of the Indians. We hear of no
diseases among the Jews, while they were under their democratical
form of government, except such as were inflicted by a supernatural
power[24]. We should be tempted to doubt the accounts given of the
populousness of that people, did we not see the practice of their simple
customs producing nearly the same populousness in Egypt, Rome, and other
countries of antiquity. The empire of China, it is said, contains more
inhabitants than the whole of Europe. The political institutions of that
country have exempted its inhabitants from a large share of the diseases
of other civilized nations. The inhabitants of Switzerland, Denmark,
Norway[25], and Sweden, enjoy the chief advantages of civilization
without having surrendered for them the blessings of natural health. But
it is unnecessary to appeal to ancient or remote nations to prove, that
health is not incompatible with civilization. The inhabitants of many
parts of New-England, particularly of the province of Connecticut, are
but little affected by artificial diseases. Some of you may remember
the time, and our fathers have told those of us who do not, when the
diseases of PENNSYLVANIA were as few and as simple as those of the
Indians. The food of the inhabitants was then simple; their only drink
was water; their appetites were restrained by labour; religion excluded
the influence of sickening passions; private hospitality supplied the
want of a public hospital; nature was their only nurse, and temperance
their principal physician. But I must not dwell upon this retrospect
of primæval manners; and I am too strongly impressed with a hope of a
revival of such happy days, to pronounce them the golden age of our
province.

  [24] The principal employments of the Jews, like those of the Romans in
       their simple ages, consisted in war and husbandry. Their diet was
       plain, consisting chiefly of vegetables. Their only remedies were
       plasters and ointments; which were calculated for those diseases
       which are produced by accidents. In proportion as they receded
       from their simple customs, we find artificial diseases prevail
       among them. The leprosy made its appearance in their journey
       through the wilderness. King Asa's pains in his feet, were
       probably brought on by a fit of the gout. Saul and Nebuchadnezzar
       were afflicted with a melancholy. In the time of our Saviour,
       we find an account of all those diseases in Judea, which mark
       the declension of a people; such as, the palsy, epilepsy, mania,
       blindness, hæmorrhagia uterina, &c. It is unnecessary to suppose,
       that they were let loose at this juncture, on purpose to give
       our Saviour an opportunity of making them the chief subject of
       his miracles. They had been produced from natural causes, by
       the gradual depravity of their manners. It is remarkable, that
       our Saviour chose those artificial diseases for the subject of
       his miracles, in preference to natural diseases. The efforts
       of nature, and the operation of medicines, are too slow and
       uncertain in these cases to detract in the least from the
       validity of the miracle. He cured Peter's mother-in-law, it is
       true, of a fever; but to show that the cure was miraculous, the
       sacred historian adds (contrary to what is common after a fever),
       "that she arose _immediately_, and ministered unto them."

  [25] In the city of Bergen, which consists of 30,000 inhabitants, there
       is but one physician; who is supported at the expense of the
       public. Pontoppidan's Nat. Hist. of Norway.

Our esteem for the customs of our savage neighbours will be lessened,
when we add, that civilization does not preclude the honours of old age.
The proportion of old people is much greater among civilized, than among
savage nations. It would be easy to decide this assertion in our favour,
by appealing to facts in the natural histories of Britain, Norway,
Sweden, North-America[26], and several of the West-India islands.

  [26] It has been urged against the state of longevity in America, that
       the Europeans, who settle among us, generally arrive to a
       greater age than the Americans. This is not occasioned so much
       by a peculiar firmness in their stamina, as by an increase of
       vigour which the constitution acquires by a change of climate. A
       Frenchman (cæteris paribus) outlives an Englishman in England. A
       Hollander prolongs his life by removing to the Cape of Good Hope.
       A Portuguese gains fifteen or twenty years by removing to Brazil.
       And there are good reasons to believe, that a North-American
       would derive the same advantages, in point of health and
       longevity, by removing to Europe, which a European derives from
       coming to this country.

       From a calculation made by an ingenious foreigner, it appears,
       that a greater proportion of old people are to be found in
       Connecticut, than in any colony in North-America. This colony
       contains 180,000 inhabitants. They have no public hospitals or
       poor-houses; nor is a beggar to be seen among them. There cannot
       be more striking proofs than these facts of the simplicity of
       their manners.

The laws of decency and nature are not necessarily abolished by the
customs of civilized nations. In many of these, we read of women among
whom nature alone still performs the office of a midwife[27], and who
feel the obligations of suckling their children to be equally binding
with the common obligations of morality.

  [27] Parturition, in the simple ages of all countries, is performed by
       nature. The Israelitish women were delivered even without the
       help of the Egyptian midwives. We read of but two women who died
       in child-birth in the whole history of the Jews. Dr. Bancroft
       says, that child-bearing is attended with so little pain in
       Guiana, that the women seem to be exempted from the curse
       inflicted upon Eve. These easy births are not confined to warm
       climates. They are equally safe and easy in Norway and Iceland,
       according to Pontoppidan and Anderson's histories of those
       countries.

Civilization does not render us less fit for the necessary hardships of
war. We read of armies of civilized nations, who have endured degrees of
cold, hunger, and fatigue, which have not been exceeded by the savages
of any country[28].

  [28] Civilized nations have, in the end, always conquered savages as
       much by their ability to bear hardships, as by their superior
       military skill. Soldiers are not to be chosen indiscriminately.
       The greatest generals have looked upon sound constitutions to
       be as essential to soldiers, as bravery or military discipline.
       Count Saxe refused soldiers born and bred in large cities; and
       sought for such only as were bred in mountainous countries.
       The King of Prussia calls young soldiers only to the dangers
       and honours of the field, in his elegant poem, Sur l'Art de la
       Guerre, chant 1. Old soldiers generally lose the advantages of
       their veteranism, by their habits of idleness and debauchery. An
       able general, and experienced officers, will always supply the
       defects of age in young soldiers.

Civilization does not always multiply the avenues of death. It appears
from the bills of mortality, of many countries, that fewer in proportion
die among civilized, than among savage nations.

Even the charms of beauty are heightened by civilization. We read of
stateliness, proportion, line teeth[29] and complexions, in both sexes,
forming the principal outlines of national characters.

  [29] Bad teeth are observed chiefly in middle latitudes, which are
       subject to alternate heats and colds. The inhabitants of Norway
       and Russia are as remarkable for their fine teeth as the
       inhabitants of Africa. We observe fine teeth to be universal
       likewise among the inhabitants of France, who live in a
       _variable_ climate. These have been ascribed to their protecting
       their heads from the action of the night air by means of woollen
       night-caps, and to the extraordinary attention to the teeth of
       their children. These precautions secure good teeth; and are
       absolutely necessary in all variable climates, where people do
       not adopt all the customs of the savage life.

The danger of many diseases is not proportioned to their violence, but
to their duration. America has advanced but a few paces in luxury and
effeminacy. There is yet strength enough in her vitals to give life to
those parts which are decayed. She may tread back her steps. For this
purpose,

I. Let our children be educated in a manner more agreeable to nature.

II. Let the common people (who constitute the wealth and strength of our
country) be preserved from the effects of ardent spirits. Had I a double
portion of all that eloquence which has been employed in describing the
political evils that lately threatened our country, it would be too
little to set forth the numerous and complicated _physical_ and _moral_
evils which these liquors have introduced among us. To encounter this
_hydra_ requires an arm accustomed, like that of Hercules, to vanquish
monsters. Sir William Temple tells us, that formerly in Spain no man
could be admitted as an evidence in a court, who had once been convicted
of drunkenness. I do not call for so severe a law in this country.
Let us first try the force of severe manners. Lycurgus governed more
by these, than by his laws. "Boni mores non bonæ leges," according to
Tacitus, were the bulwarks of virtue among the ancient Germans.

III. I despair of being able to call the votaries of Bacchus from their
bottle, and shall therefore leave them to be roused by the more eloquent
twinges of the gout.

IV. Let us be cautious what kind of manufactures we admit among us.
The rickets made their first appearance in the manufacturing towns in
England. Dr. Fothergill informed me, that he had often observed, when
a pupil, that the greatest part of the chronic patients in the London
Hospital were Spittal-field weavers. I would not be understood, from
these facts, to discourage those manufactures which employ women and
children: these suffer few inconveniences from a sedentary life: nor do
I mean to offer the least restraint to those manufactories among men,
which admit of free air, and the exercise of all their limbs. Perhaps
a pure air, and the abstraction of spiritous liquors, might render
sedentary employments less unhealthy in America, even among men, than in
the populous towns of Great-Britain.

The population of a country is not to be accomplished by rewards and
punishments. And it is happy for America, that the universal prevalence
of the protestant religion, the checks lately given to negro slavery,
the general unwillingness among us to acknowledge the usurpations of
primogeniture, the universal practice of inoculation for the small-pox,
and the absence of the plague, render the interposition of government
for that purpose unnecessary.

These advantages can only be secured to our country by AGRICULTURE.
This is the true basis of national health, riches, and populousness.
Nations, like individuals, never rise higher than when they are ignorant
whether they are tending. It is impossible to tell from history what
will be the effects of agriculture, industry, temperance, and commerce,
urged on by the competition of colonies, united in the same general
pursuits, in a country, which for extent, variety of soil, climate,
and number of navigable rivers, has never been equalled in any quarter
of the globe. America is the theatre where human nature will probably
receive her last and principal literary, moral, and political honours.

But I recall myself from the ages of futurity. The province of
Pennsylvania has already shown to her sister colonies, the influence
of agriculture and commerce upon the number and happiness of a people.
It is scarcely a hundred years since our illustrious legislator, with
a handful of men, landed upon these shores. Although the perfection
of our government, the healthiness of our climate, and the fertility
of our soil, seemed to ensure a rapid settlement of the province; yet
it would have required a prescience bordering upon divine, to have
foretold, that in such a short space of time, the province would contain
above 300,000 inhabitants; and that nearly 30,000 of this number
should compose a city, which should be the third, if not the second
in commerce in the British empire. The pursuits of literature require
leisure and a total recess from clearing forests, planting, building,
and all the common toils of settling a new country: but before these
arduous works were accomplished, the SCIENCES, ever fond of the company
of liberty and industry, chose this spot for the seat of their empire
in this new world. Our COLLEGE, so catholic in its foundation, and
extensive in its objects, already sees her sons executing offices in the
highest departments of society. I have now the honour of speaking in
the presence of a most respectable number of philosophers, physicians,
astronomers, botanists, patriots, and legislators; many of whom have
already seized the prizes of honour, which their ancestors had allotted
to a much later posterity. Our first offering had scarcely found its
way into the temple of fame, when the oldest societies in Europe turned
their eyes upon us, expecting with impatience to see the mighty fabric
of science, which, like a well-built arch, can only rest upon the
whole of its materials, completely finished from the treasures of this
unexplored quarter of the globe.

It reflects equal honour upon our society and the honourable assembly
of our province, to acknowledge, that we have always found the latter
willing to encourage by their patronage, and reward by their liberality,
all our schemes for promoting useful knowledge. What may we not expect
from this harmony between the sciences and government! Methinks I see
canals cut, rivers once impassable rendered navigable, bridges erected,
and roads improved, to facilitate the exportation of grain. I see the
banks of our rivers vying in fruitfulness with the banks of the river
of Egypt. I behold our farmers nobles; our merchants princes. But I
forbear--imagination cannot swell with the subject.

I beg leave to conclude, by deriving an argument from our connection
with the legislature, to remind my auditors of the duty they owe to the
society. Patriotism and literature are here connected together; and a
man cannot neglect the one, without being destitute of the other. Nature
and our ancestors have completed their works among us; and have left us
nothing to do, but to enlarge and perpetuate our own happiness.




                               AN ACCOUNT

                                 OF THE

                       _CLIMATE OF PENNSYLVANIA_,

                                AND ITS

                     INFLUENCE UPON THE HUMAN BODY.


In order to render the observations upon the epidemic diseases which
compose the following volumes more useful, it will be necessary to
prefix to them a short account of the climate of Pennsylvania, and
of its influence upon the human body. This account may perhaps serve
further, to lead to future discoveries, and more extensive observations,
upon this subject.

The state of Pennsylvania lies between 39° 43' 25", and 42° north
latitude, including, of course, 2° 16' 35", equal to 157 miles from its
southern to its northern boundary. The western extremity of the state is
in the longitude of 5° 23' 40", and the eastern, is that of 27' from the
meridian of Philadelphia, comprehending in a due west course 311 miles,
exclusive of the territory lately purchased by Pennsylvania from the
United States, of which as yet no accurate surveys have been obtained.
The state is bounded on the south by part of the state of Delaware, by
the whole state of Maryland, and by Virginia to her western extremity.
The last named state, the territory lately ceded to Connecticut, and
Lake Erie, (part of which is included in Pennsylvania) form the western
and north-western boundaries of the state. Part of New-York, and the
territory lately ceded to Pennsylvania, with a part of Lake Erie,
compose the northern, and another part of New-York, with a large extent
of New-Jersey (separated from Pennsylvania by the river Delaware),
compose the eastern boundaries of the state. The lands which form these
boundaries (except a part of the states of Delaware, Maryland, and
New-Jersey) are in a state of nature. A large tract of the western and
north-eastern parts of Pennsylvania are nearly in the same uncultivated
situation.

The state of Pennsylvania is intersected and diversified with numerous
rivers and mountains. To describe, or even to name them all, would far
exceed the limits I have proposed to this account of our climate. It
will be sufficient only to remark, that one of these rivers, viz. the
Susquehannah, begins at the northern boundary of the state, twelve
miles from the river Delaware, and winding several hundred miles,
through a variegated country, enters the state of Maryland on the
southern line, fifty-eight miles westward of Philadelphia; that each
of these rivers is supplied by numerous streams of various sizes; that
tides flow in parts of two of them, viz. in the Delaware and Schuylkill;
that the rest rise and fall alternately in wet and dry weather; and
that they descend with great rapidity, over prominent beds of rocks in
many places, until they empty themselves into the bays of Delaware and
Chesapeak on the east, and into the Ohio on the western part of the
state.

The mountains form a considerable part of the state of Pennsylvania.
Many of them appear to be reserved as perpetual marks of the original
empire of nature in this country. The Allegany, which crosses the state
about two hundred miles from Philadelphia, in a north, inclining to
an eastern course, is the most considerable and extensive of these
mountains. It is called by the Indians the back-bone of the continent.
Its height, in different places, is supposed to be about 1,300 feet from
the adjacent plains.

The soil of Pennsylvania is diversified by its vicinity to mountains and
rivers. The vallies and bottoms consist of a black mould, which extends
from a foot to four feet in depth. But in general a deep clay forms the
surface of the earth. Immense beds of limestone lie beneath this clay
in many parts of the state. This account of the soil of Pennsylvania is
confined wholly to the lands on the east side of the Allegany mountain.
The soil on the west side of this mountain, shall be described in
another place.

The city of Philadelphia lies in the latitude of 39° 57', in longitude
75° 8' from Greenwich, and fifty-five miles west from the Atlantic ocean.

It is situated about four miles due north from the conflux of the rivers
Delaware and Schuylkill. The buildings, which consist chiefly of brick,
extend nearly three miles north and south along the Delaware, and
above half a mile due west towards the Schuylkill, to which river the
limits of the city extend, the whole of which includes a distance of
two miles from the Delaware. The land near the rivers, between the city
and the conflux of the rivers, is in general low, moist, and subject to
be overflowed. The greatest part of it is meadow ground. The land to
the northward and westward, in the vicinity of the city, is high, and
in general well cultivated. Before the year 1778, the ground between
the present improvements of the city, and the river Schuylkill, was
covered with woods. These, together with large tracts of wood to the
northward of the city, were cut down during the winter the British army
had possession of Philadelphia. I shall hereafter mention the influence
which the cutting down of these woods, and the subsequent cultivation of
the grounds in the neighbourhood of the city, have had upon the health
of its inhabitants.

The mean height of the ground on which the city stands, is about forty
feet above the river Delaware. One of the longest and most populous
streets in the city rises only a few feet above the river. The air at
the north is much purer than at the south end of the city; hence the
lamps exhibit a fainter flame in its southern than its northern parts.

The tide of the Delaware seldom rises more than six feet. It flows four
miles in an hour. The width of the river near the city is about a mile.

The city, with the adjoining districts of Southwark and the Northern
Liberties, contains between 70 and 80,000 inhabitants.

From the accounts which have been handed down to us by our ancestors,
there is reason to believe that the climate of Pennsylvania has
undergone a material change. Thunder and lightning are less frequent,
and the cold of our winters and heat of our summers are less uniform,
than they were forty or fifty years ago. Nor is this all. The springs
are much colder, and the autumns more temperate than formerly, insomuch
that cattle are not housed so soon by one month as they were in former
years. Within the last eight years, there have been some exceptions
to part of these observations. The winter of the year 1779-80, was
uniformly and uncommonly cold. The river Delaware was frozen near three
months during this winter, and public roads for waggons and sleighs
connected the city of Philadelphia in many places with the Jersey shore.
The thickness of the ice in the river near the city, was from sixteen
to nineteen inches, and the depth of the frost in the ground was from
four to five feet, according to the exposure of the ground, and the
quality of the soil. This extraordinary depth of the frost in the earth,
compared with its depth in more northern and colder countries, is
occasioned by the long delay of snow, which leaves the earth without
a covering during the last autumnal and the first winter months. Many
plants were destroyed by the intenseness of the cold during this winter.
The ears of horned cattle and the feet of hogs exposed to the air,
were frost-bitten; squirrels perished in their holes, and partridges
were often found dead in the neighbourhood of farm houses. The mercury
in January stood for several hours at 5° below 0, in Fahrenheit's
thermometer; and during the whole of this month (except on one day), it
never rose in the city of Philadelphia so high as to the freezing point.

The cold in the winter of the year 1783-4 was as intense, but not so
steady, as it was in the winter that has been described. It differed
from it materially in one particular, viz. there was a thaw in the month
of January, which opened all our rivers for a few days.

The summer which succeeded the winter of 1779-80, was uniformly warm.
The mercury in the thermometer, during this summer, stood on one day
(the 15th of August) at 95°, and fluctuated between 93°, and 80° for
many weeks. The thermometer, in every reference that has been, or shall
be made to it, stood in the shade in the open air.

I know it has been said by many old people, that the winters in
Pennsylvania are less cold, and the summers less warm, than they were
forty or fifty years ago. The want of thermometrical observations
before, and during those years, renders it difficult to decide this
question. Perhaps the difference of clothing and sensation between youth
and old age, in winter and summer, may have laid the foundation of this
opinion. I suspect the mean temperature of the air in Pennsylvania has
not altered, but that the principal change in our climate consists in
the heat and cold being less confined than formerly to their natural
seasons. I adopt the opinion of Doctor Williamson[30] respecting
the diminution of the cold in the southern, being occasioned by the
cultivation of the northern parts of Europe; but no such cultivation
has taken place in the countries which lie to the north-west of
Pennsylvania, nor do the partial and imperfect improvements which have
been made in the north-west parts of the state, appear to be sufficient
to lessen the cold, even in the city of Philadelphia. I have been able
to collect no facts, which dispose me to believe that the winters were
colder before the year 1740, than they have been since. In the memorable
winter of 1739-40, the Delaware was crossed on the ice, in sleighs, on
the 5th of March, old style, and did not open till the 13th of the same
month. The ground was covered during this winter with a deep snow, and
the rays of the sun were constantly obscured by a mist, which hung in
the upper regions of the air. In the winter of 1779-80, the river was
navigable on the 4th of March; the depth of the snow was moderate, and
the gloominess of the cold was sometime suspended for a few days by a
cheerful sun. From these facts, it is probable the winter of 1739-40 was
colder than the winter of 1779-80.

  [30] American Philosophical Transactions, vol. I.

The winter of 1804-5 exhibited so many peculiarities that it deserves a
place in the history of the climate of Pennsylvania. The navigation of
the Delaware was obstructed on the 18th of December. The weather partook
of every disagreeable and distressing property of every cold climate on
the globe. These were intense cold, deep snows, hail, sleet, high winds,
and heavy rains. They generally occurred in succession, but sometimes
most of them took place in the course of four and twenty hours. A
serene and star-light evening, often preceded a tempestuous day. The
mercury stood for many days, in Philadelphia, at 4° and 6° above 0 in
Fahrenheit's thermometer. The medium depth of the snow was two feet,
but from its fall being accompanied with high winds, its height in many
places was three and four feet, particularly in roads, which it rendered
so impassable, as to interrupt business and social intercourse, in many
parts of the state. From the great depth of the snow, the ground was so
much protected from the cold, that the frost extended but six inches
below its surface. The newspapers daily furnished distressing accounts
of persons perishing with the cold by land and water, and of shipwrecks
on every part of the coast of the United States. Poultry were found
dead, or with frozen feet, in their coops, in many places.

This intense cold was not confined to Pennsylvania. In Norfolk, in
Virginia, the mercury stood at 18° above 0 on the 22d of January. At
Lexington, in Kentucky, it stood at 0 on the 21st of the same month.
In Lower Canada the snow was seven feet in depth, which is three feet
deeper than in common years. And such was the quantity of ice collected
in the northern seas, that a ship was destroyed, and several vessels
injured, by large masses of it, floating between the 41st and 42d
degrees of north latitude.

Great fears were entertained of an inundation in Pennsylvania, from
a sudden thaw of the immense quantities of snow and ice that had
accumulated during the winter, in every part of the state; but happily
they both dissolved away so gradually, as scarcely to injure a bridge or
a road. On the 28th of February the Delaware was navigable, and on the
2d of March no ice was to be seen in it.

Having premised these general remarks, I proceed to observe, that there
are seldom more than twenty or thirty days in summer or winter, in
Pennsylvania, in which the mercury rises above 80° in the former, or
falls below 30° in the latter season. Some old people have remarked,
that the number of _extremely_ cold and warm days in successive summers
and winters, bears an exact proportion to each other. This was strictly
true in the years 1787 and 1788.

The warmest part of the day in summer is at two, in ordinary, and at
three o'clock in the afternoon, in extremely warm weather. From these
hours, the heat gradually diminishes till the ensuing morning. The
coolest part of the four and twenty hours, is at the break of day.
There are seldom more than three or four nights in a summer in which
the heat of the air is nearly the same as in the preceding day. After
the warmest days, the evenings are generally agreeable, and often
delightful. The higher the mercury rises in the day time, the lower it
falls the succeeding night. The mercury at 80° generally falls to 68°,
while it descends, when at 60°, but to 56°. This disproportion between
the temperature of the day and night, in summer is always greatest in
the month of August. The dews at this time are heavy in proportion to
the coolness of the evening. They are sometimes so considerable as to
wet the clothes; and there are instances in which marsh-meadows, and
even creeks, which have been dry during the summer, have been supplied
with their usual waters from no other source, than the dews which have
fallen in this month, or in the first weeks of September.

There is another circumstance connected with the one just mentioned,
which contributes very much to mitigate the heat of summer, and that is,
it seldom continues more than two or three days without being succeeded
with showers of rain, accompanied sometimes by thunder and lightning,
and afterwards by a north-west wind, which produces a coolness in the
air that is highly invigorating and agreeable.

The warmest weather is _generally_ in the month of July. But intensely
warm days are often felt in May, June, August, and September. In the
annexed table of the weather for the year 1787, there is an exception to
the first of these remarks. It shows that the mean heat of August was
greater by a few degrees than that of July.

The transitions from heat to cold are often very sudden, and sometimes
to very distant degrees. After a day in which the mercury has stood at
86° and even 90°, it sometimes falls, in the course of a single night,
to the 65th, and even to the 60th degree, insomuch that fires have been
found necessary the ensuing morning, especially if the change in the
temperature of the air has been accompanied by rain and a south-east
wind. In a summer month, in the year 1775, the mercury was observed to
fall 20° in an hour and a half. There are few summers in which fires are
not agreeable during some parts of them. My ingenious friend, Mr. David
Rittenhouse, whose talent for accurate observation extends alike to all
subjects, informed me, that he had never passed a summer, during his
residence in the country, without discovering frost in every month of
the year, except July.

The weather is equally variable in Pennsylvania during the greatest
part of the winter. The mercury fell from 37° to 4-1/2° below 0 in four
and twenty hours, between the fourth and fifth of February, 1788. In
this season nature seems to play at cross purposes. Heavy falls of snow
are often succeeded in a few days by a general thaw, which frequently
in a short time leaves no vestige of the snow. The rivers Delaware,
Schuylkill, and Susquehannah have sometimes been frozen (so as to bear
horses and carriages of all kinds) and thawed so as to be passable in
boats, two or three times in the course of the same winter. The ice is
formed for the most part in a gradual manner, and seldom till the water
has been previously chilled by a fall of snow. Sometimes its production
is more sudden. On the night of the 31st of December, 1764, the Delaware
was completely frozen over between ten o'clock at night and eight the
next morning, so as to bear the weight of a man. An unusual vapour like
a fog was seen to rise from the water, in its passage from a fluid to a
solid state.

This account of the variableness of the weather in winter, does not
apply to every part of Pennsylvania. There is a line about the 41° of
the state, beyond which the winters are steady and regular, insomuch
that the earth there is seldom without a covering of snow during the
three winter months. In this line the climate of Pennsylvania forms a
union with the climate of the eastern and northern states.

The time in which frost and ice begin to show themselves in the
neighbourhood of Philadelphia, is generally about the latter end of
October or the beginning of November. But the intense cold seldom sets
in till about the the 20th or 25th of December; hence the common saying,
"as the day lengthens, the cold strengthens." The coldest weather is
commonly in January. The navigation of the river Delaware, after being
frozen, is seldom practicable for large vessels, before the first week
in March.

As in summer there are often days in which fires are agreeable, so there
are sometimes days in winter in which they are disagreeable. Vegetation
has been observed in all the winter months. Garlic was tasted in butter
in January, 1781. The leaves of the willow, the blossoms of the peach
tree, and the flowers of the dandelion and the crocus, were all seen in
February, 1779; and I well recollect, when a school-boy, to have seen an
apple orchard in full bloom, and small apples on many of the trees, in
the month of December.

A cold day in winter is often succeeded by a moderate evening. The
coldest part of the four and twenty hours, is generally at the break of
day.

In the most intense cold which has been recorded in Philadelphia, within
the last twenty years, the mercury stood at 5° below 0. But it appears
from the accounts published by Messieurs Mason and Dixon, in the 58th
volume of the Transactions of the Royal Society of London, that the
mercury stood at 22° below 0, on the 2d of January, 1767, at Brandywine,
about thirty miles to the westward of Philadelphia. They inform us, that
on the 1st of the same month, the mercury stood at 20°, and on the day
before at 7° below 0. I have to lament that I am not able to procure any
record of the temperature of the air in the same year in Philadelphia.
From the variety in the height and quality of the soil, and from the
difference in the currents of winds and the quantity of rain and snow
which fall in different parts of the state, it is very probable this
excessive cold may not have extended thirty miles from the place where
it was first perceived.

The greatest degree of heat upon record in Philadelphia, is 95°.

The standard temperature of the air in the city of Philadelphia is
52-1/2°, which is the temperature of our deepest wells, as also the mean
heat of our common spring water.

The spring in Pennsylvania is generally less pleasant than in many other
countries. In March the weather is stormy, variable, and cold. In April,
and sometimes in the beginning of May, it is moist, and accompanied by
a degree of cold which has been called _rawness_, and which, from its
disagreeable effects upon the temper, has been called the _sirocco_ of
this country. From the variable nature of the weather in the spring,
vegetation advances very differently in different years. The colder the
spring, the more favourable it proves to the fruits of the earth. The
hopes of the farmer from his fruit-trees in a warm spring are often
blasted by a frost in April and May. A fall of snow is remembered with
regret by many of them, on the night between the 3d and 4th of May, in
the year 1774; also on the morning of the 8th of May, 1803. Such was its
quantity on the latter day, that it broke down the limbs of many poplar
trees. This effect was ascribed to its not being accompanied with any
wind. The colder the winter, the greater delay we generally observe in
the return of the ensuing spring.

Sometimes the weather during the spring months is cloudy and damp,
attended occasionally with a gentle fall of rain resembling the spray
from a cataract of water. A day of this kind of weather is called, from
its resemblance to a damp day in Great-Britain, "an English day." This
damp weather seldom continues more than three or four days. The month of
May, 1786, will long be remembered, for having furnished a very uncommon
instance of the absence of the sun for fourteen days, and of constant
damp or rainy weather.

The month of June is the only month in the year which resembles a
spring month in the southern countries of Europe. The weather is then
generally temperate, the sky is serene, and the verdure of the country
is universal and delightful.

The autumn is the most agreeable season in the year in Pennsylvania.
The cool evenings and mornings, which generally begin about the first
week in September, are succeeded by a moderate temperature of the air
during the day. This kind of weather continues with an increase of cold
scarcely perceptible, till the middle of October, when the autumn is
closed by rain, which sometimes falls in such quantities as to produce
destructive freshes in the rivers and creeks, and sometimes descends
in gentle showers, which continue, with occasional interruptions by a
few fair days, for two or three weeks. These rains are the harbingers
of the winter; and the Indians have long ago taught the inhabitants
of Pennsylvania, that the degrees of cold during the winter, are in
proportion to the quantity of rain which falls during the autumn[31].

  [31] I cannot help agreeing with Mr. Kirwan, in one of his remarks
       upon the science of meteorology, in the preface to his estimate
       of the temperature of different latitudes. "This science (says
       he), if brought to perfection, would enable us at least to
       foresee those changes in the weather which we could not prevent.
       Great as is the distance between such knowledge and our own
       present attainments, we have no reason to think it above the
       level of the powers of the human mind. The motions of the
       planets must have appeared as perplexed and intricate to those
       who first contemplated them; yet, by persevering industry, they
       are now known to the utmost precision. The present is (as the
       great Leibnitz expresses it) in every case pregnant with the
       future, and the connection must be found by long and attentive
       observation."

       The influence which the perfection of this science must have upon
       health, agriculture, navigation, and commerce, is too obvious to
       be mentioned.

From this account of the temperature of the air in Pennsylvania, it
is evident that there are seldom more than four months in which the
weather is agreeable without a fire.

In winter the winds generally come from the north-west in _fair_,
and from the north-east in _wet_ weather. The north-west winds are
uncommonly dry as well as cold. It is in consequence of the violent
action of these winds that trees have uniformly a thicker and more
compact bark on their northern than on their southern exposures. Even
brick houses are affected by the force and dryness of these north-west
winds: hence it is much more difficult to demolish the northern than the
southern walls of an old brick house. This fact was communicated to me
by an eminent bricklayer in the city of Philadelphia.

The winds in fair weather in the spring, and in warm weather in the
summer, blow from the south-west and from west-north-west. The _raw_
air before-mentioned comes from the north-east. The south-west winds
likewise usually bring with them those showers of rain in the spring
and summer which refresh the earth. They moreover moderate the heat of
the weather, provided they are succeeded by a north-west wind. Now and
then showers of rain come from the west-north-west.

There is a common fact connected with the account of the usual winds in
Pennsylvania, which it may not be improper to mention in this place.
While the clouds are seen flying from the south-west, the _scud_, as it
is called, or a light vapour, is seen at the same time flying below the
clouds from the north-east.

The moisture of the air is much greater than formerly, occasioned
probably by the exhalations which in former years fell in the form of
snow, now descending in the form of rain. The depth of the snow is
sometimes between two and three feet, but in general seldom exceeds
between six and nine inches.

Hail frequently descends with snow in winter. Once in four or five years
large and heavy showers of hail fall in the spring and summer. They
generally run in narrow veins (as they are called) of thirty or forty
miles in length, and two or three miles in breadth. The heaviest shower
of hail that is remembered in Philadelphia, did not extend in breadth
more than half a mile north and south. Some of the stones weighed half
an ounce. The windows of many houses were broken by them. This shower
fell in May, 1783.

From sudden changes in the air, rain and snow often fall together,
forming what is commonly called _sleet_.

In the uncultivated parts of the state, the snow sometimes lies on the
ground till the first week in April. The backwardness of the spring has
been ascribed to the passage of the air over the undissolved beds of
snow and ice which usually remain, after the winter months are past,
on the north-west grounds and waters of the state, and of the adjacent
country.

The dissolution of the ice and snow in the spring is sometimes so sudden
as to swell the creeks and rivers in every part of the state to such a
degree, as not only to lay waste the hopes of the husbandman from the
produce of his lands, but in some instances to sweep his barns, stables,
and even his dwelling house into their currents[32]. The wind, during a
general thaw, comes from the south-west or south-east.

  [32] The following account of the thaw of the river Susquehannah, in
       the spring of 1784, was published by the author in the Columbian
       Magazine, for November, 1786. It may serve to illustrate a fact
       related formerly in the history of the winters in Pennsylvania,
       as well as to exhibit an extraordinary instance of the
       destructive effects of a sudden thaw.

       "The winter of 1783-4 was uncommonly cold, insomuch that the
       mercury in Fahrenheit's thermometer stood several times at 5
       degrees below 0. The snows were frequent, and, in many places,
       from two to three feet deep, during the greatest part of the
       winter. All the rivers in Pennsylvania were frozen, so as to
       bear waggons and sleds with immense weights. In the month of
       January a thaw came on suddenly, which opened our rivers so as to
       set the ice a-driving, to use the phrase of the country. In the
       course of one night, during the thaw, the wind shifted suddenly
       to the north-west, and the weather became intensely cold. The
       ice, which had floated the day before, was suddenly obstructed;
       and in the river Susquehannah, the obstructions were formed in
       those places where the water was most shallow, or where it had
       been accustomed to fall. This river is several hundred miles in
       length, and from half a mile to a mile and a half in breadth, and
       winds through a hilly, and in many places a fertile and highly
       cultivated country. It has as yet a most difficult communication
       with our bays and the sea, occasioned by the number and height
       of the falls which occur near the mouth of the river. The ice in
       many places, especially where there were falls, formed a kind
       of dam, of a most stupendous height. About the middle of March
       our weather moderated, and a thaw became general. The effects
       of it were remarkable in all our rivers; but in none so much as
       in the river I have mentioned. I shall therefore endeavour in a
       few words to describe them. Unfortunately the dams of ice did
       not give way all at once, nor those which lay nearest to the
       mouth of the river, first. While the upper dams were set afloat
       by the warm weather, the lower ones, which were the largest, and
       in which, of course, the ice was most impacted, remained fixed.
       In consequence of this, the river rose in a few hours, in many
       places, above 30 feet, rolling upon its surface large lumps of
       ice, from 10 to 40 cubic feet in size. The effects of this sudden
       inundation were terrible. Whole farms were laid under water.
       Barns, stables, horses, cattle, fences, mills of every kind, and,
       in one instance, a large stone house, 40 by 30 feet, were carried
       down the stream. Large trees were torn up by the roots; several
       small islands, covered with woods, were swept away, and not a
       vestige of them was left behind. On the barns which preserved
       their shape, in some instances, for many miles were to be seen
       living fowls; and, in one dwelling, a candle was seen to burn
       for some time, after it was swept from its foundation. Where the
       shore was level, the lumps of ice, and the ruins of houses and
       farms, were thrown a quarter of a mile from the ordinary height
       of the river. In some instances, farms were ruined by the mould
       being swept from them by the cakes of ice, or by depositions of
       sand; while others were enriched by large depositions of mud.
       The damage, upon the whole, done to the state of Pennsylvania by
       this fresh, was very great. In most places it happened in the day
       time, or the consequences must have been fatal to many thousands."

       "I know of but one use that can be derived from recording the
       history of this inundation. In case of similar obstructions of
       rivers, from the causes such as have been described, the terrible
       effects of their being set in motion by means of a general thaw
       may in part be obviated, by removing such things out of the
       course of the water and ice as are within our power; particularly
       cattle, hay, grain, fences, and farming utensils of all kinds."

The air, when dry in Pennsylvania, has a peculiar elasticity, which
renders the heat and cold less insupportable than the same degrees of
both are in moister countries. It is in those cases only when summer
showers are not succeeded by north-west winds, that the heat of the air
becomes oppressive and distressing, from being combined with moisture.

From tradition, as well as living observation, it is evident, that
the waters in many of the creeks in Pennsylvania have diminished
considerably within the last fifty years. Hence many mills, erected
upon large and deep streams of water, now stand idle in dry weather;
and many creeks, once navigable in large boats, are now impassable even
in canoes. This diminution of the waters has been ascribed to the
application of a part of them to the purpose of making meadows.

The mean elevation of the barometer in Philadelphia, is about 30 inches.
The variations in the barometer are very inconsiderable in the greatest
changes of the weather, which occur in the city of Philadelphia. During
the violent and destructive storm which blew from the south-west on
the 11th of November, 1788, it suddenly fell from 30 to 29-3/10. Mr.
Rittenhouse informs me, that long and faithful observations have
satisfied him, that the alterations in the height of the mercury in the
barometer do not _precede_ but always _succeed_ changes in the weather.
It falls with the south and south-west, and rises with the north and
north-west winds.

The quantity of water which falls in rain and snow, one year with
another, amounts to from 24 to 36 inches. But to complete the account
of variable qualities in the climate, it will be necessary to add, that
our summers and autumns are sometimes marked by a _deficiency_, and
sometimes by an _excessive_ quantity of rain. The summer and autumn
of 1782 were uncommonly dry. Near two months elapsed without a single
shower of rain. There were only two showers in the whole months of
September and October. In consequence of this dry weather, there was
no second crop of hay. The Indian corn failed of its increase in many
places, and was cut down for food for cattle. Trees newly planted, died.
The pasture fields not only lost their verdure, but threw up small
clouds of dust when agitated by the feet of men, or beasts. Cattle in
some instances were driven many miles to be watered, every morning
and evening. It was remarked during this dry weather, that the sheep
were uncommonly fat, and their flesh well tasted, while all the other
domestic animals languished from the want of grass and water. The earth
became so inflammable in some places, as to burn above a foot below
its surface. A complete consumption of the turf by an accidental fire
kindled in the adjoining state of New-Jersey, spread terror and distress
through a large tract of country. Springs of water and large creeks
were dried up in many parts of the state. Rocks appeared in the river
Schuylkill, which had never been observed before, by the oldest persons
then alive. On one of them were cut the figures 1701. The atmosphere,
during part of this dry weather, was often filled, especially in
the mornings, with a thin mist, which, while it deceived with the
expectation of rain, served the valuable purpose of abating the heat
of the sun. A similar mist was observed in France by Dr. Franklin, in
the summer of 1782. The winter which succeeded it was uncommonly cold
in France, as well as in Pennsylvania. I am sorry that I am not able
to furnish the mean heat of each of the summer months. My notes of the
weather enable me to add nothing further upon this subject, than that
the summer was "uncommonly cool."

The summer of the year 1788 afforded a remarkable instance of _excess_
in the quantity of rain which sometimes falls in Pennsylvania. Thirteen
days are marked with rain in July, in the records of the weather kept
at Spring-Mill. There fell on the 18th and 19th of August seven inches
of rain in the city of Philadelphia. The wheat suffered greatly by the
constant rains of July in the eastern and middle parts of the state. So
unproductive a harvest in grain, from wet weather, had not been known,
it is said, in the course of the last 70 years. The heat of the air,
during these summer months was very moderate. Its mean temperature at
Spring-Mill was 67,8 in June, 74,7 in July, and only 70,6 in August.

It is some consolation to a citizen of Pennsylvania, in recording
facts which seem to militate against our climate, to reflect that the
difference of the weather, in different parts of the state, at the
same season, is happily accommodated to promote an increase of the same
objects of agriculture; and hence a deficiency of crops has never been
known in any one year throughout the _whole_ state.

The aurora borealis and meteors are seen occasionally in Pennsylvania.
In the present imperfect state of our knowledge of their influence upon
the human body, it will be foreign to the design of this history of our
climate to describe them.

Storms and hurricanes are not unknown in Pennsylvania. They occur once
in four or five years, but they are most frequent and destructive in the
autumn. They are generally accompanied by rain. Trees are torn up by
the roots, and the rivers and creeks are sometimes swelled so suddenly
as to do considerable damage to the adjoining farms. The wind, during
these storms, generally blows from the south-east and south-west. In the
storms which occurred in September, 1769, and in the same month of the
year 1785, the wind veered round contrary to its usual course, and blew
from the north.

After what has been said, the character of the climate of Pennsylvania
may be summed up in a few words. There are no two successive years
alike. Even the same successive seasons and months differ from each
other every year. Perhaps there is but one steady trait in the character
of our climate, and that is, it is uniformly variable.

To furnish the reader with a succinct view of the weather in
Pennsylvania, that includes all the articles that have been mentioned,
I shall here sub-join a table containing the result of meteorological
observations made near the river Schuylkill, for one year, in the
neighbourhood of Philadelphia, by an ingenious French gentleman, Mr.
Legeaux, who divides his time between rural employments, and useful
philosophical pursuits. This table is extracted from the Columbian
Magazine, for February, 1788. The height of Spring-Mill above the city
of Philadelphia, is supposed to be about 70 feet.

  |====================================================================|
  |         METEOROLOGICAL OBSERVATIONS, made at SPRING-MILL,          |
  |      13 miles NNW of Philadelphia.  Result of the year 1787.       |
  |====================================================================|
  |          |       THERMOMETER.        |  BAROMETER. | PREVAILING    |
  |          |      of     |     de      |             |    WIND.      |
  |  MONTH.  |_Fahrenheit_,| _Reaumur_,  | mean height |               |
  |          | mean degree |degrés moyens|             |               |
  |          | D. 1/16 O   | D. 1/10  O  |in. pts. 1/16|               |
  |----------+-------------+-------------+-------------+---------------|
  |January   | 35  1       |  1   4      | 29   9   9  |Variable still |
  |February  | 33  8       |      8      | 29   9   9  |NE             |
  |March     | 45  1       |  5   8      | 29   9   7  |W              |
  |April     | 54  3       |  9   9      | 29   9   6  |Still, SW      |
  |May       | 61  2       | 13          | 29   9   2  |Still, WSW     |
  |June      | 70  7       | 17   2      | 29   8   2  |WNW            |
  |July      | 72  2       | 17   9      | 29   9  10  |WWSW var.      |
  |August    | 74  5       | 18   9      | 29  10   6  |W              |
  |September | 64  7       | 14   5      | 29  10   4  |WNW            |
  |October   | 51  1       | 8    5      | 29  11   9  |WNW vari.      |
  |November  | 45  1       | 5    8      | 29  11   1  |Still, vari.   |
  |December  | 34          |      9      | 29   7   7  |WNW            |
  |----------+-------------+-------------+-------------+---------------|
  |          |10 Feb.      |10 Feb. D. du| 8 Mar.      |               |
  | RESULT.  |greatest D.  |plus. gr.    | greatest    |               |
  |          |of cold.     |froid.       | elevation.  |               |
  |          |  5          | 12   0      | 30  10      |               |
  |          |-------------+-------------+-------------|               |
  |          |3 July       |3 July plus  |2 Febr. least|     WNW       |
  |          |greatest D.  |G. D. de     |elevation.   |               |
  |          |of heat.     |chaud.       |             |               |
  |          | 96  1       | 28   5      | 29          |               |
  |          |-------------+-------------+-------------|               |
  |          |Variation.   | Variation.  |Variation.   |               |
  |          | 91  1       | 40   5      |  1  10      |               |
  |----------|-------------+-------------+-------------|---------------|
  |          |Temperature. |Temperature. |Mean elevat. |               |
  |          | 53  5       |  9   6      | 20   9   9  |               |
  |====================================================================|
  |  MONTH.  |   DAYS of  |    WATER    |   WEATHER.     Key for left  |
  |          |   [Key     |   of RAIN   |                  A=aur. bor. |
  |          | at right]  |  and SNOW.  |           R=rain  Th=thunder |
  |          |A|R |Th|S |T|in. pts. 1/16|           S=snow   T=tempest |
  |----------+-+--+--+--+-+-------------+------------------------------|
  |January   | | 7| 1| 4| | 3   10   10 |Fair, still, cold, and snow.  |
  |February  | | 3|  | 3|2| 3    7    3 |Fair, overcast.               |
  |March     | | 6|  | 3| | 2    4    2 |Fair, windy.                  |
  |April     | | 3| 2| 1|2| 1    2   13 |Fair, and very dry.           |
  |May       |1|14| 6|  |2| 4   11    4 |Foggy, cold, and wet.         |
  |June      | | 9| 1|  | | 1   10    4 |Very fair & growing weather.  |
  |July      |1| 5| 2|  | | 3    1   11 |Fair, and overcast.           |
  |August    | |11| 4|  |1| 5    2    3 |Very fair, and cloudy.        |
  |September | | 6| 1|  |1| 2    7    8 |Fair weather.                 |
  |October   |1| 4|  |  | |      7   10 |Foggy, fair, and dry weather. |
  |November  |1| 5|  |  | | 2    6   10 |Very fair.                    |
  |December  | |  |  | 1|1|      9      |Very fair, and very dry.      |
  |----------+-+--+--+--+-+-------------+------------------------------|
  | RESULT.  |4|73|17|12|9|32    8   14 |TEMPERATURE OF THE YEAR 1787. |
  |          |            |             | Very fair, dry, abundant in  |
  |          |            |             |  every thing, and healthy.   |
  |====================================================================|

It is worthy of notice, how near the mean heat of the year, and of the
month of April, in two successive years, are to each other in the same
place. The mean heat of April, 1787, was 54°3, that of April, 1788,
was 52°2. By the table of the mean heat of each month in the year, it
appears that the mean heat of 1787 was 53°5 at Spring-Mill.

The following accounts of the climates of Pekin and Madrid, which lie
within a few minutes of the same latitude as Philadelphia, may serve to
show how much climates are altered by local and relative circumstances.
The account of the temperature of the air at Pekin will serve further to
show, that with all the advantages of the highest degrees of cultivation
which have taken place in China, the winters are colder, and the summers
warmer there than in Pennsylvania, principally from a cause which will
probably operate upon the winters of Pennsylvania for many centuries to
come, viz. the vicinity of an uncultivated north-west country.

"PEKIN, lat. 39° 54', long. 116° 29' W.

"By five years observations, its annual mean temperature was found to be
55° 5'.

               January    20°,75        July        84°,8
               February   32            August      83
               March      48            September   63
               April      59            October     52
               May        72            November    41
               June       83°,75        December    27

"The temperature of the Atlantic under this parallel is 62, but the
standard of this part of the globe is the North Pacific, which is here
4 or 5 degrees colder than the Atlantic. The Yellow Sea is the nearest
to Pekin, being about 200 miles distant from it; but it is itself cooled
by the mountainous country of Corea, which interposes between it and the
ocean, for a considerable part of its extent. Besides, all the northern
parts of China (in which Pekin lies) must be cooled by the vicinity of
the mountains of Chinese Tartary, among which the cold is said to be
excessive.

"The greatest cold usually experienced during this period was 5°, the
greatest heat, 98°: on the 25th of July, 1773, the heat arose to 108°
and 110°: a N. E. or N. W. wind produces the greatest cold, a S. or S.
W. or S. E. the greatest heat[33]."

  [33] "6. Mem. Scav. Etrang. p. 528."

"MADRID, lat. 40° 25', long. 3° 20' E.

The usual heat in summer is said to be from 75° to 85°; even at night it
seldom falls below 70°; the mean height of the barometer is 27,96. It
seems to be about 1900 feet above the level of the sea[34]."

  [34] "Mem. Par. 1777, p. 146."

The above accounts are extracted from Mr. Kirwan's useful and elaborate
estimate of the temperature of different latitudes.

The history which has been given of the climate of Pennsylvania, is
confined chiefly to the country on the east side of the Allegany
mountain. On the west side of this mountain, the climate differs
materially from that of the south-eastern parts of the state in the
temperature of the air, in the effects of the winds upon the weather,
and in the quantity of rain and snow which falls every year. The winter
seldom breaks up on the mountains before the 25th of March. A fall of
snow was once perceived upon it, which measured an inch and a half, on
the 11th day of June. The trees which grow upon it are small, and Indian
corn is with difficulty brought to maturity, even at the foot of the
east side of it. The south-west winds on the west side of the mountain
are accompanied by cold and rain. The soil is rich, consisting of near
a foot, in many places, of black mould. The roads in this country are
muddy in winter, but seldom dusty in summer. The arrangement of strata
of the earth on the west side, differs materially from their arrangement
on the east side the mountain. "The country (says Mr. Rittenhouse, in a
letter to a friend in Philadelphia[35]), when viewed from the western
ridge of the Allegany, appears to be one vast extended plain. All the
various strata of stone seem to lie undisturbed in the situation in
which they were first formed, and the layers of stone, sand, clay, and
coal, are nearly _horizontal_."

  [35] Columbian Magazine, for October, 1786.

The temperature of the air on the west is seldom so hot, or so cold,
as on the east side of the mountain. By comparing the state of a
thermometer examined by Dr. Bedford at Pittsburg, 284 miles from
Philadelphia, it appears that the weather was not so cold by twelve
degrees in that town, as it was in Philadelphia, on the 5th of February,
1788.

To show the difference between the weather at Spring-Mill and in
Pittsburg, I shall here sub-join an account of it, in both places, the
first taken by Mr. Legeaux, and the other by Doctor Bedford.

      +----------------------------------------------------------+
      |     METEOROLOGICAL OBSERVATIONS, made at SPRING-MILL,    |
      |       13 miles NNW. of Philadelphia. April, 1788.        |
      +-------+------------------------+-------------+-----------+
      |       |                        |             |           |
      |       |                        |             |           |
      |       |                        |             |           |
      |       |                        |             |           |
      |       |       THERMOMETER      |             |           |
      |       |-------------+----------|  BAROMETER. |           |
      |       |      of     |   de     |             |           |
      |       |_Fahrenheit_,|_Reaumur_,|    mean     |           |
      |   D.  |     mean    |  degrés  |   height    |           |
      | of the|    degree   |  moyens  |             |PREVAILING |
      | month.|  D. 1/10  O | D. 1/10 O|in. pts. 1/10|  WIND.    |
      +-------+-------------+--------+-+-------------+-----------+
      |    1  | 58    1 |   | 11   6 | | 29  10   5  |W.         |
      |    2  | 46    9 |   |  6   9 | | 30   1      |Calm.      |
      |    3  | 40    3 |   |  3   7 | | 30       3  |Changeable.|
      |    4  | 51    3 |   |  8   6 | | 29  11   7  |SW.        |
      |    5  | 51    1 |   |  8   5 | | 30       7  |E.         |
      |    6  | 55    7 |   | 10   5 | | 29  11   7  |Calm.      |
      |    7  | 51    3 |   |  8   6 | | 30   2      |NE.        |
      |    8  | 42    1 |   |  4   5 | | 29  11      |E.         |
      |    9  | 63    5 |   | 14     | | 29   8      |W.         |
      |   10  | 46    7 |   |  6   5 | | 29  10      |W.         |
      |   11  | 53    8 |   |  9   7 | | 30   2      |W.         |
      |   12  | 44    5 |   |  5   5 | | 29  10      |Calm.      |
      |   13  | 60    5 |   | 12   7 | | 29  10   3  |SW.        |
      |   14  | 50    2 |   |  8   1 | | 29   9      |E.         |
      |   15  | 58    1 |   | 11   6 | | 29   9   7  |SW.        |
      +-------+-----  --+---+-- -----+-+-------------+-----------+
      |    METEOROLOGICAL OBSERVATIONS, made at PITTSBURG,       |
      |     284 miles west of Philadelphia. April, 1788.         |
      +-------+---------+---+--------+-+-------------+-----------+
      |    1  | 46      |   |        | |             |SW.        |
      |    2  | 42      |   |        | |             |NE. by N.  |
      |    3  | 43      |   |        | |             |SE.        |
      |    4  | 64      |   |        | |             |Calm.      |
      |    5  | 80      |   |        | |             |SE. by S.  |
      |    6  | 52      |   |        | |             |SW.        |
      |    7  | 48      |   |        | |             |NE. by N.  |
      |    8  | 66      |   |        | |             |SE. by S.  |
      |    9  | 56      |   |        | |             |NW. by N.  |
      |   10  | 60      |   |        | |             |SW.        |
      |   11  | 62      |   |        | |             |Calm.      |
      |   12  | 67      |   |        | |             |SW.        |
      |   13  | 62      |   |        | |             |Calm.      |
      |   14  | 60      |   |        | |             |Variable.  |
      |   15  | 52      |   |        | |             |W.         |
      +-------+---------+---+--------+-+-------------+-----------+
        +------------------------------------------------------+
        |   METEOROLOGICAL OBSERVATIONS, made at SPRING-MILL,  |
        |     13 miles NNW. of Philadelphia. April, 1788.      |
        +-------+-----------------------+----------------------+
        |       |   DAYS of             |                      |
        |       |aur. boreal.           |                      |
        |       | |rain.                |                      |
        |       | | |thunder.           |                      |
        |       | | | |snow.            |                      |
        |       | | | | | +-------------|                      |
        |       | | | | | |   WATER.    |                      |
        |   D.  | | | | | |  of RAIN    |                      |
        | of the| | | | | |  and SNOW.  |                      |
        | month.| | | | | |in. pts. 1/16|     WEATHER.         |
        +-------+-+-+-+-+-+-------------+----------------------+
        |    1  | | | | | |             |Overcast, fair.       |
        |    2  | | | | | |             |Overcast and windy.   |
        |    3  | |1| | | |      1   15 |Overcast, rainy.      |
        |    4  | | | | | |             |Overcast.             |
        |    5  | | | | | |             |Overcast, fair.       |
        |    6  | |1| | | |      1    3 |Overcast, rainy.      |
        |    7  | |1| | | |      2    7 |Overcast, rainy.      |
        |    8  | |1| | | |      1    4 |Rainy.                |
        |    9  | | | | | |             |Overcast, windy.      |
        |   10  | | | | | |             |Fair.                 |
        |   11  | | | | | |             |Very fair.            |
        |   12  | |1| | | |      1   11 |Overcast, rainy.      |
        |   13  | | | | | |             |Very fair.            |
        |   14  | |1| | | |      1   14 |Fair, overcast, rainy.|
        |   15  | |1| | | |      2   13 |Foggy, rainy.         |
        +-------+-+-+-+-+-+-------------+----------------------+
        |    METEOROLOGICAL OBSERVATIONS, made at PITTSBURG,   |
        |     284 miles west of Philadelphia. April, 1788.     |
        +-------+-+-+-+-+-+-------------+----------------------+
        |    1  | |1| | | |             |Cloudy.               |
        |    2  | | | | | |             |Clear.                |
        |    3  | |1| | | |             |Cloudy.               |
        |    4  | | | | | |             |Clear.                |
        |    5  | |1|1| | |             |Cloudy.               |
        |    6  | |1| | | |             |Cloudy.               |
        |    7  | | | | | |             |Cloudy.               |
        |    8  | |1|1| | |             |Cloudy.               |
        |    9  | | | | | |             |Cloudy.               |
        |   10  | | | | | |             |Cloudy, with wind.    |
        |   11  | | | | | |             |Clear.                |
        |   12  | | | | | |             |Cloudy, with wind.    |
        |   13  | | | | | |             |Clear.                |
        |   14  | |1| | | |             |Cloudy.               |
        |   15  | | | | | |             |Cloudy.               |
        +-------+-+-+-+-+-+-------------+----------------------+

From a review of all the facts which have been mentioned, it appears
that the climate of Pennsylvania is a compound of most of the climates
in the world. Here we have the moisture of Britain in the spring, the
heat of Africa in summer, the temperature of Italy in June, the sky of
Egypt in the autumn, the cold and snows of Norway and the ice of Holland
in the winter, the tempests (in a certain degree) of the West-Indies in
every season, and the variable winds and weather of Great-Britain in
every month of the year.

From this history of the climate of Pennsylvania, it is easy to
ascertain what degrees of health, and what diseases prevail in the
state. As we have the climates, so we have the health, and the acute
diseases, of all the countries that have been mentioned. Without
attempting to enumerate the diseases, I shall only add a few words upon
the _time_ and _manner_ in which they are produced.

I. It appears from the testimonies of many aged persons, that pleurisies
and inflammatory diseases of all kinds, are less frequent now than they
were forty or fifty years ago.

II. It is a well known fact, that intermitting and bilious fevers
have increased in Pennsylvania in proportion as the country has been
_cleared of its wood_, in many parts of the state.

III. It is equally certain that these fevers have lessened, or
disappeared, in proportion as the country has been _cultivated_.

IV. Heavy rains and freshes in the spring seldom produce fevers, unless
they are succeeded by unseasonably warm weather.

V. Sudden changes from great heat to cold, or cool weather, if they
occur before the 20th of August, seldom produce fevers. After that time,
they are generally followed by them.

VI. The same state of the atmosphere, whether cold or warm, moist or
dry, continued for a long time, without any material changes, is always
healthy. Acute and inflammatory fevers were in vain looked for in the
cold winter of 1779-80. The dry summer of 1782, and the wet summer of
1788, were likewise uncommonly healthy in the city of Philadelphia.
These facts extend only to those diseases which depend upon the sensible
qualities of the air, for diseases from miasmata and contagion, are less
influenced by the uniformity of the weather. The autumn of 1780 was very
sickly in Philadelphia, from the peculiar situation of the grounds in
the neighbourhood of the city, while the country was uncommonly healthy.
The dry summer and autumn of 1782 were uncommonly sickly in the country,
from the extensive sources of morbid exhalations which were left by the
diminution of the waters in the creeks and rivers.

VII. Diseases are often _generated_ in one season and _produced_ in
another. Hence we frequently observe fevers of different kinds to
_follow_ every species of the weather that was mentioned in the last
observation.

VIII. The excessive heat in Pennsylvania has sometimes proved fatal to
persons who have been much exposed to it. Its morbid effects discover
themselves by a difficulty of breathing, a general languor, and, in
some instances, by a numbness and an immobility of the extremities. The
excessive cold in Pennsylvania has more frequently proved fatal, but it
has been chiefly to those persons who have sought a defence from it,
by large draughts of spiritous liquors. Its operation in bringing on
sleepiness previous to death, is well known. On the 5th of February,
1788, many people were affected by the cold. It produced a violent
pain in the head; and, in one instance, a sickness at the stomach,
and a vomiting appeared to be the consequence of it. I have frequently
observed that a greater number of old people die, during the continuance
of extreme cold and warm weather, than in the same number of days in
moderate weather.

IX. May and June are usually the healthiest months in the year.

X. The influence of the winds upon health, depends very much upon the
nature of the country over which they pass. Winds which pass over
mill-dams and marshes in August and September, generally carry with them
the seeds of fevers.

XI. The country in the neighbourhood of Philadelphia was formerly more
sickly than the central parts of the city, after the 20th of August.
Since the year 1793, the reverse of this has been the case.

XII. The night-air is always unwholesome from the 20th of August,
especially during the passive state of the system in _sleep_. The
frequent and sudden changes of the air from heat to cold render it
unsafe to sleep with open windows, during the autumnal months.

XIII. Valetudinarians always enjoy the most health in Pennsylvania in
the summer and winter months. The spring, in a particular manner, is
very unfavourable to them.

I shall conclude the account of the influence of the climate of
Pennsylvania upon the human body, with the following observations.

1. The sensations of heat and cold are influenced so much by outward
circumstances, that we often mistake the degrees of them by neglecting
to use such conveniences as are calculated to obviate the effects of
their excess. A native of Jamaica often complains less of the heat, and
a native of Canada of the cold, in their respective countries, than they
do under certain circumstances in Pennsylvania. Even a Pennsylvanian
frequently complains less of the heat in Jamaica, and of the cold in
Canada, than in his native state. The reason of this is plain. In
countries where heat and cold are intense and regular, the inhabitants
guard themselves, by accommodating their houses and dresses to each of
them. The instability and short duration of excessive heat and cold in
Pennsylvania, have unfortunately led its inhabitants, in many instances,
to neglect adopting customs, which are used in hot and cold countries
to guard against them. Where houses are built with a southern or
south-western front exposure, and where other accommodations to the
climate are observed in their construction, the disagreeable excesses
of heat and cold are rendered much less perceptible in Pennsylvania.
Perhaps the application of the principles of philosophy and taste to the
construction of our houses, within the last thirty or forty years, may
be another reason why some old people have supposed that the degrees of
heat and cold are less in Pennsylvania than they were in former years.

2. The variable nature of the climate of Pennsylvania does not render
it _necessarily_ unhealthy. Doctor Huxham has taught us, that the
healthiest seasons in Great-Britain have often been accompanied by the
most variable weather. His words upon this subject convey a reason for
the fact. "When the constitutions of the year are frequently changing,
so that by the _contrast_ a sort of _equilibrium_ is kept up, and health
with it; and that especially if persons are careful to guard themselves
well against these sudden changes[36]." Perhaps no climate or country is
unhealthy, where men acquire from experience, or tradition, the arts of
accommodating themselves to it. The history of all the nations of the
world, whether savage, barbarous, or civilized, previously to a mixture
of their manners by an intercourse with strangers, seems to favour this
opinion. The climate of China appears, in many particulars, to resemble
that of Pennsylvania. The Chinese wear loose garments of different
lengths, and increase or diminish the number of them, according to the
frequent and sudden changes of their weather; hence they have very few
acute diseases among them. Those inhabitants of Pennsylvania who have
acquired the arts of conforming to the changes and extremes of our
weather in dress, diet, and manners, escape most of those acute diseases
which are occasioned by the sensible qualities of the air; and faithful
inquiries and observations have proved, that they attain to as great
ages as the same number of people in any part of the world.

  [36] Observations on the Air and Epidemic Diseases, vol. I. p. 5.




                               AN ACCOUNT

                                 OF THE

                        BILIOUS REMITTING FEVER,

                             AS IT APPEARED

                           _IN PHILADELPHIA_,

               IN THE SUMMER AND AUTUMN OF THE YEAR 1780.


Before I proceed to describe this fever, it will be necessary to give
a short account of the weather, and of the diseases which preceded its
appearance.

The spring of 1780 was dry and cool. A catarrh appeared among children
between one year, and seven years of age. It was accompanied by a
defluxion from the eyes and nose, and by a cough and dyspn[oe]a,
resembling, in some instances, the cynanche trachealis, and in others
a peripneumony. In some cases it was complicated with the symptoms of
a bilious remitting, and intermitting fever. The exacerbations of this
fever were always attended with dyspn[oe]a and cough. A few patients
expectorated blood. Some had swellings behind their ears, and others
were affected with small ulcers in the throat. I met with only one case
of this fever in which the pulse indicated bleeding. The rest yielded
in a few days to emetics, blisters, and the bark, assisted by the usual
more simple remedies in such diseases.

An intermittent prevailed among adults in the month of May.

July and August were uncommonly warm. The mercury stood on the 6th of
August at 94-1/2°, on the 15th of the same month at 95°, and for several
days afterwards at 90°. Many labouring people perished during this month
by the heat, and by drinking, not only cold water, but cold liquors of
several kinds, while they were under the violent impressions of the heat.

The vomiting and purging prevailed universally, during these two warm
months, among the children, and with uncommon degrees of mortality.
Children from one year to eight and nine years old were likewise very
generally affected by blotches and little boils, especially in their
faces. An eruption on the skin, called by the common people the prickly
heat, was very common at this time among persons of all ages. The winds
during these months blew chiefly from the south, and south-west. Of
course they passed over the land which lies between the city, and the
conflux of the rivers Delaware and Schuylkill, the peculiar situation of
which, at that time, has been already described.

The dock, and the streets of Philadelphia, supplied the winds at this
season, likewise, with a portion of their unwholesome exhalations.

The muschetoes were uncommonly numerous during the autumn. A certain
sign (says Dr. Lind) of an unwholesome atmosphere.

The remitting fever made its first appearance in July and August, but
its symptoms were so mild, and its extent so confined, that it excited
no apprehensions of its subsequent more general prevalence throughout
the city.

On the 19th of August the air became suddenly very cool. Many hundred
people in the city complained, the next day, of different degrees of
indisposition, from a sense of lassitude, to a fever of the remitting
type. This was the signal of the epidemic. The weather continued cool
during the remaining part of the month, and during the whole month of
September. From the exposure of the district of Southwark (which is
often distinguished by the name of the _Hill_) to the south-west winds,
the fever made its first appearance in that appendage of the city.
Scarcely a family, and, in many families, scarcely a member of them,
escaped it. From the Hill it gradually travelled along the second street
from the Delaware, improperly called Front-street. For a while it was
confined to this street only, after it entered the city, and hence it
was called by some people the _Front-street fever_. It gradually spread
through other parts of the city, but with very different degrees of
violence. It prevailed but little in the Northern Liberties. It was
scarcely known beyond Fourth-street from the Delaware. Intemperance in
eating or drinking, riding in the sun or rain, watching, fatigue, or
even a fright, but more frequently cold, all served to excite the seeds
of this fever into action, where-ever they existed.

All ages and both sexes were affected by this fever. Seven of the
practitioners of physic were confined by it nearly at the same time. The
city, during the prevalence of the fever, was filled with an unusual
number of strangers, many of whom, particularly the Friends (whose
yearly meeting was held in the month of September), were affected by
it. No other febrile disease was observed during this time in the city.

This fever generally came on with rigour, but seldom with a regular
chilly fit, and often without any sensation of cold. In some persons it
was introduced by a slight sore throat, and in others by a hoarseness
which was mistaken for a common cold. A giddiness in the head was the
forerunner of the disease in some people. This giddiness attacked so
suddenly, as to produce, in several instances, a faintness, and even
symptoms of apoplexy. It was remarkable, that all those persons who were
affected in this violent manner, recovered in two or three days.

I met with one instance of this fever attacking with coma, and another
with convulsions, and with many instances, in which it was introduced by
a delirium.

The pains which accompanied this fever were exquisitely severe in the
head, back, and limbs. The pains in the head were sometimes in the back
parts of it, and at other times they occupied only the eyeballs. In some
people, the pains were so acute in their backs and hips, that they could
not lie in bed. In others, the pains affected the neck and arms, so as
to produce in one instance a difficulty of moving the fingers of the
right hand. They all complained more or less of a soreness in the seats
of these pains, particularly when they occupied the head and eyeballs. A
few complained of their flesh being sore to the touch, in every part of
the body. From these circumstances, the disease was sometimes believed
to be a rheumatism; but its more general name among all classes of
people was, the _break-bone fever_.

I met with one case of pain in the back, and another of an acute
ear-ach, both of which returned periodically every night, and without
any fever.

A nausea universally, and in some instances a vomiting, accompanied by a
disagreeable taste in the mouth, attended this fever. The bowels were,
in most cases, regular, except where the disease fell with its whole
force upon them, producing a dysentery.

The tongue was generally moist, and tinctured of a yellow colour.

The urine was high coloured, and in its usual quantity in fevers.

The skin was generally moist, especially where the disease terminated on
the third or fourth day.

The pulse was quick and full, but never hard, in a single patient that
came under my care, till the 28th of September.

It was remarkable, that little, and, in some instances, no thirst
attended this fever.

A screatus, or constant hawking and spitting, attended in many cases
through the whole disease, and was a favourable symptom.

There were generally remissions in this fever every morning, and
sometimes in the evening. The exacerbations were more severe every other
day, and two exacerbations were often observed in one day.

A rash often appeared on the third and fourth days, which proved
favourable. This rash was accompanied, in some cases, by a burning in
the palms of the hands and soles of the feet. Many people at this time,
who were not confined to their beds, and some, who had no fever, had an
efflorescence on their skins.

In several persons the force of the disease seemed to fall upon the
face, producing swellings under the jaw and in the ears, which in some
instances terminated in abscesses.

When the fever did not terminate on the third or fourth day, it
frequently ran on to the eleventh, fourteenth, and even twentieth days,
assuming in its progress, according to its duration, the usual symptoms
of the typhus gravior, or mitior, of Doctor Cullen. In some cases, the
discharge of a few spoons-full of blood from the nose accompanied a
solution of the fever on the third or fourth day; while in others, a
profuse hæmorrhage from the nose, mouth, and bowels, on the tenth and
eleventh days, preceded a fatal issue of the disease.

Several cases came under my care, in which the fever was succeeded by a
jaundice.

The disease terminated in some cases without sweating, or a sediment in
the urine; nor did I observe such patients more disposed to relapse than
others, provided they took a sufficient quantity of the bark.

About the beginning of October the weather became cool, accompanied
by rain and an easterly wind. This cool and wet weather continued
for four days. The mercury in the thermometer fell to 60°, and fires
became agreeable. From this time the fever evidently declined, or was
accompanied by inflammatory symptoms. On the 16th of October, I met
with a case of inflammatory angina; and on the next day I visited a
patient who had a complication of the bilious fever with a pleurisy, and
whose blood discovered strong marks of the presence of the inflammatory
diathesis. His stools were of a green and black colour. On the third
day of his disease a rash appeared on his skin, and on the fourth, in
consequence of a second bleeding, his fever terminated with the common
symptoms of a crisis.

During the latter end of October, and the first weeks in November, the
mercury in the thermometer fluctuated between 50° and 60°. Pleurisies
and inflammatory diseases of all kinds now made their appearance. They
were more numerous and more acute, than in this stage of the autumn, in
former years. I met with one case of pleurisy in November, which did not
yield to less than four plentiful bleedings.

I shall now add a short account of the METHOD I pursued in the treatment
of this fever.

I generally began by giving a gentle vomit of tartar emetic. This
medicine, if given while the fever was in its forming state, frequently
produced an immediate cure; and if given after its formation, on the
_first_ day, seldom failed of producing a crisis on the third or fourth
day. The vomit always discharged more or less bile. If a nausea, or
an ineffectual attempt to vomit continued after the exhibition of the
tartar emetic, I gave a second dose of it with the happiest effects.

If the vomit failed of opening the bowels, I gave gentle doses of salts
and cream of tartar[37], or of the butter-nut pill[38], so as to procure
two or three plentiful stools. The matter discharged from the bowels was
of a highly bilious nature. It was sometimes so acrid as to excoriate
the rectum, and so offensive, as to occasion, in some cases, sickness
and faintness both in the patients and in their attendants. In every
instance, the patients found relief by these evacuations, especially
from the pains in the head and limbs.

  [37] I have found that cream of tartar renders the purging neutral
       salts less disagreeable to the taste and stomach; but accident
       has lately taught me, that the juice of two limes or of one
       lemon, with about half an ounce of loaf sugar, added to six
       drachms of Glauber or Epsom salt, in half a pint of boiling
       water, form a mixture that is nearly as pleasant as strong
       beverage.

  [38] This pill is made from an extract of a strong decoction of the
       bark of the white walnut-tree.

In those cases, where the prejudices of the patients against an emetic,
or where an advanced state of pregnancy, or a habitual predisposition
to a vomiting of blood occurred, I discharged the bile entirely by
means of the lenient purges that have been mentioned. In this practice
I had the example of Doctor Cleghorn, who prescribed purges with great
success in a fever of the same kind in Minorca, with that which has been
described[39]. Doctor Lining prescribed purges with equal success in an
autumnal pleurisy in South Carolina, which I take to have been a form
of a bilious remittent, accompanied by an inflammatory affection of the
breast.

  [39] The tertiana interposita remissione tantum of Dr. Cullen.

After evacuating the contents of the stomach and bowels, I gave small
doses of tartar emetic, mixed with Glauber's salt. This medicine excited
a general perspiration. It likewise kept the bowels gently open, by
which means the bile was discharged as fast as it was accumulated.

I constantly recommended to my patients, in this stage of the disorder,
to _lie in bed_. This favoured the eruption of the rash, and the
solution of the disease by perspiration. Persons who struggled against
the fever by _sitting up_, or who attempted to shake it off by labour or
exercise, either sunk under it, or had a slow recovery.

A clergyman of a respectable character from the country, who was
attacked by the disease in the city, returned home, from a desire of
being attended by his own family, and died in a few days afterwards.
This is only one, of many cases, in which I have observed travelling,
even in the easiest carriages, to prove fatal in fevers after they were
formed, or after the first symptoms had shown themselves. The quickest
and most effectual way of conquering a fever, in most cases, is, by an
early submission to it.

The drinks I recommended to my patients were sage and balm teas, weak
punch, lemonade, wine whey, tamarind and apple water.

The apple water should be made by pouring boiling water upon slices of
raw apples. It is more lively than that which is made by pouring the
water on roasted apples.

I found obvious advantages, in many cases, from the use of pediluvia,
every night.

In every case, I found the patients refreshed and relieved by frequent
changes of their linen.

On the third or fourth day, in the forenoon, the pains in the head and
back generally abated, with a sweat which was diffused over the whole
body. The pulse at this time remained quick and weak. This was, however,
no objection to the use of the bark, a few doses of which immediately
abated its quickness, and prevented a return of the fever.

If the fever continued beyond the third or fourth day without an
intermission, I always had recourse to blisters. Those which were
applied to the neck, and behind the ears, produced the most immediate
good effects. They seldom failed of producing an intermission in the
fever, the day after they were applied. Where delirium or coma attended,
I applied the blister to the neck on the _first_ day of the disease. A
worthy family in this city will always ascribe the life of a promising
boy, of ten years old, to the early application of a blister to the
neck, in this fever.

Where the fever did not yield to blisters, and assumed malignant, or
typhus symptoms, I gave the medicines usually exhibited in both those
states of fever.

I took notice, in the history of this fever, that it was sometimes
accompanied with symptoms of a dysentery. Where this disease appeared,
I prescribed lenient purges and opiates. Where these failed of success,
I gave the bark in the intermissions of the pain in the bowels, and
applied blisters to the wrists. The good effects of these remedies led
me to conclude, that the dysentery was the febris introversa of Dr.
Sydenham.

I am happy in having an opportunity, in this place, of bearing a
testimony in favour of the usefulness of OPIUM in this disease, after
the necessary evacuations had been made. I yielded, in prescribing it
at first, to the earnest solicitations of my patients for something to
give them relief from their insupportable pains, particularly when they
were seated in the eyeballs and head. Its salutary effects in procuring
sweat, and a remission of the fever, led me to prescribe it afterwards
in almost every case, and always with the happiest effects. Those
physicians enjoy but little pleasure in practising physic, who know not
how much of the pain and anguish of fevers, of a certain kind, may be
lessened by the judicious use of opium.

In treating of the remedies used in this disease, I have taken no notice
of blood-letting. Out of several hundred patients whom I visited in this
fever, I did not meet with a single case, before the 27th of September,
in which the state of the pulse indicated this evacuation. It is true,
the pulse was _full_, but never _hard_. I acknowledge that I was called
to several patients who had been bled without the advice of a physician,
who recovered afterwards on the usual days of the solution of the fever.
This only can be ascribed to that disposition which Doctor Cleghorn
attributes to fevers, to preserve their types under every variety of
treatment, as well as constitution. But I am bound to declare further,
that I heard of several cases in which bleeding was followed by a fatal
termination of the disease.

In this fever relapses were very frequent, from exposure to the rain,
sun, or night air, and from an excess in eating or drinking.

The convalescence from this disease was marked by a number of
extraordinary symptoms, which rendered patients the subjects of medical
attention for many days after the pulse became perfectly regular, and
after the crisis of the disease.

A bitter taste in the mouth, accompanied by a yellow colour on the
tongue, continued for near a week.

Most of those who recovered complained of nausea, and a total want of
appetite. A faintness, especially upon sitting up in bed, or in a chair,
followed this fever. A weakness in the knees was universal. I met with
two patients, who were most sensible of this weakness in the right knee.
An inflammation in one eye, and in some instances in both eyes, occurred
in several patients after their recovery.

But the most remarkable symptom of the convalescence from this fever,
was an uncommon dejection of the spirits. I attended two young ladies,
who shed tears while they vented their complaints of their sickness
and weakness. One of them very aptly proposed to me to change the name
of the disease, and to call it, in its present stage, instead of the
break-bone, the _break-heart fever_.

To remove these symptoms, I gave the tincture of bark and elixir of
vitriol in frequent doses. I likewise recommended the plentiful use of
ripe fruits; but I saw the best effects from temperate meals of oysters,
and a liberal use of porter. To these was added, gentle exercise in the
open air, which gradually completed the cure.




                               AN ACCOUNT

                                 OF THE

                         _SCARLATINA ANGINOSA_,

                                 AS IT

                       APPEARED IN PHILADELPHIA,

                      IN THE YEARS 1783 AND 1784.


The beginning of the month of July was unusually cool; insomuch that
the mercury in Fahrenheit's thermometer stood at 61° in the day time,
and fires were very comfortable, especially in the evening. In the last
week but one of this month, the weather suddenly became so warm, that
the mercury rose to 94-1/2°, at which it remained for three days. As
this heat was accompanied by no breeze from any quarter, the sense of
it was extremely distressing to many people. Upwards of twenty persons
died in the course of those three days, from the excess of the heat,
and from drinking cold water. Three old people died suddenly within
this space of time. This extreme heat was succeeded by cool weather,
the mercury having fallen to 60°, and the month closed with producing
a few intermitting and remitting fevers, together with several cases of
inflammatory angina.

The weather in the month of August was extremely variable. The mercury,
after standing for several days at 92°, suddenly fell so low, as not
only to render fires necessary, but in many places to produce frost.

Every form of fever made its appearance in this month. The synocha was
so acute, in several cases, as to require from three to four bleedings.
The remitting fever was accompanied by an uncommon degree of nausea
and faintness. Several people died, after a few days' illness, of
the malignant bilious fever, or typhus gravior, of Dr. Cullen. The
intermittents had nothing peculiar in them, in their symptoms or method
of cure.

Towards the close of the month, the scarlatina anginosa made its
appearance, chiefly among children.

The month of September was cool and dry, and the scarlatina anginosa
became epidemic among adults as well as young people. In most of the
patients who were affected by it, it came on with a chilliness and a
sickness at the stomach, or a vomiting; which last was so invariably
present, that it was with me a pathognomonic sign of the disease. The
matter discharged from the stomach was always bile. The swelling of
the throat was in some instances so great, as to produce a difficulty
of speaking, swallowing, and breathing. In a few instances, the speech
was accompanied by a squeaking voice, resembling that which attends the
cynanche trachealis. The ulcers on the tonsils were deep, and covered
with white, and, in some instances, with black sloughs. In several
cases, there was a discharge of a thick mucus from the nose, from the
beginning, but it oftener occurred in the decline of the disease, which
most frequently happened on the fifth day. Sometimes the subsiding of
the swelling of the throat was followed by a swelling behind the ears.

An eruption on the skin generally attended the symptoms which have been
described. But this symptom appeared with considerable variety. In some
people it preceded, and in others it followed the ulcers and swelling of
the throat. In some, it appeared only on the outside of the throat, and
on the breast; in others, it appeared chiefly on the limbs. In a few it
appeared on the second or third day of the disease, and never returned
afterwards. I saw two cases of eruption without a single symptom of
sore throat. The face of one of those patients was swelled, as in the
erisypelas. In the other, a young girl of seven years old, there was
only a slight redness on the skin. She was seized with a vomiting, and
died delirious in fifty-four hours. Soon after her death, a livid colour
appeared on the outside of her throat.

The bowels, in this degree of the disease, were in general regular. I
can recollect but few cases which were attended by a diarrh[oe]a.

The fever which accompanied the disease was generally the typhus mitior
of Doctor Cullen. In a few cases it assumed symptoms of great malignity.

The disease frequently went off with a swelling of the hands and feet.
I saw one instance in a gentlewoman, in whom this swelling was absent,
who complained of very acute pains in her limbs, resembling those of the
rheumatism.

In two cases which terminated fatally, there were large abscesses; the
one on the outside, and the other on the inside of the throat. The first
of these cases was accompanied by troublesome sores on the ends of the
fingers. One of these patients lived twenty-eight, and the other above
thirty days, and both appeared to die from the discharge which followed
the opening of their abscesses.

Between the degrees of the disease which I have described, there were
many intermediate degrees of indisposition which belonged to this
disease.

I saw in several cases a discharge from behind the ears, and from the
nose, with a slight eruption, and no sore throat. All these patients
were able to sit up, and walk about.

I saw one instance of a discharge from the inside of one of the ears in
a child, who had ulcers in his throat, and the squeaking voice.

In some, a pain in the jaw, with swellings behind the ears, and a slight
fever, constituted the whole of the disease.

In one case, the disease came on with a coma, and in several patients it
went off with this symptom.

A few instances occurred of adults, who walked about, and even
transacted business, until a few hours before they died.

The intermitting fever, which made its appearance in August, was not
lost during the month of September. It continued to prevail, but with
several peculiar symptoms. In many persons it was accompanied by an
eruption on the skin, and a swelling of the hands and feet. In some,
it was attended by a sore throat and pains behind the ears. Indeed,
such was the predominance of the scarlatina anginosa, that many
hundred people complained of sore throats, without any other symptom
of indisposition. The slightest occasional or exciting cause, and
particularly cold, seldom failed of producing the disease.

The month of October was much cooler than September, and the disease
continued, but with less alarming symptoms. In several adults, who were
seized with it, the hardness of the pulse indicated blood-letting. The
blood, in one case, was covered with a buffy coat, but beneath its
surface it was dissolved.

In the month of November, the disease assumed several inflammatory
symptoms, and was attended with much less danger than formerly. I
visited one patient whose symptoms were so inflammatory as to require
two bleedings. During the decline of the disease, many people complained
of troublesome sores on the ends of their fingers. A number of children
likewise had sore throats and fevers, with eruptions on their skins,
which resembled the chicken-pox. I am disposed to suspect that this
eruption was the effect of a spice of the scarlatina anginosa, as
several instances occurred of patients who had all the symptoms of this
disease, in whom an eruption of white blisters succeeded their recovery.
This form of the disease has been called by Sauvage, the scarlatina
variolosa.

I saw one case of sore throat, which was succeeded not only by swellings
in the abdomen and limbs, but by a catarrh, which brought on a fatal
consumption.

A considerable shock of an earthquake was felt on the 29th of this
month, at ten o'clock at night, in the city of Philadelphia; but no
change was perceived in the disease, in consequence of it.

In December, January, and February, the weather was intensely cold.
There was a thaw for a few days in January, which broke the ice of the
Delaware, but it was followed by cold so excessive, as to close the
river till the beginning of March. The mercury, on the 28th and 29th of
February, stood below 0 in Fahrenheit's thermometer.

For a few weeks in the beginning of December, the disease disappeared
in the circle of my patients, but it broke out with great violence the
latter end of that month, and in the January following. Some of the
worst cases that I met with (three of which proved fatal) were in those
two months.

The disease disappeared in the spring, but it spread afterwards through
the neighbouring states of New-Jersey, Delaware, and Maryland.

I shall now add an account of the remedies which I administered in this
disease.

In every case that I was called to, I began the cure by giving a vomit
joined with calomel. The vomit was either tartar emetic or ipecacuanha,
according to the prejudices, habits, or constitutions of my patients.
A quantity of bile was generally discharged by this medicine. Besides
evacuating the contents of the stomach, it cleansed the throat in its
passage downwards. To ensure this effect from the calomel, I always
directed it to be given mixed with syrup or sugar and water, so as to
diffuse it generally over every part of the throat. The calomel seldom
failed to produce two or three stools. In several cases I was obliged,
by the continuance of nausea, to repeat the emetics, and always with
immediate and obvious advantage. I gave the calomel in moderate doses
in every stage of the disease. To restrain its purgative effects, when
necessary, I added to it a small quantity of opium.

During the whole course of the disease, where the calomel failed of
opening the bowels, I gave lenient purges, when a disposition to
costiveness required them.

The throat was kept clean by detergent gargles. In several instances
I saw evident advantages from adding a few grains of calomel to them.
In cases of great difficulty of swallowing or breathing, the patients
found relief from receiving the steams of warm water mixed with a little
vinegar, through a funnel into the throat.

A perspiration kept up by gentle doses of antimonials, and diluting
drinks, impregnated with wine, always gave relief.

In every case which did not yield to the above remedies on the third
day, I applied a blister behind each ear, or one to the neck, and, I
think, always with good effects.

I met with no cases in which the bark appeared to be indicated, except
the three in which the disease proved fatal. Where the sore throat was
blended with the intermitting fever, the bark was given with advantage.
But in common cases it was unnecessary. Subsequent observations have led
me to believe, with Doctor Withering, that it is sometimes hurtful in
this disease.

It proved fatal in many parts of the country, upon its first appearance;
but wherever the mode of treatment here delivered was adopted, its
mortality was soon checked. The calomel was used very generally in
New-Jersey and New-York. In the Delaware state, a physician of character
made it a practice not only to give calomel, but to anoint the outside
of the throat with mercurial ointment.


                        ADDITIONAL OBSERVATIONS

                                UPON THE

                         _Scarlatina Anginosa_.

This disease has prevailed in Philadelphia, at different seasons,
ever since the year 1783. It has blended itself occasionally with all
our epidemics. Many cases have come under my notice since its first
appearance, in which dropsical swellings have succeeded the fever. In
some instances there appeared to be effusions of water not only in the
limbs and abdomen, but in the thorax. They yielded, in every case that
I attended, to purges of calomel and jalap. Where these swellings were
neglected, they sometimes proved fatal.

In the winter of 1786-7, the scarlatina anginosa was blended with the
cynanche parotidea, and in one instance with a typhus mitior. The
last was in a young girl of nine years of age. She was seized with a
vomiting of bile and an efflorescence on her breast, but discovered no
other symptoms of the scarlatina anginosa till the sixteenth day of her
fever, when a swelling appeared on the outside of her throat, and after
her recovery, a pain and swelling in one of her knees.

In the month of July, 1787, a number of people were affected by sudden
swellings of their lips and eyelids. These swellings generally came on
in the night, were attended with little or no pain, and went off in two
or three days. I met with only one case in which there was a different
issue to these symptoms. It was in a patient in the Pennsylvania
hospital, in whom a swelling in the lips ended in a suppuration, which,
notwithstanding the liberal use of bark and wine, proved fatal in the
course of twelve days.

In the months of June and July, 1788, a number of people were affected
by sudden swellings, not only of the lips, but of the cheeks and throat.
At the same time many persons were affected by an inflammation of the
eyes. The swellings were attended with more pain than they were the year
before, and some of them required one or two purges to remove them; but
in general they went without medicine, in two or three days.

Is it proper to refer these complaints to the same cause which produces
the scarlatina anginosa?

The prevalence of the scarlatina anginosa at the _same time_ in this
city; its disposition to produce swellings in different parts of the
body; and the analogy of the intermitting fever, which often conceals
itself under symptoms that are foreign to its usual type; all seem to
render this conjecture probable. In one of the cases of an inflammation
of the eye, which came under my notice, the patient was affected by a
vomiting a few hours before the inflammation appeared, and complained
of a sickness at his stomach for two or three days afterwards. Now
a vomiting and nausea appear to be very generally symptoms of the
scarlatina anginosa.

In the autumn of 1788, the scarlatina anginosa appeared with different
degrees of violence in many parts of the city. In two instances it
appeared with an obstinate diarrh[oe]a; but it was in young subjects,
and not in adults, as described by Doctor Withering. In both cases, the
disease proved fatal; the one on the third, the other on the fifth day.

In the month of December of the same year, I saw one case in which a
running from one of the ears, and a deafness came on, on the fifth day,
immediately after the discharge of mucus from the nose had ceased. This
case terminated favourably on the ninth day, but was succeeded, for
several days afterwards, by a troublesome cough.

I shall conclude this essay by the following remarks:

1. Camphor has often been suspended in a bag from the neck, as a
preservative against this disease. Repeated observations have taught
me, that it possesses little or no efficacy for this purpose. I have
had reason to entertain a more favourable opinion of the benefit of
washing the hands and face with vinegar, and of rinsing the mouth and
throat with vinegar and water every morning, as means of preventing this
disease.

2. Whenever I have been called to a patient where the scarlatina
appeared to be in a _forming_ state, a vomit of ipecacuanha or tartar
emetic, mixed with a few grains of calomel, has never failed of
completely checking the disease, or of so far mitigating its violence,
as to dispose it to a favourable issue in a few days; and if these
observations should serve no other purpose than to awaken the early
attention of patients and physicians to this speedy and effectual
remedy, they will not have been recorded in vain.

3. When the matter which produces this disease has been received into
the body, a purge has prevented its being excited into action, or
rendered it mild, throughout a whole family. For this practice I am
indebted to some observations on the scarlatina, published by Dr. Sims
in the first volume of the Medical Memoirs.

4. During the prevalence of the inflammatory constitution of the
atmosphere, between the years 1793 and 1800, this disease occurred
occasionally in Philadelphia, and yielded, like the other epidemics of
those years, to copious blood-letting, and other depleting remedies.




                               AN INQUIRY

                                  INTO

                           THE CAUSE AND CURE

                                   OF

                        _THE CHOLERA INFANTUM_.


By this name I mean to designate a disease, called, in Philadelphia,
the "vomiting and purging of children." From the regularity of its
appearance in the summer months, it is likewise known by the name of
"the disease of the season." It prevails in most of the large towns of
the United States. It is distinguished in Charleston, in South Carolina,
by the name of "the April and May disease," from making its first
appearance in those two months. It seldom appears in Philadelphia till
the middle of June, or the beginning of July, and generally continues
till near the middle of September. Its frequency and danger are always
in proportion to the heat of the weather. It affects children from the
first or second week after their birth, till they are two years old. It
sometimes begins with a diarrh[oe]a, which continues for several days
without any other symptom of indisposition; but it more frequently comes
on with a violent vomiting and purging, and a high fever. The matter
discharged from the stomach and bowels is generally yellow or green,
but the stools are sometimes slimy and bloody, without any tincture
of bile. In some instances they are nearly as limpid as water. Worms
are frequently discharged in each kind of the stools that has been
described. The children, in this stage of the disease, appear to suffer
a good deal of pain. They draw up their feet, and are never easy in one
posture. The pulse is quick and weak. The head is unusually warm, while
the extremities retain their natural heat, or incline to be cold. The
fever is of the remitting kind, and discovers evident exacerbations,
especially in the evenings. The disease affects the head so much, as in
some instances to produce symptoms not only of delirium, but of mania,
insomuch that the children throw their heads backwards and forwards, and
sometimes make attempts to scratch, and to bite their parents, nurses,
and even themselves. A swelling frequently occurs in the abdomen, and
in the face and limbs. An intense thirst attends every stage of the
disease. The eyes appear languid and hollow, and the children generally
sleep with them half closed. Such is the insensibility of the system in
some instances in this disease, that flies have been seen to alight upon
the eyes when open, without exciting a motion in the eyelids to remove
them. Sometimes the vomiting continues without the purging, but more
generally the purging continues without the vomiting, through the whole
course of the disease. The stools are frequently large, and extremely
f[oe]tid, but in some instances they are without smell, and resemble
drinks and aliment which have been taken into the body. The disease is
sometimes fatal in a few days. I once saw it carry off a child in four
and twenty hours. Its duration is varied by the season of the year, and
by the changes in the temperature of the weather. A cool day frequently
abates its violence, and disposes it to a favourable termination. It
often continues, with occasional variations in its appearance, for six
weeks or two months. Where the disease has been of long continuance, the
approach of death is gradual, and attended by a number of distressing
symptoms. An emaciation of the body to such a degree, as that the
bones come through the skin, livid spots, a singultus, convulsions, a
strongly marked hippocratic countenance, and a sore mouth, generally
precede the fatal termination of this disease. Few children ever
recover, after the last symptoms which have been mentioned make their
appearance.

This disease has been ascribed to several causes; of each of which I
shall take notice in order.

I. It has been attributed to dentition. To refute this opinion, it will
be necessary to observe, that it appears only in one season of the year.
Dentition, I acknowledge, sometimes aggravates it; hence we find it is
most severe in that period of life, when the greatest number of teeth
make their appearance, which is generally about the 10th month. I think
I have observed more children to die of this disease at that age, than
at any other.

II. Worms have likewise been suspected of being the cause of this
disease. To this opinion, I object the uncertainty of worms ever
producing an idiopathic fever, and the improbability of their combining
in such a manner as to produce an annual epidemic disease of any kind.
But further, we often see the disease in all its force, before that age,
in which worms usually produce diseases; we likewise often see it resist
the most powerful anthelmintic medicines; and, lastly, it appears
from dissection, where the disease has proved fatal, that not a single
worm has been discovered in the bowels. It is true, worms are in some
instances discharged in this disease, but they are frequently discharged
in greater numbers in the hydrocephalus internus, and in the small-pox,
and yet who will assert either of those diseases to be produced by worms.

III. The summer fruits have been accused of producing this disease. To
this opinion I object, that the disease is but little known in country
places, where children eat much more fruit than in cities. As far as I
have observed, I am disposed to believe, that the moderate use of ripe
fruits, rather tends to prevent, than to induce the disease.

From the discharge of bile which generally introduces the disease,
from the remissions and exacerbations of the fever which accompanies
it, and from its occurring nearly in the same season with the cholera
and remitting fever in adults, I am disposed to consider it as a
modification of the same diseases. Its appearance earlier in the season
than the cholera and remitting fever in adults, must be ascribed to the
constitutions of children being more predisposed from weakness to be
acted upon, by the remote causes which produce those diseases.

I shall now mention the remedies which are proper and useful in this
disease.

I. The first indication of cure is to evacuate the bile from the stomach
and bowels. This should be done by gentle doses of ipecacuanha, or
tartar emetic. The vomits should be repeated occasionally, if indicated,
in every stage of the disease. The bowels should be opened by means
of calomel, manna, castor oil, or magnesia. I have generally found
rhubarb improper for this purpose, while the stomach was in a very
irritable state. In those cases, where there is reason to believe that
the offending contents of the primæ viæ have been discharged by nature
(which is often the case), the emetics and purges should by no means be
given; but, instead of them, recourse must be had to

II. Opiates. A few drops of liquid laudanum, combined in a testaceous
julep, with peppermint or cinnamon-water, seldom fail of composing the
stomach and bowels. In some instances, this medicine alone subdues
the disease in two or three days; but where it does not prove so
successful, it produces a remission of pain, and of other distressing
symptoms, in every stage of the disease.

III. Demulcent and diluting drinks have an agreeable effect in this
disease. Mint and mallow teas, or a tea made of blackberry roots infused
in cold water, together with a decoction of the shavings of hartshorn
and gum arabic with cinnamon, should all be given in their turns for
this purpose.

IV. Glysters made of flaxseed tea, or of mutton broth, or of starch
dissolved in water, with a few drops of liquid laudanum in them, give
ease, and produce other useful effects.

V. Plasters of Venice treacle applied to the region of the stomach,
and flannels dipped in infusions of bitter and aromatic herbs in warm
spirits, or Madeira wine, and applied to the region of the abdomen,
often afford considerable relief.

VI. As soon as the more violent symptoms of the disease are composed,
tonic and cordial medicines should be given. The bark in decoction,
or in substance (where it can be retained in that form), mixed with
a little nutmeg, often produces the most salutary effects. Port wine
or claret mixed with water are likewise proper in this stage of the
disease. After the disease has continued for some time, we often see
an appetite suddenly awakened for articles of diet of a stimulating
nature. I have seen many children recover from being gratified in an
inclination to eat salted fish, and the different kinds of salted meat.
In some instances they discover an appetite for butter, and the richest
gravies of roasted meats, and eat them with obvious relief to all their
symptoms. I once saw a child of sixteen months old, perfectly restored,
from the lowest stage of this disease, by eating large quantities of
rancid English cheese, and drinking two or three glasses of port wine
every day. She would in no instance eat bread with the cheese, nor taste
the wine, if it was mixed with water.

We sometimes see relief given by the use of the warm bath, in cases
of obstinate pain. The bath is more effectual, if warm wine is used,
instead of water.

I have had but few opportunities of trying the effects of cold water
applied to the body in this disease; but from the benefit which
attended its use in the cases in which it was prescribed, I am disposed
to believe that it would do great service, could we overcome the
prejudices which subsist in the minds of parents against it.

After all that has been said in favour of the remedies that have been
mentioned, I am sorry to add, that I have very often seen them all
administered without effect. My principal dependence, therefore, for
many years, has been placed upon

VII. Country air. Out of many hundred children whom I have sent into the
country, in every stage of this disease, I have lost but three; two of
whom were sent, contrary to my advice, into that unhealthy part of the
neighbourhood of Philadelphia called the _Neck_, which lies between the
city and the conflux of the rivers Delaware and Schuylkill. I have seen
one cure performed by this remedy, after convulsions had taken place.
To derive the utmost benefit from the country air, children should be
carried out on horseback, or in a carriage, every day; and they should
be exposed to the open air as much as possible in fair weather, in the
day time. Where the convenience of the constant benefit of country air
cannot be obtained, I have seen evident advantages from taking children
out of the city once or twice a day. It is extremely agreeable to see
the little sufferers revive as soon as they escape from the city air,
and inspire the pure air of the country.

I shall conclude this inquiry, by recommending the following methods of
preventing this disease, all of which have been found by experience to
be useful.

1. The daily use of the cold bath.

2. A faithful and attentive accommodation of the dresses of children, to
the state and changes of the air.

3. A moderate quantity of salted meat taken occasionally in those months
in which this disease usually prevails. It is perhaps in part from the
daily use of salted meat in diet, that the children of country people
escape this disease.

4. The use of sound old wine in the summer months. From a
tea-spoon-full, to half a wine glass full, according to the age of the
child, may be given every day. It is remarkable, that the children of
persons in easy circumstances, who sip occasionally with their parents
the remains of a glass of wine after dinner, are much less subject to
this disease, than the children of poor people, who are without the
benefit of that article of diet.

5. Cleanliness, both with respect to the skin and clothing of children.
Perhaps the neglect of this direction may be another reason why the
children of the poor, are most subject to this disease.

6. The removal of children into the country before the approach of warm
weather. This advice is peculiarly necessary during the whole period of
dentition. I have never known but one instance of a child being affected
by this disease, who had been carried into the country in order to avoid
it.

I have only to add to the above observations, that since the prevalence
of the yellow fever in Philadelphia after the year 1793, the cholera
infantum has assumed symptoms of such malignity, as to require bleeding
to cure it. In some cases, two and three bleedings were necessary for
that purpose.




                              OBSERVATIONS

                                 ON THE

                         _CYNANCHE TRACHEALIS_.


The vulgar name of this disease in Pennsylvania is HIVES. It is a
corruption of the word _heaves_, which took its rise from the manner in
which the lungs heave in breathing. The worst degree of the disease is
called the BOWEL HIVES, from the great motion of the abdominal muscles
in respiration.

It has been called suffocatio stridula by Dr. Home, and cynanche
trachealis by Dr. Cullen. Professor Frank calls it trachitis, and Dr.
Darwin considers it as a pleurisy of the windpipe. By the two latter
names, the authors mean to convey the correct idea, that the disease is
the same in its nature with the common diseases of other internal parts
of the body.

It is brought on by the same causes which induce fever, particularly
by cold. I have seen it accompany, as well as succeed, the small-pox,
measles, scarlet-fever, and apthous sore throat. In the late Dr. Foulke
it succeeded acute rheumatism. The late Dr. Sayre informed me, he had
seen it occur in a case of yellow fever, in the year 1798.

It sometimes comes on suddenly, but it more frequently creeps on in the
form of a common cold. Its symptoms are sometimes constant, but they
more generally remit, particularly during the day. It attacks children
of all ages, from three months to five years old. But it occasionally
attacks adults. It generally runs its course in three or four days, but
we now and then see it protracted in a chronic and feeble form, for
eight and ten days.

Dissections show the following appearances in the trachea. 1. A slight
degree of inflammation. 2. A thick matter resembling mucus. 3. A
membrane similar to that which succeeds inflammation in the pleura and
bowels, formed from the coagulating lymph of the blood. 4. In some cases
the trachea exhibits no marks of disease of any kind. These cases are
generally violent, and terminate suddenly. The morbid excitement here
transcends inflammation. Similar instances of the absence of the common
signs of disease after death, occur in other parts of the body. Where
the cynanche trachealis has appeared in the high grade which has been
last mentioned, it has been called spasmodic. Where the serous vessels
of the trachea have been tinged with red blood, it has been considered
as inflammatory. Where a liquid matter has been found in the trachea,
it has been called humoral; and where a membrane has been seen adhering
to the trachea, it has received from Dr. Michaelis the name of angina
polyposa. But all these different issues of the cynanche trachealis are
the effects of a difference only in its force, or in its duration: they
all depend upon one remote, and one proximate cause.

In the _forming_ state of this disease, which may be easily known
by a hoarseness, and a slight degree of stertorous cough, a puke of
antimonial wine, tartar emetic, ipecacuanha, or oxymel of squills, is
for the most part an immediate cure. To be effectual, it should operate
four or five times. Happily children are seldom injured by a little
excess in the operation of this class of medicines. I have prevented the
formation of this disease many hundred times, and frequently in my own
family, by means of this remedy.

After the disease is completely formed, and appears with the usual
symptoms described by authors, the remedies should be

1. Blood-letting. The late Dr. Bailie of New-York used to bleed until
fainting was induced. His practice has been followed by Dr. Dick of
Alexandria, and with great success. I have generally preferred small,
but frequent, to copious bleedings. I once drew twelve ounces of blood,
at four bleedings, in one day, from a son of Mr. John Carrol, then in
the fourth year of his age. Dr. Physick bled a child, of but three
months old, three times in one day. Life was saved in both these cases.
Powerful as the lancet is, in this disease, its violence and danger
require that it should be aided by

2. Vomits. These should be given every day, or oftener, during the
continuance of the disease. Their good effects are much more obvious
and certain in a disease of the trachea, than of the lungs, and hence
their greater utility, as I shall say hereafter, in a consumption from a
catarrh, than from any other of its causes.

3. Purges. These should consist of calomel and jalap, or rhubarb, and
should always follow the use of emetics, if they fail of opening the
bowels.

4. Calomel should likewise be given in large doses. Dr. Physick gave
half a drachm of this medicine, in one day, to the infant whose case
has been mentioned. I have never known it excite a salivation when
given to children whose ages rendered them subjects of it, probably
because it has been given in such large quantities as to pass rapidly
through the bowels. Its good effects seem to depend upon its exciting a
counter-action in the whole intestinal canal, and thereby lessening the
disposition of the tracheal blood-vessels to discharge the mucus, or
form the membrane, which have been described.

5. Blisters should be applied to the throat, breast, neck, and even to
the limbs.

6. Dr. Archer of Maryland commends, in high terms, the use of polygola,
or Seneka snake-root, in this disease. I can say nothing in favour of
its exclusive use, from my own experience, having never given it, but as
an auxiliary to other remedies.

7. I have seen great relief given by the use of the warm bath,
especially when it has been followed by a gentle perspiration.

8. Towards the close of the disease, after the symptoms of great morbid
action begin to decline, a few drops of liquid laudanum, by quieting
the cough which generally succeeds it, often produce the most salutary
effects. They should be given in flaxseed, or bran, or onion tea, of
which drinks the patient should drink freely in every stage of the
disease.

The cynanche trachealis is attended with most danger, when the patient
labours under a _constant_ and audible stertorous breathing. The danger
is less, when a dry stertorous cough attends, with _easy_ respiration
in its intervals. The danger is nearly over, when the cough, though
stertorous, is _loose_, and accompanied with a _discharge_ of mucus from
the trachea.

An eruption of little red blotches, which frequently appears and
disappears two or three times in the course of this disease, is always a
favourable symptom.

I once attended a man from Virginia, of the name of Bampfield, who,
after an attack of this disease, was much distressed with the stertorous
breathing and cough which belong to it. I suspected both to arise from
a membrane formed by inflammation in his trachea. This membrane I
supposed to be in part detached from the trachea, from the rattling
noise which attended his breathing. He had used many remedies for it
to no purpose. I advised a salivation, which in less than three weeks
perfectly cured him.

Since the general adoption of the remedies which have been enumerated,
for the cynanche trachealis, instances of its mortality have become very
uncommon in the city of Philadelphia.




                               AN ACCOUNT

                           OF THE EFFICACY OF

                         BLISTERS AND BLEEDING,

                        IN THE CURE OF OBSTINATE

                         _Intermitting Fevers_.


The efficacy of these remedies will probably be disputed by every
regular-bred physician, who has not been a witness of their utility in
the above disease; but it becomes such physicians, before they decide
upon this subject, to remember, that many things are true in medicine,
as well as in other branches of philosophy, which are very improbable.

In all those cases of _autumnal_ intermittents, whether quotidian,
tertian, or quartan, in which the bark did not succeed after three or
four days trial, I have seldom found it fail after the application of
blisters to the wrists.

But in those cases where blisters had been neglected, or applied without
effect, and where the disease had been protracted into the _winter_
months, I have generally cured it by means of one or two moderate
bleedings.

The pulse in those cases is generally full, and sometimes a little hard,
and the blood when drawn for the most part appears sizy.

The bark is seldom necessary to prevent the return of the disease.
It is always ineffectual, where blood-letting is indicated. I have
known several instances where pounds of that medicine have been taken
without effect, in which the loss of ten or twelve ounces of blood has
immediately cured the disease.

I once intended to have added to this account of the efficacy of
blisters and bleeding in curing obstinate intermittents, testimonies
from a number of medical gentlemen, of the success with which they have
used them; but these vouchers have become so numerous, that they would
swell this essay far beyond the limits I wish to prescribe to it.




                               AN ACCOUNT

                                   OF

                         THE DISEASE OCCASIONED

                                   BY

                         _DRINKING COLD WATER_

                            IN WARM WEATHER,

                      AND THE METHOD OF CURING IT.


Few summers elapse in Philadelphia, in which there are not instances of
many persons being diseased by drinking cold water. In some seasons,
four or five persons have died suddenly from this cause, in one day.
This mortality falls chiefly upon the labouring part of the community,
who seek to allay their thirst by drinking the water from the pumps in
the streets, and who are too impatient, or too ignorant, to use the
necessary precautions for preventing its morbid or deadly effects upon
them. These accidents seldom happen, except when the mercury rises above
85° in Fahrenheit's thermometer.

Three circumstances generally concur to produce disease or death, from
drinking cold water. 1. The patient is extremely warm. 2. The water is
extremely cold. And 3. A large quantity of it is suddenly taken into the
body. The danger from drinking the cold water is always in proportion to
the degrees of combination which occur in the three circumstances that
have been mentioned.

The following symptoms generally follow, where cold water has been
taken, under the above circumstances, into the body:

In a few minutes after the patient has swallowed the water, he is
affected by a dimness of sight; he staggers in attempting to walk, and,
unless supported, falls to the ground; he breathes with difficulty; a
rattling is heard in his throat; his nostrils and cheeks expand and
contract in every act of respiration; his face appears suffused with
blood, and of a livid colour; his extremities become cold, and his pulse
imperceptible; and, unless relief be speedily obtained, the disease
terminates in death, in four or five minutes.

This description includes only the less common cases of the effects
of drinking a _large_ quantity of _cold_ water, when the body is
_preternaturally_ heated. More frequently, patients are seized with
acute spasms in the breast and stomach. These spasms are so painful as
to produce syncope, and even asphyxia. They are sometimes of the tonic,
but more frequently of the clonic kind. In the intervals of the spasms,
the patient appears to be perfectly well. The intervals between each
spasm become longer or shorter, according as the disease tends to life
or death.

It may not be improper to take notice, that punch, beer, and even toddy,
when drunken under the same circumstances as cold water, have all been
known to produce the same morbid and fatal effects.

I know of but one certain remedy for this disease, and that is LIQUID
LAUDANUM. The doses of it, as in other cases of spasm, should be
proportioned to the violence of the disease. From a tea-spoonful to near
a table-spoonful have been given in some instances, before relief has
been obtained. Where the powers of life appear to be suddenly suspended,
the same remedies should be used, which have been so successfully
employed in recovering persons supposed to be dead from drowning.

Care should be taken in every case of disease, or apparent death, from
drinking cold water, to prevent the patient's suffering from being
surrounded, or even attended by too many people.

Persons who have been recovered from the immediate danger which attends
this disease, are sometimes affected after it, by inflammations and
obstructions in the breast or liver. These generally yield to the usual
remedies which are administered in those complaints, when they arise
from other causes.

If neither the voice of reason, nor the fatal examples of those who
have perished from this cause, are sufficient to produce restraint
in drinking a _large_ quantity of _cold_ liquors, when the body is
_preternaturally_ heated, then let me advise to

1. Grasp the vessel out of which you are about to drink for a minute or
longer, with both your hands. This will abstract a portion of heat from
the body, and impart it at the same time to the cold liquor, provided
the vessel be made of metal, glass, or earth; for heat follows the same
laws, in many instances, in passing through bodies, with regard to its
relative velocity, which we observe to take place in electricity.

2. If you are not furnished with a cup, and are obliged to drink by
bringing your mouth in contact with the stream which issues from a
pump, or a spring, always wash your hands and face, previously to your
drinking, with a little of the cold water. By receiving the shock of
the water first upon those parts of the body, a portion of its heat is
conveyed away, and the vital parts are thereby defended from the action
of the cold.

By the use of these preventives, inculcated by advertisements pasted
upon pumps by the Humane Society, death from drinking cold water has
become a rare occurrence for many years past in Philadelphia.




                               AN ACCOUNT

                                 OF THE

                       _EFFICACY OF COMMON SALT_,

                             IN THE CURE OF

                              HÆMOPTYSIS.


From the present established opinions and practice respecting the
cause and cure of hæmoptysis, the last medicine that would occur to a
regular-bred physician for the cure of it, is COMMON SALT; and yet I
have seen and heard of a great number of cases, in which it has been
administered with success.

The mode of giving it is to pour down from a tea to a table-spoonful
of clean fine salt, as soon as possible after the hæmorrhage begins
from the lungs. This quantity generally stops it; but the dose must
be repeated daily for three or four days, to prevent a return of the
disease. If the bleeding continue, the salt must be continued till it is
checked, but in larger doses. I have heard of several instances in which
two table spoons-full were taken at one time for several days.

It sometimes excites a sickness at the stomach, and never fails to
produce a burning sensation in the throat, in its passage into the
stomach, and considerable thirst afterwards.

I have found this remedy to succeed equally well in hæmorrhages, whether
they occurred in young or in old people, or with a weak or active pulse.

I had prescribed it for several years before I could satisfy myself with
a theory, to account for its extraordinary action upon the human body.
My inquiries led me to attend more particularly to the following facts:

1. Those persons who have been early instructed in vocal music, and who
use their vocal organs moderately through life, are seldom affected by a
hæmorrhage from the lungs.

2. Lawyers, players, public cryers, and city watchmen, all of whom
exercise their lungs either by long or loud speaking, are less affected
by this disease, than persons of other occupations.

I acknowledge I cannot extend this observation to the public teachers
of religion. I have known several instances of their being affected
by hæmoptysis; but never but one in which the disease came on in the
pulpit, and that was in a person who had been recently cured of it. The
cases which I have seen, have generally been brought on by catarrhs.

To this disease, the practice of some of our American preachers disposes
them in a peculiar manner; for it is very common with this class of
them, to expose themselves to the cold or evening air, immediately after
taking what a celebrated and eloquent preacher used to call a _pulpit
sweat_.

3. This hæmorrhage chiefly occurs in debilitated habits, or in persons
afflicted by such a predisposition to consumption, as indicates a weak
and relaxed state of the lungs.

4. It generally occurs when the lungs are in a passive state; as in
sitting, walking, and more frequently in lying. Many of the cases that I
have known, have occurred during _sleep_, in the middle of the night.

From these facts, is it not probable that the common salt, by acting
primarily and with great force upon the throat, extends its stimulus
to the bleeding vessel, and by giving it a tone, checks the further
effusion of blood?

I shall only add to this conjecture the following observations:

1. I have never known the common salt perform a cure, where the
hæmorrhage from the lungs has been a symptom of a confirmed consumption.
But even in this case it gives a certain temporary relief.

2. The exhibition of common salt in the hæmoptysis, should by no means
supersede the use of occasional bleeding when indicated by plethora,
nor of that diet which the state of the pulse, or of the stomach, may
require.

3. I have given the common salt in one case with success, in a
hæmorrhage from the stomach, accompanied by a vomiting; and have
heard of several cases in which it has been supposed to have checked
a discharge of blood from the nose and uterus, but I can say nothing
further in its favour in these last hæmorrhages, from my own experience.

It may perhaps serve to lessen the prejudices of physicians against
adopting improvements in medicine, that are not recommended by the
authority of colleges or universities, to add, that we are indebted to
an old woman, for the discovery of the efficacy of common salt in the
cure of hæmoptysis.




                                THOUGHTS

                                  UPON

                           THE CAUSE AND CURE

                                 OF THE

                        _PULMONARY CONSUMPTION_.


The ancient Jews used to say, that a man does not fulfil his duties in
life, who passes through it, without building a house, planting a tree,
and leaving a child behind him. A physician, in like manner, should
consider his obligations to his profession and society as undischarged,
who has not attempted to lessen the number of incurable diseases. This
is my apology for presuming to make the consumption the object of a
medical inquiry.

Perhaps I may suggest an idea, or fact, that may awaken the ideas and
facts which now lie useless in the memories or common-place books
of other physicians; or I may direct their attention to some useful
experiments upon this subject.

I shall begin my observations upon the consumption, by remarking,

1. That it is unknown among the Indians in North-America.

2. It is scarcely known by those citizens of the United States, who live
in the _first_ stage of civilized life, and who have lately obtained the
title of the _first settlers_.

The principal occupations of the Indian consist in war, fishing, and
hunting. Those of the first settler, are fishing, hunting, and the
laborious employments of subduing the earth, cutting down forests,
building a house and barn, and distant excursions, in all kinds of
weather, to mills and courts, all of which tend to excite and preserve
in the system, something like the Indian vigour of constitution.

3. It is less common in country places than in cities, and increases in
both, with intemperance and sedentary modes of life.

4. Ship and house carpenters, smiths, and all those artificers whose
business requires great exertions of strength in the _open_ air, in
_all_ seasons of the year, are less subject to this disease, than men
who work under cover, and at occupations which do not require the
constant action of their limbs.

5. Women, who sit more than men, and whose work is connected with less
exertion, are most subject to the consumption.

From these facts it would seem, that the most probable method of curing
the consumption, is to revive in the constitution, by means of exercise
or labour, that vigour which belongs to the Indians, or to mankind in
their first stage of civilization.

The efficacy of these means of curing consumption will appear, when we
inquire into the relative merit of the several remedies which have been
used by physicians in this disease.

I shall not produce among these remedies the numerous receipts for
syrups, boluses, electuaries, decoctions, infusions, pills, medicated
waters, powders, draughts, mixtures, and diet-drinks, which have so long
and so steadily been used in this disease; nor shall I mention as a
remedy, the best accommodated diet, submitted to with the most patient
self-denial; for not one of them all, without the aid of exercise, has
ever, I believe, cured a single consumption.

1. SEA-VOYAGES have cured consumptions; but it has been only when they
have been so long, or so frequent, as to substitute the long continuance
of gentle, to violent degrees of exercise of a shorter duration, or
where they have been accompanied by some degree of the labour and care
of navigating the ship.

2. A CHANGE OF CLIMATE has often been prescribed for the cure of
consumptions, but I do not recollect an instance of its having
succeeded, except when it has been accompanied by exercise, as in
travelling, or by some active laborious pursuit.

Doctor Gordon of Madeira, ascribes the inefficacy of the air of Madeira
in the consumption, in part to the difficulty patients find of using
exercise in carriages, or even on horseback, from the badness of the
roads in that island.

3. JOURNIES have often performed cures in the consumption, but it has
been chiefly when they have been long, and accompanied by difficulties
which have roused and invigorated the powers of the mind and body.

4. VOMITS and NAUSEATING MEDICINES have been much celebrated for the
cure of consumptions. These, by procuring a temporary determination to
the surface of the body, so far lessen the pain and cough, as to enable
patients to use profitable exercise. Where this has not accompanied or
succeeded the exhibition of vomits, I believe they have seldom afforded
any _permanent_ relief.

5. BLOOD-LETTING has often relieved consumptions; but it has been only
by removing the troublesome symptoms of inflammatory diathesis, and
thereby enabling the patients to use exercise, or labour, with advantage.

6. VEGETABLE BITTERS and some of the STIMULATING GUMS have in some
instances afforded relief in consumptions; but they have done so only
in those cases where there was great debility, accompanied by a total
absence of inflammatory diathesis. They have most probably acted by
their tonic qualities, as substitutes for labour and exercise.

7. A PLENTIFUL and REGULAR PERSPIRATION, excited by means of a flannel
shirt, worn next to the skin, or by means of a stove-room, or by a warm
climate, has in many instances _prolonged_ life in consumptive habits;
but all these remedies have acted as palliatives only, and thereby have
enabled the consumptive patients to enjoy the more beneficial effects of
exercise.

8. BLISTERS, SETONS, and ISSUES, by determining the perspirable matter
from the lungs to the surface of the body, lessen pain and cough, and
thereby prepare the system for the more salutary effects of exercise.

9. The effects of SWINGING upon the pulse and respiration, leave us no
room to doubt of its being a tonic remedy, and therefore a safe and
agreeable substitute for exercise.

From all these facts it is evident, that the remedies for consumptions
must be sought for in those _exercises and employments which give the
greatest vigour to the constitution_. And here I am happy in being able
to produce several facts which demonstrate the safety and certainty of
this method of cure.

During the late war, I saw three instances of persons in confirmed
consumptions, who were perfectly cured by the hardships of a military
life. They had been my patients previously to their entering into
the army. Besides these, I have heard of four well-attested cases of
similar recoveries from nearly the same remedies. One of these was
the son of a farmer in New-Jersey, who was sent to sea as the last
resource for a consumption. Soon after he left the American shore, he
was taken by a British cruiser, and compelled to share in all the duties
and hardships of a common sailor. After serving in this capacity for
twenty-two months, he made his escape, and landed at Boston, from whence
he travelled on foot to his father's house (nearly four hundred miles),
where he arrived in perfect health.

Doctor Way of Wilmington informed me, that a certain Abner Cloud, who
was reduced so low by a pulmonary consumption as to be beyond all relief
from medicine, was so much relieved by sleeping in the open air, and
by the usual toils of building a hut, and improving a farm, in the
unsettled parts of a new country in Pennsylvania, that he thought him in
a fair way of a perfect recovery.

Doctor Latimer of Wilmington had been long afflicted with a cough and an
occasional hæmoptysis. He entered into the American army as a surgeon,
and served in that capacity till near the end of the war; during which
time he was perfectly free from all pulmonary disease. The spitting of
blood returned soon after he settled in private practice. To remedy this
complaint, he had recourse to a low diet, but finding it ineffectual, he
partook liberally of the usual diet of healthy men, and he now enjoys a
perfect exemption from it.

It would be very easy to add many other cases, in which labour, the
employments of agriculture, and a life of hardship by sea and land, have
prevented, relieved, or cured, not only the consumption, but pulmonary
diseases of all kinds.

To the cases that have been mentioned, I shall add only one more,
which was communicated to me by the venerable Doctor Franklin, whose
conversation at all times conveyed instruction, and not less in
medicine than upon other subjects. In travelling, many years ago,
through New-England, the doctor overtook the post-rider; and after
some inquiries into the history of his life, he informed him that he
was bred a shoe-maker; that his confinement, and other circumstances,
had brought on a consumption, for which he was ordered by a physician
to ride on horseback. Finding this mode of exercise too expensive, he
made interest, upon the death of an old post-rider, to succeed to his
appointment, in which he perfectly recovered his health in two years.
After this he returned to his old trade, upon which his consumption
returned. He again mounted his horse, and rode post in all seasons and
weathers, between New-York and Connecticut river (about 140 miles), in
which employment he continued upwards of thirty years, in perfect health.

These facts, I hope, are sufficient to establish the advantages of
restoring the original vigour of the constitution, in every attempt to
effect a radical cure of consumption.

But how shall these remedies be applied in the time of peace, or in a
country where the want of woods, and brooks without bridges, forbid the
attainment of the laborious pleasures of the Indian mode of hunting;
or where the universal extent of civilization does not admit of our
advising the toils of a new settlement, and improvements upon bare
creation? Under these circumstances, I conceive substitutes may be
obtained for each of them, nearly of equal efficacy, and attainable with
much less trouble.

1. Doctor Sydenham pronounced riding on horseback, to be as certain a
cure for consumptions as bark is for an intermitting fever. I have no
more doubt of the truth of this assertion, than I have that inflammatory
fevers are now less frequent in London than they were in the time of
Doctor Sydenham. If riding on horseback in consumptions has ceased to be
a remedy in Britain, the fault is in the patient, and not in the remedy.
"It is a sign that the stomach requires milk (says Doctor Cadogan), when
it cannot bear it." In like manner, the inability of the patient to
bear this manly and wholesome exercise, serves only to demonstrate the
necessity and advantages of it. I suspect the same objections to this
exercise which have been made in Britain, will not occur in the United
States of America; for the Americans, with respect to the symptoms and
degrees of epidemic and chronic diseases, appear to be nearly in the
same state that the inhabitants of England were in the seventeenth
century. We find, in proportion to the decline of the vigour of the
body, that many occasional causes produce fever and inflammation, which
would not have done it a hundred years ago.

2. The laborious employments of agriculture, if steadily pursued, and
accompanied at the same time by the simple, but wholesome diet of a
farmhouse, and a hard bed, would probably afford a good substitute for
the toils of a savage or military life.

3. Such occupations or professions as require constant labour or
exercise in the open air, in all kinds of weather, may easily be
chosen for a young man who, either from hereditary predisposition, or
an accidental affection of the lungs, is in danger of falling into a
consumption. In this we should imitate the advice given by some wise
men, always to prefer those professions for our sons, which are the
least favourable to the corrupt inclinations of their hearts. For
example, where an undue passion for money, or a crafty disposition,
discover themselves in early life, we are directed to oppose them by
the less profitable and more disinterested professions of divinity or
physic, rather than cherish them by trade, or the practice of the law.
Agreeably to this analogy, weakly children should be trained to the
laborious, and the robust, to the sedentary occupations. From a neglect
of this practice, many hundred apprentices to taylors, shoemakers,
conveyancers, watchmakers, silversmiths, and mantua-makers, perish every
year by consumptions.

4. There is a case recorded by Dr. Smollet, of the efficacy of the cold
bath in a consumption; and I have heard of its having been used with
success, in the case of a negro man, in one of the West-India islands.
To render this remedy useful, or even safe, it will be necessary to
join it with labour, or to use it in degrees that shall prevent the
alternation of the system with vigour and debility; for I take the cure
of consumption ultimately to depend upon the simple and constant action
of tonic remedies. It is to be lamented that it often requires so much
time, or such remedies to remove the inflammatory diathesis, which
attends the first stage of consumption, as to reduce the patient too low
to make use of those tonic remedies afterwards, which would effect a
radical cure.

If it were possible to graduate the tone of the system by means of
a scale, I would add, that to cure consumption, the system should
be raised to the highest degree of this scale. Nothing short of an
equilibrium of tone, or a free and vigorous action of every muscle and
viscus in the body, will fully come up to a radical cure of this disease.

In regulating the diet of consumptive patients, I conceive it to be
as necessary to feel the pulse, as it is in determining when and in
what quantity to draw blood. Where inflammatory diathesis prevails,
a vegetable diet is certainly proper; but where the patient has
_escaped_, or _passed_ this stage of the disease, I believe a vegetable
diet alone to be injurious; and am sure a moderate quantity of animal
food may be taken with advantage.

The presence or absence of this inflammatory diathesis, furnishes the
indications for administering or refraining from the use of the bark
and balsamic medicines. With all the testimonies of their having done
mischief, many of which I could produce, I have known several cases in
which they have been given with obvious advantage; but it was only when
there was a total absence of inflammatory diathesis.

Perhaps the remedies I have recommended, and the opinions I have
delivered, may derive some support from attending to the analogy of
ulcers on the legs, and in other parts of the body. The first of these
occur chiefly in habits debilitated by spiritous liquors, and the last
frequently in habits debilitated by the scrophula. In curing these
diseases, it is in vain to depend upon internal or external medicines.
The whole system must be strengthened, or we do nothing; and this is to
be effected only by exercise and a generous diet.

In relating the facts that are contained in this inquiry, I wish I
could have avoided reasoning upon them; especially as I am confident of
the certainty of the facts, and somewhat doubtful of the truth of my
reasonings.

I shall only add, that if the cure of consumptions should at last be
effected by remedies in every respect the opposites of those palliatives
which are now fashionable and universal, no more will happen than what
we have already seen in the tetanus, the small-pox, and the management
of fractured limbs.

Should this be the case, we shall not be surprised to hear of
physicians, instead of prescribing any one, or all of the medicines
formerly enumerated for consumptions, ordering their patients to
exchange the amusements, or indolence of a city, for the toils
of a country life; of their advising farmers to exchange their
plentiful tables, and comfortable fire-sides, for the scanty but
solid subsistence, and midnight exposure of the herdsman; or of their
recommending, not so much the exercise of a _passive_ sea voyage, as
the _active_ labours and dangers of a common sailor. Nor should it
surprise us, after what we have seen, to hear patients relate the
pleasant adventures of their excursions or labours, in quest of their
recovery from this disease, any more than it does now to see a strong
or well-shaped limb that has been broken; or to hear a man talk of his
studies, or pleasures, during the time of his being inoculated and
attended for the small-pox.

I will not venture to assert, that there does not exist a medicine
which shall supply, at least in some degree, the place of the labour
or exercises, whose usefulness in consumptions has been established by
the facts that have been mentioned. Many instances of the analogous
effects of medicines, and of exercise upon the human body, forbid
the supposition. If there does exist in nature such a medicine, I am
disposed to believe it will be found in the class of TONICS. If this
should be the case, I conceive its strength, or its dose, must far
exceed the present state of our knowledge or practice, with respect to
the efficacy or dose of tonic medicines.

I except the disease, which arises from recent abscesses in the lungs,
from the general observation which has been made, respecting the
inefficacy of the remedies that were formerly enumerated for the cure
of consumptions without labour or exercise. These abscesses often
occur without being preceded by general debility, or accompanied by a
consumptive diathesis, and are frequently cured by nature, or by very
simple medicines.




                        OBSERVATIONS UPON WORMS

                                 IN THE

                           ALIMENTARY CANAL,

                                AND UPON

                        ANTHELMINTIC MEDICINES.


With great diffidence I venture to lay before the public my opinions
upon worms: nor should I have presumed to do it, had I not entertained a
hope of thereby exciting further inquiries upon this subject.

When we consider how universally worms are found in all young animals,
and how frequently they exist in the human body, without producing
disease of any kind, it is natural to conclude, that they serve some
useful and necessary purposes in the animal economy. Do they consume the
superfluous aliment which all young animals are disposed to take, before
they have been taught, by experience or reason, the bad consequences
which arise from it? It is no objection to this opinion, that worms are
unknown in the human body in some countries. The laws of nature are
diversified, and often suspended under peculiar circumstances in many
cases, where the departure from uniformity is still more unaccountable,
than in the present instance. Do worms produce diseases from an _excess_
in their _number_, and an _error_ in their place, in the same manner
that blood, bile, and air produce diseases from an _error_ in their
place, or from _excess_ in their _quantities_? Before these questions
are decided, I shall mention a few facts which have been the result of
my own observations upon this subject.

1. In many instances, I have seen worms discharged in the small-pox and
measles, from children who were in perfect health previously to their
being attacked by those diseases, and who never before discovered a
single symptom of worms. I shall say nothing here of the swarms of worms
which are discharged in fevers of all kinds, until I attempt to prove
that an idiopathic fever is never produced by worms.

2. Nine out of ten of the cases which I have seen of worms, have been in
children of the grossest habits and most vigorous constitutions. This is
more especially the case where the worms are dislodged by the small-pox
and measles. Doctor Capelle of Wilmington, in a letter which I received
from him, informed me, that in the livers of sixteen, out of eighteen
rats which he dissected, he found a number of the tænia worms. The rats
were fat, and appeared in other respects to have been in perfect health.
The two rats in which he found no worms, he says, "were very lean, and
their livers smaller in proportion than the others."

3. In weakly children, I have often known the most powerful
anthelmintics given without bringing away a single worm. If these
medicines have afforded any relief, it has been by their tonic quality.
From this fact, is it not probable--the conjecture, I am afraid, is too
bold, but I will risk it:--is it not probable, I say, that children
are sometimes disordered from the want of worms? Perhaps the tonic
medicines which have been mentioned, render the bowels a more quiet and
comfortable asylum for them, and thereby provide the system with the
means of obviating the effects of crapulas, to which all children are
disposed. It is in this way that nature, in many instances, cures evil
by evil. I confine the salutary office of worms only to that species of
them which is known by the name of the round worm, and which occurs most
frequently in children.

Is there any such disease as an idiopathic WORM-FEVER? The Indians in
this country say there is not, and ascribe the discharge of worms to a
fever, and not a fever to the worms[40].

  [40] See the Inquiry into the Diseases of the Indians, p. 19.

By adopting this opinion, I am aware that I contradict the observations
of many eminent and respectable physicians.

Doctor Huxham describes an epidemic pleurisy, in the month of March, in
the year 1740, which he supposes was produced by his patients feeding
upon some corn that had been injured by the rain the August before[41].
He likewise mentions that a number of people, and those too of the
elderly sort[42], were afflicted at one time with worms, in the month of
April, in the year 1743.

  [41] Vol. II. of his Epidemics, p. 56.

  [42] P. 136.

Lieutade gives an account of an epidemic worm-fever from Velchius,
an Italian physician[43]; and Sauvages describes, from Vandermonde,
an epidemic dysentery from worms, which yielded finally only to worm
medicines[44]. Sir John Pringle, and Doctor Monro, likewise frequently
mention worms as accompanying the dysentery and remitting fever, and
recommend the use of calomel as an antidote to them.

  [43] Vol. I. p. 76.

  [44] Vol. II. p. 329.

I grant that worms appear more frequently in some epidemic diseases
than in others, and oftener in some years than in others. But may not
the same heat, moisture, and diet which produced the diseases, have
produced the worms? And may not their discharge from the bowels have
been occasioned in those epidemics, as in the small-pox and measles,
by the increased heat of the body, by the want of nourishment, or by
an anthelmintic quality being accidentally combined with some of the
medicines that are usually given in fevers?

In answer to this, we are told that we often see the crisis of a fever
brought on by the discharge of worms from the bowels by means of a
purge, or by an anthelmintic medicine. Whenever this is the case, I
believe it is occasioned by offending bile being dislodged by means
of the purge, at the same time with the worms, or by the anthelmintic
medicine (if not a purge) having been given on, or near one of the usual
critical days of the fever. What makes the latter supposition probable
is, that worms are seldom suspected in the beginning of fevers, and
anthelmintic medicines seldom given, till every other remedy has failed
of success; and this generally happens about the usual time in which
fevers terminate in life or death.

It is very remarkable, that since the discovery and description of the
hydrocephalus internus, we hear and read much less than formerly of
worm-fevers. I suspect that disease of the brain has laid the foundation
for the principal part of the cases of worm-fevers which are upon record
in books of medicine. I grant that worms sometimes increase the danger
from fevers, and often confound the diagnosis and prognosis of them, by
a number of new and anomalous symptoms. But here we see nothing more
than that complication of symptoms which often occurs in diseases of a
very different and opposite nature.

Having rejected worms as the cause of fevers, I proceed to remark, that
the diseases most commonly produced by them, belong to Dr. Cullen's
class of NEUROSES. And here I might add, that there is scarcely a
disease, or a symptom of a disease, belonging to this class, which is
not produced by worms. It would be only publishing extracts from books,
to describe them.

The _chronic_ and _nervous_ diseases of children, which are so numerous
and frequently fatal, are, I believe, frequently occasioned by worms.
There is no great danger, therefore, of doing mischief, by prescribing
anthelmintic medicines in all our first attempts to cure their chronic
and nervous diseases.

I have been much gratified by finding myself supported in the above
theory of worm-fevers, by the late Dr. William Hunter, and by Dr.
Butter, in his excellent treatise upon the infantile remitting fever.

I have taken great pains to find out, whether the presence of the
different species of worms might not be discovered by certain peculiar
symptoms; but all to no purpose. I once attended a girl of twelve years
of age in a fever, who discharged four yards of a tænia, and who was
so far from having discovered any peculiar symptom of this species
of worms, that she had never complained of any other indisposition,
than now and then a slight pain in the stomach, which often occurs in
young girls from a sedentary life, or from errors in their diet. I
beg leave to add further, that there is not a symptom which has been
said to indicate the presence of worms of any kind, as the cause of
a disease, that has not deceived me; and none oftener than the one
that has been so much depended upon, viz. the picking of the nose. A
discharge of worms from the bowels, is, perhaps, the only symptom that
is pathognomonic of their presence in the intestines.

I shall now make a few remarks upon anthelmintic remedies.

But I shall first give an account of some experiments which I made
in the year 1771, upon the common earth-worm, in order to ascertain
the anthelmintic virtues of a variety of substances. I made choice of
the earth-worm for this purpose, as it is, according to naturalists,
nearly the same in its structure, manner of subsistence, and mode of
propagating its species, with the round worm of the human body.

In the first column I shall set down, under distinct heads, the
substances in which worms were placed; and in the second and third
columns the _time_ of their death, from the action of these substances
upon them.

  I. BITTER AND ASTRINGENT              | HOURS. | MINUTES.
  SUBSTANCES.                           |        |
                                        |        |
    Watery infusion of aloes            |    2   |   48
    ---- of rhubarb                     |    1   |   30
    ---- of Peruvian bark               |    1   |   30
                                        |        |
  II. PURGES.                           |        |
                                        |        |
    Watery infusion of jalap            |    1   |   --
    ------ bear's-foot                  |    1   |   17
    ------ gamboge                      |    1   |   --
                                        |        |
  III. SALTS.                           |        |
                                        |        |
      1. _Acids._                       |        |
                                        |        |
    Vinegar                             |   --   |    1-1/2 convulsed.
    Lime juice                          |   --   |    1
    Diluted nitrous acid                |   --   |    1-1/2
                                        |        |
      2. _Alkali._                      |        |
                                        |        |
    A watery solution of salt of tartar |   --   |  2 convulsed, throwing
                                        |        |    up a mucus
                                        |        |    on the surface of
      3. _Neutral Salts._               |        |    the water.
                                        |        |
    In a watery solution of common      |        |
     salt                               |   --   |    1 convulsed.
    ---- of nitre                       |   --   |    ditto.
    ---- of sal diuretic                |   --   |    ditto.
    ---- of sal ammoniac                |   --   |    1-1/2
    ---- of common salt and sugar.      |   --   |    4
                                        |        |
      4. _Earthy and metallic salts._   |        |
                                        |        |
    In a watery solution of Epsom salt  |   --   |   15-1/2
    ---- of rock alum                   |   --   |   10
    ---- of corrosive sublimate         |   --   |    1-1/2 convulsed.
    ---- of calomel                     |   --   |   49
    ---- of turpeth mineral             |   --   |    1 convulsed.
    ---- of sugar of lead               |   --   |    3
    ---- of green vitriol               |   --   |    1
    ---- of blue vitriol                |   --   |   10
    ---- of white vitriol               |   --   |   30
  IV. METALS.                           |        |
                                        |        |
    Filings of steel                    |   --   |    2-1/2
    Filings of tin                      |    1   |   --
                                        |        |
  V. CALCAREOUS EARTH.                  |        |
                                        |        |
    Chalk                               |    2   |   --
                                        |        |
  VI. NARCOTIC SUBSTANCES.              |        |
                                        |        |
    Watery infusion of opium            |   --   |   11-1/2 convulsed.
    ---- of Carolina pink-root          |   --   |   33
    ---- of tobacco                     |   --   |   14
                                        |        |
  VII. ESSENTIAL OILS.                  |        |
                                        |        |
    Oil of wormwood                     |   --   |    3 convulsed.
    ---- of mint                        |   --   |    3
    ---- of caraway seed                |   --   |    3
    ---- of amber                       |   --   |    1-1/2
    ---- of anniseed                    |   --   |    4-1/2
    ---- of turpentine                  |   --   |    6
                                        |        |
  VIII. ARSENIC.                        |        |
                                        |        |
    A watery solution of white          |  near  |
      arsenic                           |    2   |   --
                                        |        |
  IX. FERMENTED LIQUORS.                |        |
                                        |        |
    In Madeira wine                     |   --   |    3 convulsed.
    Claret                              |   --   |   10
                                        |        |
  X. DISTILLED SPIRIT.                  |        |
                                        |        |
    Common rum                          |   --   |    1 convulsed.
                                        |        |
  XI. THE FRESH JUICES OF RIPE FRUITS.  |        |
                                        |        |
    The juice of red cherries           |   --   |    5-1/2
    ---- of black do.                   |   --   |    5
    ---- of red currants                |   --   |    2-1/2
    ---- of gooseberries                |   --   |    3-1/2
    ---- of whortleberries              |   --   |   12
    ---- of blackberries                |   --   |    7
    ---- of raspberries                 |   --   |    5-1/2
    ---- of plums                       |   --   |   13
    ---- of peaches                     |   --   |   25
    The juice of water-melons, no       |        |
      effect.                           |   --   |   --
                                        |        |
  XII. SACCHARINE SUBSTANCES.           |        |
                                        |        |
    Honey                               |   --   |    7
    Molasses                            |   --   |    7
    Brown sugar                         |   --   |   30
    Manna                               |   --   |    2-1/2
                                        |        |
  XIII. IN AROMATIC SUBSTANCES.         |        |
                                        |        |
    Camphor                             |   --   |    5
    Pimento                             |   --   |    3-1/2
    Black pepper                        |   --   |   45
                                        |        |
  XIV. FOETID SUBSTANCES                |        |
                                        |        |
    Juice of onions                     |   --   |    3-1/2
    Watery infusion of assaf[oe]tida    |   --   |   27
    ---- Santonicum, or worm seed       |    1   |   --
                                        |        |
  XV. MISCELLANEOUS SUBSTANCES.         |        |
                                        |        |
    Sulphur mixed with oil              |    2   |   --
    Æthiops mineral                     |    2   |   --
    Sulphur                             |    2   |   --
    Solution of gunpowder               |   --   |    1-1/2
    ---- of soap                        |   --   |   19
    Oxymel of squills                   |   --   |    3-1/2
    Sweet oil                           |    2   |   30

In the application of these experiments to the human body, an allowance
must always be made for the alteration which the several anthelmintic
substances that have been mentioned, may undergo from mixture and
diffusion in the stomach and bowels.

In order to derive any benefit from these experiments, as well as from
the observations that have been made upon anthelmintic medicines, it
will be necessary to divide them into such as act,

1. Mechanically,

2. Chemically upon worms; and,

3. Into those which possess a power composed of chemical and mechanical
qualities.

1. The mechanical medicines act indirectly and directly upon the worms.

Those which act _indirectly_ are, vomits, purges, bitter and astringent
substances, particularly aloes, rhubarb, bark, bear's-foot, and
worm-seed. Sweet oil acts indirectly and very feebly upon worms. It was
introduced into medicine from its efficacy in destroying the botts in
horses; but the worms which infest the human bowels, are of a different
nature, and possess very different organs of life from those which are
found in the stomach of a horse.

Those mechanical medicines which act _directly_ upon the worms, are
cowhage[45] and powder of tin. The last of these medicines has been
supposed to act chemically upon the worms, from the arsenic which
adheres to it; but from the length of time a worm lived in a solution of
white arsenic, it is probable the tin acts altogether mechanically upon
them.

  [45] Dolichos Pruriens, of Linnæus.

2. The medicines which act chemically upon worms, appear, from our
experiments, to be very numerous.

Nature has wisely guarded children against the morbid effects of worms,
by implanting in them an early appetite for common salt, ripe fruits,
and saccharine substances; all of which appear to be among the most
speedy and effectual poisons for worms.

Let it not be said, that nature here counteracts her own purposes. Her
conduct in this business is conformable to many of her operations in the
human body, as well as throughout all her works. The bile is a necessary
part of the animal fluids, and yet an appetite for ripe fruits seems
to be implanted chiefly to obviate the consequences of its excess, or
acrimony, in the summer and autumnal months.

The use of common salt as an anthelmintic medicine, is both ancient and
universal. Celsus recommends it. In Ireland it is a common practice
to feed children, who are afflicted by worms, for a week or two upon
a salt-sea weed, and when the bowels are well charged with it, to
give a purge of wort in order to carry off the worms, after they are
debilitated by the salt diet.

I have administered many pounds of common salt coloured with cochineal,
in doses of half a drachm, upon an empty stomach in the morning, with
great success in destroying worms.

Ever since I observed the effects of sugar and other sweet substances
upon worms, I have recommended the liberal use of all of them in the
diet of children, with the happiest effects. The sweet substances
probably act in preventing the diseases from worms in the stomach only,
into which they often insinuate themselves, especially in the morning.
When we wish to dislodge worms from the bowels by sugar or molasses, we
must give these substances in large quantities, so that they may escape
in part the action of the stomach upon them.

I can say nothing from my own experience of the efficacy of the mineral
salts, composed of copper, iron, and zinc, combined with vitriolic
acid, in destroying worms in the bowels. Nor have I ever used the
corrosive sublimate in small doses as an anthelmintic.

I have heard of well-attested cases of the efficacy of the oil of
turpentine in destroying worms.

The expressed juices of onions and of garlic are very common remedies
for worms. From one of the experiments, it appears that the onion juice
possesses strong anthelmintic virtues.

I have often prescribed a tea-spoonful of gunpowder in the morning upon
an empty stomach, with obvious advantage. The active medicine here is
probably the nitre.

I have found a syrup made of the bark of the Jamaica cabbage-tree[46],
to be a powerful as well as a most agreeable anthelmintic medicine.
It sometimes purges and vomits, but its good effects may be obtained
without giving it in such doses as to produce these evacuations.

  [46] Geoffrea, of Linnæus.

There is not a more _certain_ anthelmintic than Carolina pink-root[47].
But as there have been instances of death having followed excessive
doses of it, imprudently administered, and as children are often
affected by giddiness, stupor, and a redness and pain in the eyes after
taking it, I acknowledge that I have generally preferred to it, less
certain, but more safe medicines for destroying worms.

  [47] Spigelia Marylandica, of Linnæus.

3. Of the medicines whose action is compounded of mechanical and
chemical qualities, calomel, jalap, and the powder of steel, are the
principal.

Calomel, in order to be effectual, must be given in large doses. It is
a safe and powerful anthelmintic. Combined with jalap, it often brings
away worms when given for other purposes.

Of all the medicines that I have administered, I know of none more safe
and certain than the simple preparations of iron, whether they be given
in the form of steel-filings or of the rust of iron. If ever they fail
of success, it is because they are given in too small doses. I generally
prescribe from five to thirty grains every morning, to children
between one year, and ten years old; and I have been taught by an old
sea-captain, who was cured of a tænia by this medicine, to give from two
drachms to half an ounce of it, every morning, for three or four days,
not only with safety, but with success.

I shall conclude this essay with the following remarks:

1. Where the action of medicines upon worms in the bowels does not agree
exactly with their action upon the earth-worms in the experiments that
have been related, it must be ascribed to the medicines being more or
less altered by the action of the stomach upon them. I conceive that the
superior anthelmintic qualities of pink-root, steel-filings, and calomel
(all of which acted but slowly upon the earth-worms compared with many
other substances) are in a great degree occasioned by their escaping the
digestive powers unchanged, and acting in a concentrated state upon the
worms.

2. In fevers attended with anomalous symptoms, which are supposed
to arise from worms, I have constantly refused to yield to the
solicitations of my patients, to abandon the indications of cure in the
fever, and to pursue worms as the _principal_ cause of the disease.
While I have adhered steadily to the usual remedies for the different
states of fever, in all their stages, I have at the same time blended
those remedies occasionally with anthelmintic medicines. In this I
have imitated the practice of physicians in many other diseases, in
which troublesome and dangerous symptoms are pursued, without seducing
the attention from the original disease. The anthelmintic medicines
prescribed in these cases, should not be the rust of iron, and common
salt, which are so very useful in chronic diseases from worms, but
calomel and jalap, and such other medicines as aid in the cure of
fevers.




                               AN ACCOUNT

                                 OF THE

                       _EXTERNAL USE OF ARSENIC_,

                                 IN THE

                            CURE OF CANCERS.


A few years ago, a certain Doctor Hugh Martin, a surgeon of one of the
Pennsylvania regiments stationed at Pittsburg, during the latter part
of the late war, came to this city, and advertised to cure cancers
with a medicine which he said he had discovered in the woods, in the
neighbourhood of the garrison. As Dr. Martin had once been my pupil,
I took the liberty of waiting upon him, and asked him some questions
respecting his discovery. His answers were calculated to make me
believe, that his medicine was of a vegetable nature, and that it was
originally an Indian remedy. He showed me some of the medicine, which
appeared to be the powder of a well-dried root of some kind. Anxious to
see the success of this medicine in cancerous sores, I prevailed upon
the doctor to admit me to see him apply it in two or three cases. I
observed, in some instances, he applied a powder to the parts affected,
and in others only touched them with a feather dipped in a liquid which
had a white sediment, and which he made me believe was the vegetable
root diffused in water. It gave me great pleasure to witness the
efficacy of the doctor's applications. In several cancerous ulcers, the
cures he performed were complete. Where the cancers were much connected
with the lymphatic system, or accompanied with a scrophulous habit of
body, his medicine always failed, and, in some instances, did evident
mischief.

Anxious to discover a medicine that promised relief in even a few cases
of cancers, and supposing that all the caustic vegetables were nearly
alike, I applied the phytolacca or poke-root, the stramonium, the arum,
and one or two others, to foul ulcers, in hopes of seeing the same
effects from them which I had seen from Doctor Martin's powder; but in
these I was disappointed. They gave some pain, but performed no cures.
At length I was furnished by a gentleman from Pittsburg with a powder
which I had no doubt, from a variety of circumstances, was of the same
kind as that used by Dr. Martin. I applied it to a fungous ulcer, but
without producing the degrees of pain, inflammation, or discharge,
which I had been accustomed to see from the application of Dr. Martin's
powder. After this, I should have suspected that the powder was not a
_simple_ root, had not the doctor continued upon all occasions to assure
me, that it was wholly a vegetable preparation.

In the beginning of the year 1784, the doctor died, and it was generally
believed that his medicine had died with him. A few weeks after his
death I procured, from one of his administrators, a few ounces of the
doctor's powder, partly with a view of applying it to a cancerous sore
which then offered, and partly with a view of examining it more minutely
than I had been able to do during the doctor's life. Upon throwing the
powder, which was of a brown colour, upon a piece of white paper, I
perceived distinctly a number of white particles scattered through it.
I suspected at first that they were corrosive sublimate, but the usual
tests of that metallic salt soon convinced me, that I was mistaken.
Recollecting that arsenic was the basis of most of the celebrated cancer
powders that have been used in the world, I had recourse to the tests
for detecting it. Upon sprinkling a small quantity of the powder upon
some coals of fire, it emitted the garlick smell so perceptibly as to
be known by several persons whom I called into the room where I made the
experiment, and who knew nothing of the object of my inquiries. After
this, with some difficulty I picked out about three or four grains of
the white powder, and bound them between two pieces of copper, which
I threw into the fire. After the copper pieces became red hot, I took
them out of the fire, and when they had cooled, discovered an evident
whiteness imparted to both of them. One of the pieces afterwards looked
like dull silver. These two tests have generally been thought sufficient
to distinguish the presence of arsenic in any bodies; but I made use of
a third, which has lately been communicated to the world by Mr. Bergman,
and which is supposed to be in all cases infallible.

I infused a small quantity of the powder in a solution of a vegetable
alkali in water for a few hours, and then poured it upon a solution of
blue vitriol in water. The colour of the vitriol was immediately changed
to a beautiful green, and afterwards precipitated.

I shall close this paper with a few remarks upon this powder, and upon
the cure of cancers and foul ulcers of all kinds.

1. The use of caustics in cancers and foul ulcers is very ancient, and
universal. But I believe _arsenic_ to be the most efficacious of any
that has ever been used. It is the basis of Plunket's and probably
of Guy's well-known cancer powders. The great art of applying it
successfully, is to dilute and mix it in such a manner as to mitigate
the violence of its action. Doctor Martin's composition was happily
calculated for this purpose. It gave less pain than the common or
lunar caustic. It excited a moderate inflammation, which separated
the morbid from the sound parts, and promoted a plentiful afflux of
humours to the sore during its application. It seldom produced an escar;
hence it insinuated itself into the deepest recesses of the cancers,
and frequently separated those fibres in an unbroken state, which are
generally called the roots of the cancer. Upon this account, I think,
in some ulcerated cancers it is to be preferred to the knife. It has
no action upon the sound skin. This Doctor Hall proved, by confining a
small quantity of it upon his arm for many hours. In those cases where
Doctor Martin used it to extract cancerous or schirrous tumours that
were not ulcerated, I have reason to believe that he always broke the
skin with Spanish flies.

2. The arsenic used by the doctor was the pure white arsenic. I should
suppose from the examination I made of the powder with the eye, that the
proportion of arsenic to the vegetable powder, could not be more than
one-fortieth part of the whole compound. I have reason to think that the
doctor employed different vegetable substances at different times. The
vegetable matter with which the arsenic was combined in the powder which
I used in my experiments, was probably nothing more than the powder of
the root and berries of the solanum lethale, or deadly nightshade. As
the principal, and perhaps the only design of the vegetable addition
was to blunt the activity of the arsenic, I should suppose that the
same proportion of common wheat flour as the doctor used of his caustic
vegetables, would answer nearly the same purpose. In those cases where
the doctor applied a feather dipped in a liquid to the sore of his
patient, I have no doubt but his phial contained nothing but a weak
solution of arsenic in water. This is no new method of applying arsenic
to foul ulcers. Doctor Way of Wilmington has spoken in the highest terms
to me of a wash for foulnesses on the skin, as well as old ulcers,
prepared by boiling an ounce of white arsenic in two quarts of water to
three pints, and applying it once or twice a day.

3. I mentioned, formerly, that Doctor Martin was often unsuccessful
in the application of his powder. This was occasioned by his using it
indiscriminately in _all_ cases. In schirrous and cancerous tumours, the
knife should always be preferred to the caustic. In cancerous ulcers
attended with a scrophulous or a bad habit of body, such particularly
as have their seat in the neck, in the breasts of females, and in the
axillary glands, it can only protract the patient's misery. Most of
the cancerous sores cured by Doctor Martin were seated on the nose, or
cheeks, or upon the surface or extremities of the body. It remains yet
to discover a cure for cancers that taint the fluids, or infect the
whole lymphatic system. This cure I apprehend must be sought for in
diet, or in the long use of some internal medicine.

To pronounce a disease incurable, is often to render it so. The
intermitting fever, if left to itself, would probably prove frequently,
and perhaps more speedily fatal than cancers. And as cancerous tumours
and sores are often neglected, or treated improperly by injudicious
people, from an apprehension that they are incurable (to which the
frequent advice of physicians "to let them alone," has no doubt
contributed), perhaps the introduction of arsenic into regular practice
as a remedy for cancers, may invite to a more early application to
physicians, and thereby prevent the deplorable cases that have been
mentioned, which are often rendered so by delay or unskilful management.

4. It is not in cancerous sores only that Doctor Martin's powder has
been found to do service. In sores of all kinds, and from a variety of
causes, where they have been attended with fungous flesh or callous
edges, I have used the doctor's powder with advantage.

I flatter myself that I shall be excused in giving this detail of a
_quack_ medicine, when we reflect that it was from the inventions and
temerity of quacks, that physicians have derived some of their most
active and most useful medicines.




                              OBSERVATIONS

                                  UPON

                             _THE TETANUS_.


For a history of the different names and symptoms of this disease, I beg
leave to refer the reader to practical books, particularly to Doctor
Cullen's First Lines. My only design in this inquiry, is to deliver such
a theory of the disease, as may lead to a new and successful use of old
and common remedies for it.

All the remote and predisposing causes of the tetanus act by inducing
preternatural debility, and irritability in the muscular parts of
the body. In many cases, the remote causes act alone, but they more
frequently require the co-operation of an exciting cause. I shall
briefly enumerate, without discriminating them, or pointing out when
they act singly, or when in conjunction with each other.

I. Wounds on different parts of the body are the most frequent causes
of this disease. It was formerly supposed it was the effect only of a
wound, which partially divided a tendon, or a nerve; but we now know
it is often the consequence of læsions which affect the body in a
superficial manner. The following is a list of such wounds and læsions
as have been known to induce the disease:

1. Wounds in the soles of the feet, in the palms of the hands, and under
the nails, by means of nails or splinters of wood.

2. Amputations, and fractures of limbs.

3. Gun-shot wounds.

4. Venesection.

5. The extraction of a tooth, and the insertion of new teeth.

6. The extirpation of a schirrous.

7. Castration.

8. A wound on the tongue.

9. The injury which is done to the feet by frost.

10. The injury which is sometimes done to one of the toes, by stumping
it (as it is called) in walking.

11. Cutting a nail too closely. Also,

12. Cutting a corn too closely.

13. Wearing a shoe so tight as to abrade the skin of one of the toes.

14. A wound, not more than an eighth part of an inch, upon the forehead.

15. The stroke of a whip upon the arm, which only broke the skin.

16. Walking too soon upon a broken limb.

17. The sting of a wasp upon the glands penis.

18. A fish bone sticking in the throat.

19. Cutting the navel string in new-born infants.

Between the time in which the body is thus wounded or injured, and the
time in which the disease makes its appearance, there is an interval
which extends from one day to six weeks. In the person who injured his
toe by stumping it in walking, the disease appeared the next day. The
trifling wound on the forehead which I have mentioned, produced both
tetanus and death, the day after it was received. I have known two
instances of tetanus, from running nails in the feet, which did not
appear until six weeks afterwards. In most of the cases of this disease
from wounds which I have seen, there was a total absence of pain and
inflammation, or but very moderate degrees of them, and in some of
them the wounds had entirely healed, before any of the symptoms of the
disease had made their appearance. Wounds and læsions are most apt to
produce tetanus, after the long continued application of heat to the
body; hence its greater frequency, from these causes, in warm than in
cold climates, and in warm than in cold weather, in northern countries.

II. Cold applied suddenly to the body, after it has been exposed to
intense heat. Of this Dr. Girdlestone mentions many instances, in his
Treatise upon Spasmodic Affections in India. It was most commonly
induced by sleeping upon the ground, after a warm day. Such is the
dampness and unwholesome nature of the ground, in some parts of that
country, that "fowls (the doctor says) put into coops at night, in the
sickly season of the year, and on the same soil that the men slept,
were always found dead the next morning, if the coop was not placed at
a certain height above the surface of the earth[48]." It was brought
on by sleeping on a damp pavement in a servant girl of Mr. Alexander
Todd of Philadelphia, in the evening of a day in which the mercury in
Fahrenheit's thermometer stood at 90°. Dr. Chalmers relates an instance
of its having been induced by a person's sleeping without a nightcap,
after shaving his head. The late Dr. Bartram informed me, that he
had known a draught of cold water produce it in a man who was in a
preternaturally heated state. The cold air more certainly brings on this
disease, if it be applied to the body in the form of a current. The
stiff neck which is sometimes felt after exposure to a stream of cool
air from an open window, is a tendency to a locked jaw, or a feeble and
partial tetanus.

  [48] Page 55.

III. Worms and certain acrid matters in the alimentary canal. Morgagni
relates an instance of the former, and I shall hereafter mention
instances of the latter in new-born infants.

IV. Certain poisonous vegetables. There are several cases upon record of
its being induced by the hemlock dropwort, and the datura stramonium, or
Jamestown weed of our country.

V. It is sometimes a symptom of the bilious remitting and intermitting
fever. It is said to occur more frequently in those states of fever in
the island of Malta, than in any other part of the world.

VI. It is likewise a symptom of that malignant state of fever which is
brought on by the bite of a rabid animal, also of hysteria and gout.

VII. The grating noise produced by cutting with a knife upon a pewter
plate excited it in a servant, while he was waiting upon his master's
table in London. It proved fatal in three days.

VIII. The sight of food, after long fasting.

IX. Drunkenness.

X. Certain emotions and passions of the mind. Terror brought it on
a brewer in this city. He had been previously debilitated by great
labour, in warm weather. I have heard of its having been induced in a
man by agitation of mind, occasioned by seeing a girl tread upon a nail.
Fear excited it in a soldier who kneeled down to be shot. Upon being
pardoned he was unable to rise, from a sudden attack of tetanus. Grief
produced it in a case mentioned by Dr. Willan.

XI. Parturition.

All these remote and exciting causes act with more or less certainty and
force, in proportion to the greater or less degrees of fatigue which
have preceded them.

It has been customary with authors to call all those cases of tetanus,
which are not brought on by wounds, symptomatic. They are no more so
than those which are said to be idiopathic. They all depend alike upon
irritating impressions, made upon one part of the body, producing
morbid excitement, or disease in another. It is immaterial, whether
the impression be made upon the intestines by a worm, upon the ear by
an ungrateful noise, upon the mind by a strong emotion, or upon the
sole of the foot by a nail; it is alike communicated to the muscles,
which, from their previous debility and irritability, are thrown into
commotions by it. In yielding to the impression of irritants, they
follow in their contractions the order of their predisposing debility.
The muscles which move the lower jaw are affected more early, and more
obstinately than any of the other external muscles of the body, only
because they are more constantly in a relaxed, or idle state.

The negroes in the West-Indies are more subject to this disease than
white people. This has been ascribed to the greater irritability of
their muscular systems, which constitutes a part of its predisposing
cause. It is remarkable that their sensibility lessens with the increase
of their irritability; and hence, Dr. Moseley says, they bear surgical
operations much better than white people.

New-born infants are often affected by this disease in the West-Indies.
I have seen a few cases of it in Philadelphia. It is known by the name
of the jaw-fall. Its causes are:

1. The cutting of the navel string. This is often done with a pair of
dull scissors, by which means the cord is bruised.

2. The acrimony of the meconium retained in the bowels.

3. Cold air acting upon the body, after it has been heated by the air of
a hot room.

4. Smoke is supposed to excite it, in the negro quarters in the
West-Indies.

It is unknown, Dr. Winterbottom informs us, among the native Africans in
the neighbourhood of Sierra Leone.

I am aware that it is ascribed by many physicians to only one of the
above causes; but I see no reason why it should not be induced by
more than one cause in infants, when we see it brought on by so many
different causes in grown people.

The tetanus is not confined to the human species. It often affects
horses in the West-Indies. I have seen several cases of it in
Philadelphia.

The want of uniform success in the treatment of this disease, has long
been a subject of regret among physicians. It may be ascribed to the use
of the same remedies, without any respect to the nature of the causes
which produce it, and to an undue reliance upon some one remedy, under
a belief of its specific efficacy. Opium has been considered as its
antidote, without recollecting that it was one only, of a numerous class
of medicines, that are all alike useful in it.

Tetanus, from all its causes, has nearly the same premonitory symptoms.
These are a stiffness in the neck, a disposition to bend forward, in
order to relieve a pain in the back, costiveness, a pain about the
external region of the stomach, and a disposition to start in sleep. In
this feeble state of the disease, an emetic, a strong dose of laudanum,
the warm bath, or a few doses of bark, have often prevented its being
completely formed. When it has arisen from a wound, dilating it if small
or healed, and afterwards inflaming it, by applying to it turpentine,
common salt, corrosive sublimate, or Spanish flies, have, in many
hundred instances, been attended with the same salutary effects.

The disease I have said is seated in the muscles, and, while they are
preternaturally excited, the blood-vessels are in a state of reduced
excitement. This is evident from the feebleness and slowness of the
pulse. It sometimes beats, according to Dr. Lining, but forty strokes
in a minute. By stimulating the wound, we not only restore the natural
excitement of the blood-vessels, but we produce an inflammatory
diathesis in them, which abstracts morbid excitement from the muscular
system, and, by equalizing it, cures the disease. This remedy I
acknowledge has not been as successfully employed in the West-Indies as
in the United States, and that for an obvious reason. The blood-vessels
in a warm climate refuse to assume an inflammatory action. Stimuli hurry
them on suddenly to torpor or gangrene. Hence the danger and even fatal
effects of blood-letting, in the fevers which affect the natives of the
islands, a few hours after they are formed. But widely different is
the nature of wounds, and of the tension of the blood-vessels, in the
inhabitants of northern countries. While Dr. Dallas deplores the loss
of 49 out of 50 affected with tetanus from wounds, in the West-India
islands, I am sure I could mention many hundred instances of the
disease being prevented, and a very different proportion of cures being
performed, by inflaming the wounds, and exciting a counter _morbid_
action in the blood-vessels.

When the disease is the effect of fever, the same remedies should be
given, as are employed in the cure of that fever. I have once unlocked
the jaw of a woman who was seized at the same time with a remitting
fever, by an emetic, and I have heard of its being cured in a company
of surveyors, in whom it was the effect of an intermittent, by large
doses of bark. When it accompanies malignant fever, hysteria, or gout,
the remedies for those forms of disease should be employed. Bleeding
was highly useful in it in a case of yellow fever which occurred in
Philadelphia in the year 1794.

When it is produced by the suppression of perspiration by means of cold,
the warm bath and sweating medicines have been found most useful in it.
Nature has in one instance pointed out the use of this remedy, by curing
the disease by a miliary eruption on the skin[49].

  [49] Burserus.

If it be the effect of poisonous substances taken into the stomach, or
of worms in the bowels, the cure should be begun by emetics, purges, and
anthelmintic medicines.

Where patients are unable to swallow, from the teeth of the upper and
lower jaw pressing upon each other, a tooth or two should be extracted,
to open a passage for our medicines into the throat. If this be
impracticable or objected to, they should be injected by way of glyster.

In the locked jaw which arises from the extraction of a tooth, an
instrument should be introduced to depress the jaw. This has been done
by a noted English dentist in London, with success.

As the habit of diseased action often continues after the removal of its
causes, and as some of the remote causes of this disease are beyond the
reach of medicine, such remedies should be given as are calculated, by
their stimulating power, to overcome the morbid or spasmodic action of
the muscles. These are:

1. OPIUM. It should be given in large and frequent doses. Dr. Streltz
says he has found from one to two drachms of an alkali, taken in the
course of a day, greatly to aid the action of the opium in this disease.

2. WINE. This should be given in quarts, and even gallons daily. Dr.
Currie relates a case of a man in the infirmary of Liverpool, who was
cured of tetanus, by drinking nearly a quarter cask of Madeira wine.
Dr. Hosack speaks in high terms of it, in a letter to Dr. Duncan, and
advises its being given without any other stimulating medicine.

3. ARDENT SPIRITS. A quack in New-England has lately cured tetanus, by
giving ardent spirits in such quantities as to produce intoxication.
Upon being asked his reason for this strange practice, he said, he had
always observed the jaw to fall in drunken men, and any thing that would
produce that effect, he supposed to be proper in the locked jaw.

4. The BARK has of late years been used in this disease with success. I
had the pleasure of first seeing its good effects in the case of Colonel
Stone, in whom a severe tetanus followed a wound in the foot, received
at the battle of Germantown, in October, 1777.

5. The COLD BATH. This remedy has been revived by Dr. Wright of Jamaica,
and has in many instances performed cures of this disease. In one of two
cases in which I have used it with success, the patient's jaw opened in
a few minutes after the affusion of a single bucket of water upon her
body. The disease was occasioned by a slight injury done to one of her
toes, by wearing a tight shoe. The signals for continuing the use of the
cold bath, are its being followed by a slight degree of fever, and a
general warmth of the skin. Where these do not occur, there is reason
to believe it will do no service, or perhaps do harm. We have many
proofs of the difference in the same disease, and in the operation of
the same medicine, in different and opposite climates. Dr. Girdlestone
has mentioned the result of the use of the cold bath in tetanus in
the East-Indies, which furnishes a striking addition to the numerous
facts that have been collected upon that subject. He tells us the cold
bath uniformly destroyed life, in every case in which it was used. The
reason is obvious. In that extremely debilitating climate, the system in
tetanus was prostrated too low to re-act, under the sedative operation
of the cold water.

6. The WARM BATH has often been used with success in this disease. Its
temperature should be regulated by our wishes to promote sweats, or to
produce excitement in the blood-vessels. In the latter case it should
rise above the heat of the human body.

7. The OIL OF AMBER acts powerfully upon the muscular system. I have
seen the happiest effects from the exhibition of six or eight drops of
it, every two hours, in this disease.

8. A SALIVATION has been often recommended for the cure of tetanus, but
unfortunately it can seldom be excited in time to do service. I once saw
it complete the cure of a sailor in the Pennsylvania hospital, whose
life was prolonged by the alternate use of bark and wine. The disease
was brought on him by a mortification of his feet, in consequence of
their being frost-bitten.

9. Dr. Girdlestone commends BLISTERS in high terms in this disease.
He says he never saw it prove fatal, even where they only produced a
redness on the skin.

10. I have heard of ELECTRICITY having been used with advantage in
tetanus, but I can say nothing in its favour from my own experience.

In order to ensure the utmost benefit from the use of the above
remedies, it will be necessary for a physician always to recollect, that
the disease is attended with great morbid action, and of course each of
the stimulating medicines that has been mentioned should be given, 1st,
in large doses; 2dly, in succession; 3dly, in rotation; and 4thly, by
way of glyster, as well as by the mouth.

The jaw-fall in new-born infants is, I believe, always fatal. Purging
off the meconium from the bowels immediately after birth has often
prevented it from one of its causes; and applying a rag wetted with
spirit of turpentine to the navel-string, immediately after it is cut,
Dr. Chisholm says, prevents it from another of its causes which has been
mentioned.

This disease, I have said, sometimes affects horses. I have twice seen
it cured by applying a potential caustic to the neck under the mane,
by large doses of the oil of amber, and by plunging one of them into a
river, and throwing buckets of cold water upon the other.

I shall conclude my observations upon the tetanus with the following
queries:

1. What would be the effects of _copious_ blood-letting in this disease?
There is a case upon record of its efficacy, in the Medical Journal
of Paris, and I have now in my possession a letter from the late Dr.
Hopkins of Connecticut, containing the history of a cure performed by
it. Where tetanus is the effect of primary gout, hysteria, or fever,
attended with highly inflammatory symptoms, bleeding is certainly
indicated, but, in general, the disease is so completely insulated in
the muscles, and the arteries are so far below their par of excitement
in frequency and force, that little benefit can be expected from that
remedy. The disease, in these cases, seems to call for an elevation,
instead of a diminution, of the excitement of the blood-vessels.

2. What would be the effect of _extreme_ cold in this disease? Mr. John
Hunter used to say, in his lectures, "Were he to be attacked by it,
he would, if possible, fly to Nova-Zembla, or throw himself into an
ice-house." I have no doubt of the efficacy of intense cold, in subduing
the inordinate morbid actions which occur in the muscular system; but
it offers so much violence to the fears and prejudices of sick people,
or their friends, that it can seldom be applied in such a manner as to
derive much benefit from it. Perhaps the sedative effects of cold might
be obtained with less difficulty, by wrapping the body in sheets, and
wetting them occasionally for an hour or two with cold water.

3. What would be the effect of exciting a strong counter-action in
the stomach and bowels in this disease? Dr. Brown of Kentucky cured
a tetanus by inflaming the stomach, by means of the tincture of
cantharides. It has likewise been cured by a severe cholera morbus,
induced by a large dose of corrosive sublimate. The stomach and bowels,
and the external muscles of the body, discover strong associations in
many diseases. A sick stomach is always followed by general weakness,
and the dry gripes often paralyze the muscles of the arms and limbs. But
further, one of the remote causes of tetanus, viz. cold air, often shows
the near relationship of the muscles to the bowels, and the vicarious
nature of disease in each of them. It often produces in the latter, in
the West-Indies, what the French physicians call a "crampe seche," or,
in other words, if I may be allowed the expression, a tetanus in the
bowels.

4. A sameness has been pointed out between many of the symptoms of
hydrophobia and tetanus. A similar difficulty of swallowing, and similar
convulsions after it, have been remarked in both diseases. Death often
takes place suddenly in tetanus, as it does in hydrophobia, without
producing marks of fatal disorganization in any of the internal parts
of the body. Dr. Physick supposes death in these cases to be the
effect of suffocation, from a sudden spasm and closure of the glottis,
and proposes to prevent it in the same manner that he has proposed
to prevent death from hydrophobia, that is, by laryngotomy[50]. The
prospect of success from it appears alike reasonable in both cases.

  [50] Medical Repository.




                       THE RESULT OF OBSERVATIONS

                               MADE UPON

                             _THE DISEASES_

                           WHICH OCCURRED IN

                         THE MILITARY HOSPITALS

                         OF THE UNITED STATES,

           DURING THE REVOLUTIONARY WAR BETWEEN GREAT BRITAIN

                         AND THE UNITED STATES.


1. The army when in tents, was always more sickly, than in the open air.
It was likewise more healthy when it was kept in motion, than when it
lay in an encampment.

2. Young men under twenty years of age, were subject to the greatest
number of camp diseases.

3. The southern troops were more sickly than the northern or eastern
troops.

4. The native Americans were more sickly than the natives of Europe who
served in the American army.

5. Men above thirty, and five and thirty years of age, were the hardiest
soldiers in the army. Perhaps the reason why the natives of Europe were
more healthy than the native Americans, was, they were more advanced in
life.

6. The southern troops sickened from the want of salt provisions. Their
strength and spirits were restored only by means of salted meat. I once
saw a private in a Virginia regiment, throw away his ration of choice
fresh beef, and give a dollar for a pound of salted bacon.

7. Those officers who wore flannel shirts or waistcoats next to their
skins, in general escaped fevers and diseases of all kinds.

8. The principal diseases in the hospitals were the typhus gravior and
mitior of Doctor Cullen. Men who came into the hospitals with pleurisies
or rheumatisms, soon lost the types of their original diseases, and
suffered, or died, by the above-mentioned states of fever.

9. The typhus mitior always prevailed most, and with the worst symptoms
in winter. A free air, which could only be obtained in summer, always
prevented, or mitigated it.

10. In all those cases, where the contagion was received, cold seldom
failed to render it active. Whenever an hospital was removed in winter,
one half of the patients generally sickened on the way, or soon after
their arrival at the place to which they were sent.

11. Drunken soldiers and convalescents were most subject to this fever.

12. Those patients in this fever who had large ulcers on their back or
limbs, generally recovered.

13. I met with several instances of buboes, also of ulcers in the
throat, as described by Doctor Donald Monro. They were mistaken by some
of the junior surgeons for venereal sores, but they yielded to the
common remedies of the hospital fever.

14. There were many instances of patients in this fever, who suddenly
fell down dead, upon being moved, without any previous symptoms of
approaching dissolution. This was more especially the case, when they
arose to go to stool.

15. The contagion of this fever was frequently conveyed from the
hospital to the camp, by means of blankets and clothes.

16. Those black soldiers who had been previously slaves, died in a
greater proportion by this fever, or had a much slower recovery from it,
than the same number of white soldiers.

17. The remedies which appeared to do most service in this disease were
vomits of tartar emetic, gentle dozes of laxative salts, bark, wine,
volatile salt, opium, and blisters.

18. An emetic seldom failed of checking this fever if exhibited while it
was in a _forming_ state, and before the patient was confined to his bed.

19. Many causes concurred to produce, and increase this fever; such as
the want of cleanliness, excessive fatigue, the ignorance or negligence
of officers in providing suitable diet and accommodations for their
men, the general use of linen instead of woollen clothes in the summer
months, and the crowding too many patients together in one hospital,
with such other inconveniences and abuses, as usually follow the union
of the _purveying_ and _directing_ departments of hospitals in the
_same_ persons. But there is one more cause of this fever which remains
to be mentioned, and that is, the sudden assembling of a great number of
persons together of different habits and manners, such as the soldiers
of the American army were in the years 1776 and 1777. Doctor Blane
informs us, in his observations upon the diseases of seamen, "that it
sometimes happens that a ship with a long established crew shall be very
_healthy_, yet if strangers are introduced among them, who are also
_healthy_, sickness will be mutually produced." The history of diseases
furnishes many proofs of the truth of this assertion[51]. It is very
remarkable, that while the American army at Cambridge, in the year 1775,
consisted only of New-Englandmen (whose habits and manners were the
same) there was scarcely any sickness among them. It was not till the
troops of the eastern, middle, and southern states met at New-York and
Ticonderoga, in the year 1776, that the typhus became universal, and
spread with such peculiar mortality in the armies of the United States.

  [51] "Cleanliness is founded on a natural aversion to what is unseemly
       and offensive in the persons of others; and there seems also to
       be an instinctive horror at strangers implanted in human nature
       for the same purpose, as is visible in young children, and
       uncultivated people. In the early ages of Rome, the same word
       signified both a stranger and an enemy." Dr. Blane, p. 225.

20. The dysentery prevailed, in the summer of 1777, in the military
hospitals of New-Jersey, but with very few instances of mortality. This
dysentery was frequently followed by an obstinate diarrh[oe]a, in which
the warm bath was found in many cases to be an effectual remedy.

21. I saw several instances of fevers occasioned by the use of the
common ointment made of the flour of sulphur and hog's lard, for the
cure of the itch. The fevers were probably brought on by the exposure of
the body to the cold air, in the usual method in which that ointment is
applied. I have since learned, that the itch may be cured as speedily by
rubbing the parts affected, two or three times, with the dry flour of
sulphur, and that no inconvenience, and scarcely any smell, follow this
mode of using it.

22. In gun-shot wounds of the joints, Mr. Ranby's advice of amputating
the limb was followed with success. I saw two cases of death where this
advice was neglected.

23. There was one instance of a soldier who lost his hearing, and
another of a soldier who had been deaf who recovered his hearing, by the
noise of artillery in a battle.

24. Those soldiers who were billetted in private houses, generally
escaped the hospital fever, and recovered soonest from all their
diseases.

25. Hospitals built of coarse logs, with _ground_ floors, with
fire-places in the middle of them, and a hole in the roof, for the
discharge of smoke, were found to be very conducive to the recovery of
the soldiers from the hospital fever. This form of a military hospital
was introduced into the army by Dr. Tilton of the state of Delaware[52].

  [52] "It is proved, in innumerable instances, that sick men recover
       health sooner and better in sheds, huts, and barns, exposed
       occasionally to wind, and sometimes to rain, than in the
       most superb hospitals in Europe." Jackson's Remarks on the
       Constitution of the Medical Department of the British Army,
       p. 340.

26. In fevers and dysenteries, those soldiers recovered most certainly,
and most speedily, who lay at the greatest distance from the walls of
the hospitals. This important fact was communicated to me by the late
Dr. Beardsley of Connecticut.

27. Soldiers are but little more than adult children. That officer,
therefore, will best perform his duty to his men, who obliges them to
take the most care of their HEALTH.

28. Hospitals are the sinks of human life in an army. They robbed the
United States of more citizens than the sword. Humanity, economy, and
philosophy, all concur in giving a preference to the conveniences and
wholesome air of private houses; and should war continue to be the
absurd and unchristian mode of deciding national disputes, it is to
be hoped that the progress of science will so far mitigate one of its
greatest calamities, as to produce an abolition of hospitals for acute
diseases. Perhaps there are no cases of sickness in which reason and
religion do not forbid the seclusion of our fellow creatures from the
offices of humanity in private families, except where they labour under
the calamities of madness and the venereal disease, or where they are
the subjects of some of the operations of surgery.




                      AN ACCOUNT OF THE INFLUENCE

                                 OF THE

                     MILITARY AND POLITICAL EVENTS

                                 OF THE

                         _AMERICAN REVOLUTION_

                                UPON THE

                              HUMAN BODY.


There were several circumstances peculiar to the American revolution,
which should be mentioned previously to an account of the influence of
the events which accompanied it, upon the human body.

1. The revolution interested every inhabitant of the country of both
sexes, and of every rank and age that was capable of reflection. An
indifferent, or neutral spectator of the controversy, was scarcely to be
found in any of the states.

2. The scenes of war and government which it introduced, were new to the
greatest part of the inhabitants of the United States, and operated with
all the force of _novelty_ upon the human mind.

3. The controversy was conceived to be the most important of any that
had ever engaged the attention of mankind. It was generally believed, by
the friends of the revolution, that the very existence of _freedom_ upon
our globe, was involved in the issue of the contest in favour of the
United States.

4. The American revolution included in it the cares of government, as
well as the toils and dangers of war. The American mind was, therefore,
frequently occupied at the _same time_, by the difficult and complicated
duties of political and military life.

5. The revolution was conducted by men who had been born _free_, and
whose sense of the blessings of liberty was of course more exquisite
than if they had just emerged from a state of slavery.

6. The greatest part of the soldiers in the armies of the United States
had family connections and property in the country.

7. The war was carried on by the Americans against a nation, to whom
they had long been tied by the numerous obligations of consanguinity,
laws, religion, commerce, language, interest, and a mutual sense of
national glory. The resentments of the Americans of course rose, as is
usual in all disputes, in proportion to the number and force of these
ancient bonds of affection and union.

8. A predilection to a limited monarchy, as an essential part of a
free and safe government, and an attachment to the reigning king of
Great-Britain (with a very few exceptions), were universal in every part
of the United States.

9. There was at one time a sudden dissolution of civil government in
_all_, and of ecclesiastical establishments in several of the states.

10. The expences of the war were supported by means of a paper currency,
which was continually depreciating.

From the action of each of these causes, and frequently from their
combination in the same persons, effects might reasonably be expected,
both upon the mind and body, which have seldom occurred; or if they
have, I believe were never fully recorded in any age or country.

It might afford some useful instruction, to point out the influence
of the military and political events of the revolution upon the
understandings, passions, and morals of the citizens of the United
States; but my business in the present inquiry, is only to take notice
of the influence of those events upon the human body, through the medium
of the mind.

I shall first mention the effects of the military, and secondly, of the
political events of the revolution. The last must be considered in a
two-fold view, accordingly as they affected the friends, or the enemies
of the revolution.

I. In treating of the effects of the military events, I shall take
notice, first, of the influence of _actual_ war, and, secondly, of the
influence of the military life.

In the beginning of a battle, I have observed _thirst_ to be a very
common sensation among both officers and soldiers. It occurred where no
exercise, or action of the body, could have excited it.

Many officers have informed me, that after the first onset in a battle,
they felt a glow of heat, so universal as to be perceptible in both
their ears. This was the case, in a particular manner, in the battle of
Princeton, on the third of January, in the year 1777, on which day the
weather was remarkably cold.

A veteran colonel of a New-England regiment, whom I visited at
Princeton, and who was wounded in the hand at the battle of Monmouth,
on the 28th of June, 1778 (a day in which the mercury stood at 90° of
Fahrenheit's thermometer), after describing his situation at the time
he received his wound, concluded his story by remarking, that "fighting
was hot work on a cold day, but much more so on a warm day." The many
instances which appeared after that memorable battle, of soldiers who
were found among the slain without any marks of wounds or violence upon
their bodies, were probably occasioned by the heat excited in the body,
by the emotions of the mind, being added to that of the atmosphere.

Soldiers bore operations of every kind immediately _after_ a battle,
with much more fortitude than they did at _any time_ afterwards.

The effects of the military life upon the human body come next to be
considered under this head.

In another place[53] I have mentioned three cases of pulmonary
consumption being perfectly cured by the diet and hardships of a camp
life.

  [53] Page 204.

Doctor Blane, in his valuable observations on the diseases incident to
seamen, ascribes the extraordinary healthiness of the British fleet in
the month of April, 1782, to the effects produced on the spirit of the
soldiers and seamen, by the victory obtained over the French fleet on
the 12th of that month; and relates, upon the authority of Mr. Ives,
an instance in the war between Great-Britain and the combined powers
of France and Spain, in 1744, in which the scurvy, as well as other
diseases, were checked by the prospect of a naval engagement.

The American army furnished an instance of the effects of victory upon
the human mind, which may serve to establish the inferences from the
facts related by Doctor Blane. The Philadelphia militia who joined the
remains of General Washington's army, in December, 1776, and shared with
them a few days afterwards in the capture of a large body of Hessians at
Trenton, consisted of 1500 men, most of whom had been accustomed to the
habits of a city life. These men slept in tents and barns, and sometimes
in the open air during the usual colds of December and January; and yet
there were but two instances of sickness, and only one of death, in that
body of men in the course of nearly six weeks, in those winter months.
This extraordinary healthiness of so great a number of men under such
trying circumstances, can only be ascribed to the vigour infused into
the human body by the victory of Trenton having produced insensibility
to all the usual remote causes of diseases.

Militia officers and soldiers, who enjoyed good health during a
campaign, were often affected by fevers and other diseases, as soon
as they returned to their respective homes. I knew one instance of a
militia captain, who was seized with convulsions the first night he lay
on a feather bed, after sleeping several months on a mattrass, or upon
the ground. These affections of the body appeared to be produced only by
the sudden abstraction of that tone in the system which was excited by a
sense of danger, and the other invigorating objects of a military life.

The NOSTALGIA of Doctor Cullen, or the _home-sickness_, was a frequent
disease in the American army, more especially among the soldiers of
the New-England states. But this disease was suspended by the superior
action of the mind under the influence of the principles which governed
common soldiers in the American army. Of this General Gates furnished
me with a remarkable instance in 1776, soon after his return from the
command of a large body of regular troops and militia at Ticonderoga.
From the effects of the nostalgia, and the feebleness of the discipline,
which was exercised over the militia, desertions were very frequent and
numerous in his army, in the latter part of the campaign; and yet during
the _three weeks_ in which the general expected every hour an attack to
be made upon him by General Burgoyne, there was not a single desertion
from his army, which consisted at that time of 10,000 men.

The patience, firmness, and magnanimity with which the officers and
soldiers of the American army endured the complicated evils of hunger,
cold, and nakedness, can only be ascribed to an insensibility of body
produced by an uncommon tone of mind excited by the love of liberty and
their country.

Before I proceed to the second general division of this subject, I shall
take notice, that more instances of apoplexies occurred in the city of
Philadelphia, in the winter of 1774-5, than had been known in former
years. I should have hesitated in recording this fact, had I not found
the observation supported by a fact of the same kind, and produced
by a nearly similar cause, in the appendix to the practical works of
Doctor Baglivi, professor of physic and anatomy at Rome. After a very
wet season in the winter of 1694-5, he informs us, that "apoplexies
displayed their rage; and perhaps (adds our author) that some part of
this epidemic illness was owing to the universal grief and domestic
care, occasioned by all Europe being engaged in a war. All commerce
was disturbed, and all the avenues of peace blocked up, so that the
strongest heart could scarcely bear the thoughts of it." The winter of
1774-5 was a period of uncommon anxiety among the citizens of America.
Every countenance wore the marks of painful solicitude, for the event
of a petition to the throne of Britain, which was to determine whether
reconciliation, or a civil war, with all its terrible and distressing
consequences, were to take place. The apoplectic fit, which deprived the
world of the talents and virtues of Peyton Randolph, while he filled
the chair of congress, in 1775, appeared to be occasioned in part by
the pressure of the uncertainty of those great events upon his mind. To
the name of this illustrious patriot, several others might be added,
who were affected by the apoplexy in the same memorable year. At this
time a difference of opinion upon the subject of the contest with
Great-Britain, had scarcely taken place among the citizens of America.

II. The political events of the revolution produced different effects
upon the human body, through the medium of the mind, according as they
acted upon the friends or enemies of the revolution.

I shall first describe its effects upon the former class of citizens of
the United States.

Many persons, of infirm and delicate habits, were restored to perfect
health, by the change of place, or occupation, to which the war exposed
them. This was the case in a more especial manner with hysterical women,
who were much interested in the successful issue of the contest. The
same effects of a civil war upon the hysteria, were observed by Doctor
Cullen in Scotland, in the years 1745 and 1746. It may perhaps help to
extend our ideas of the influence of the passions upon diseases, to add,
that when either love, jealousy, grief, or even devotion, wholly engross
the female mind, they seldom fail, in like manner, to cure or to suspend
hysterical complaints.

An uncommon cheerfulness prevailed every where, among the friends of the
revolution. Defeats, and even the loss of relations and property, were
soon forgotten in the great objects of the war.

The population in the United States was more rapid from births during
the war, than it had ever been in the same number of years since the
settlement of the country.

I am disposed to ascribe this increase of births _chiefly_ to the
quantity and extensive circulation of money, and to the facility of
procuring the means of subsistence during the war, which favoured
marriages among the labouring part of the people[54]. But I have
sufficient documents to prove, that marriages were more fruitful than
in former years, and that a considerable number of unfruitful marriages
became fruitful during the war. In 1783, the year of the peace, there
were several children born of parents who had lived many years together
without issue.

  [54] Wheat, which was sold before the war for seven shillings and
       sixpence, was sold for several years _during_ the war for four,
       and in some places for two and sixpence Pennsylvania currency
       per bushel. Beggars of every description disappeared in the year
       1776, and were seldom seen till near the close of the war.

Mr. Hume informs us, in his History of England, that some old people,
upon hearing the news of the restoration of Charles II, died suddenly
of joy. There was a time when I doubted the truth of this assertion;
but I am now disposed to believe it, from having heard of a similar
effect from an agreeable political event, in the course of the American
revolution. The door-keeper of congress, an aged man, died suddenly,
immediately after hearing of the capture of Lord Cornwallis' army. His
death was universally ascribed to a violent emotion of political joy.
This species of joy appears to be one of the strongest emotions that can
agitate the human mind.

Perhaps the influence of that ardour in trade and speculation, which
seized many of the friends of the revolution, and which was excited
by the fallacious nominal amount of the paper money, should rather be
considered as a disease, than as a passion. It unhinged the judgment,
deposed the moral faculty, and filled the imagination, in many people,
with airy and impracticable schemes of wealth and grandeur. Desultory
manners, and a peculiar species of extempore conduct, were among its
characteristic symptoms. It produced insensibility to cold, hunger, and
danger. The trading towns, and in some instances the extremities of the
United States, were frequently visited in a few hours or days by persons
affected by this disease; and hence "to travel with the speed of a
speculator," became a common saying in many parts of the country. This
species of insanity (if I may be allowed to call it by that name) did
not require the confinement of a bedlam to cure it, like the South-Sea
madness described by Doctor Mead. Its remedies were the depreciation of
the paper money, and the events of the peace.

The political events of the revolution produced upon its enemies very
different effects from those which have been mentioned.

The hypochondriasis of Doctor Cullen occurred, in many instances, in
persons of this description. In some of them, the terror and distress
of the revolution brought on a true melancholia[55]. The causes which
produced these diseases may be reduced to four heads. 1. The loss of
former power or influence in government. 2. The destruction of the
hierarchy of the English church in America. 3. The change in the habits
of diet, and company, and manners, produced by the annihilation of just
debts by means of depreciated paper money. And 4. The neglect, insults,
and oppression, to which the loyalists were exposed, from individuals,
and, in several instances, from the laws of some of the states.

  [55] Insania partialis sine dyspepsia, of Doctor Cullen.

It was observed in South-Carolina, that several gentlemen who had
protected their estates by swearing allegiance to the British
government, died soon after the evacuation of Charleston by the British
army. Their deaths were ascribed to the neglect with which they were
treated by their ancient friends, who had adhered to the government of
the United States. The disease was called, by the common people, the
_protection fever_.

From the causes which produced this hypochondriasis, I have taken the
liberty of distinguishing it by the name of _revolutiana_.

In some cases, this disease was rendered fatal by exile and confinement;
and, in others, by those persons who were afflicted with it, seeking
relief from spiritous liquors.

The termination of the war by the peace in 1783, did not terminate the
American revolution. The minds of the citizens of the United States were
wholly unprepared for their new situation. The excess of the passion
for liberty, inflamed by the successful issue of the war, produced, in
many people, opinions and conduct which could not be removed by reason
nor restrained by government. For a while, they threatened to render
abortive the goodness of heaven to the United States, in delivering them
from the evils of slavery and war. The extensive influence which these
opinions had upon the understandings, passions, and morals of many of
the citizens of the United States, constituted a form of insanity, which
I shall take the liberty of distinguishing by the name of _anarchia_.

I hope no offence will be given by the freedom of any of these remarks.
An inquirer after philosophical truth should consider the passions of
men in the same light that he does the laws of matter or motion. The
friends and enemies of the American revolution must have been more, or
less than men, if they could have sustained the magnitude and rapidity
of the events that characterised it, without discovering some marks of
human weakness, both in body and mind. Perhaps these weaknesses were
permitted, that human nature might receive fresh honours in America,
by the contending parties (whether produced by the controversies about
independence or the national government) mutually forgiving each other,
and uniting in plans of general order, and happiness.




                               AN INQUIRY

                                  INTO

                            THE RELATION OF

                         _TASTES AND ALIMENTS_

                             TO EACH OTHER,

                                  AND

                  INTO THE INFLUENCE OF THIS RELATION

                                  UPON

                          HEALTH AND PLEASURE.


In entering upon this subject, I feel like the clown, who, after several
unsuccessful attempts to play upon a violin, threw it hastily from him,
exclaiming at the same time, that "there was music in it," but that he
could not bring it out.

I shall endeavour, by a few brief remarks, to lay a foundation for more
successful inquiries upon this difficult subject.

Attraction and repulsion seem to be the active principles of the
universe. They pervade not only the greatest, but the minutest works
of nature. Salts, earths, inflammable bodies, metals, and vegetables,
have all their respective relations to each other. The order of these
relations is so uniform, that it has been ascribed by some philosophers
to a latent principle of intelligence pervading each of them.

Colours, odours, and sounds, have likewise their respective relations to
each other. They become agreeable and disagreeable, only in proportion
to the natural or unnatural combination which takes place between each
of their different species.

It is remarkable, that the number of original colours and notes in
music is exactly the same. All the variety in both, proceeds from the
difference of combination. An arbitrary combination of them is by no
means productive of pleasure. The relation which every colour and sound
bear to each other, was as immutably established at the creation, as
the order of the heavenly bodies, or as the relation of the objects of
chemistry to each other.

But this relation is not confined to colours and sounds alone. It
probably extends to the objects of human aliment. For example, bread and
meat, meat and salt, the alkalescent meats and acescent vegetables, all
harmonize with each other upon the tongue; while fish and flesh, butter
and raw onions, fish and milk, when combined, are all offensive to a
pure and healthy taste.

It would be agreeable to trace the analogy of sounds and tastes. They
have both their flats and their sharps. They are both improved by the
contrast of discords. Thus pepper, and other condiments (which are
disagreeable when taken by themselves) enhance the relish of many of our
aliments, and they are both delightful in proportion as they are simple
in their composition. To illustrate this analogy by more examples from
music, would lead us from the subject of the present inquiry.

It is observable that the tongue and the stomach, like instinct and
reason, are, by nature, in unison with each other. One of those organs
must always be disordered, when they disagree in a single article of
aliment. When they both unite in articles of diet that were originally
disagreeable, it is owing to a perversion in each of them, similar to
that which takes place in the human mind, when both the moral faculty
and the conscience lose their natural sensibility to virtue and vice.

Unfortunately for this part of science, the taste and the stomach are
so much perverted in infancy and childhood by heterogeneous aliment,
that it is difficult to tell what kinds, and mixtures of food are
natural, and what are artificial. It is true, the system possesses a
power of accommodating itself both to artificial food, and to the most
discordant mixtures of that which is natural; but may we not reasonably
suppose, that the system would preserve its natural strength and order
much longer, if no such violence had been offered to it?

If the relation of aliments to each other follows the analogy of the
objects of chemistry, then their union will be influenced by many
external circumstances, such as heat and cold, dilution, concentration,
rest, motion, and the addition of substances which promote unnatural,
or destroy natural mixtures. This idea enlarges the field of inquiry
before us, and leads us still further from facts and certainty upon this
subject, but at the same time it does not preclude us from the hope of
obtaining both; for every difficulty that arises out of this view of the
subject, may be removed by observation and experiment.

I come now to apply these remarks to health and pleasure. I shall select
only a few cases for this purpose; for if my principles be true, my
readers cannot avoid discovering many other illustrations of them.

1. When an article of diet is grateful to the taste, and afterwards
disagrees with the stomach, may it not be occasioned by some other kind
of food, or by some drink being taken into the stomach, which refuses to
unite with the offending article of diet?

2. May not the uneasiness which many persons feel after a moderate meal,
arise from its having consisted of articles of aliment which were not
related to each other?

3. May not the delicacy of stomach which sometimes occurs after the
fortieth or forty-fifth year of human life, be occasioned by nature
recovering her empire in the stomach, so as to require simplicity in
diet, or such articles only of aliment as are related? May not this be
the reason why most people, who have passed those periods of life, are
unable to retain or to digest fish and flesh at the same time, and why
they generally dine only upon one kind of food?

4. Is not the language of nature in favour of simplicity in diet,
discovered by the avidity with which the luxurious and intemperate often
seek relief from variety and satiety, by retreating to spring water for
drink, and to bread and milk for aliment?

5. May not the reason why plentiful meals of fish, venison, oysters,
beef, or mutton, when eaten alone, lie so easily in the stomach, and
digest so speedily, be occasioned by no other food being taken with
them? A pound, and even more, of the above articles, frequently oppress
the system much less than half the quantity of heterogeneous aliments.

6. Does not the facility with which a due mixture of vegetable and
animal food digests in the stomach, indicate the certainty of their
relation to each other?

7. May not the peculiar good effects of a diet wholly vegetable, or
animal, be occasioned by the more frequent and intimate relation of the
articles of the same kingdoms to each other? And may not this be the
reason why so few inconveniences are felt from the mixture of a variety
of vegetables in the stomach?

8. May not the numerous acute and chronic diseases of the rich and
luxurious, arise from heterogeneous aliments being distributed in a
_diffused_, instead of a _mixed_ state, through every part of the body?

9. May not the many cures which are ascribed to certain articles of
diet, be occasioned more by their being taken alone, than to any
medicinal quality inherent in them? A diet of oysters in one instance,
of strawberries in another, and of sugar of roses in many instances,
has cured violent and dangerous diseases of the breast[56]. Grapes,
according to Doctor Moore, when eaten in large quantities, have produced
the same salutary effect. A milk diet, persisted in for several
years, has cured the gout and epilepsy. I have seen many cases of
dyspepsia cured by a simple diet of beef and mutton, and have heard of
a well-attested case of a diet of veal alone having removed the same
disease. Squashes, and turnips likewise, when taken by themselves, have
cured that distressing complaint in the stomach. It has been removed
even by milk, when taken by itself in a moderate quantity[57]. The
further the body, and more especially the stomach, recede from health,
the more this simplicity of diet becomes necessary. The appetite in
these cases does not speak the language of uncorrupted nature. It
frequently calls for various and improper aliment; but this is the
effect of intemperance having produced an early breach between the taste
and the stomach.

  [56] Vansweiten, 1209. 3.

  [57] Medical Observations and Inquiries, vol. VI. p. 310, 319.

Perhaps the extraordinary cures of obstinate diseases which are
sometimes performed by persons not regularly educated in physic, may
be occasioned by a long and steady perseverance in the use of a single
article of the materia medica. Those chemical medicines which decompose
each other, are not the only substances which defeat the intention
of the prescriber. Galenical medicines, by combination, I believe,
frequently produce effects that are of a compound and contrary nature to
their original and simple qualities. This remark is capable of extensive
application, but I quit it as a digression from the subject of this
inquiry.

10. I wish it to be observed, that I have condemned the mixture of
different aliments in the stomach only in a few cases, and under certain
circumstances. It remains yet to determine by experiments, what changes
are produced upon aliments by heat, dilution, addition, concentration,
motion, rest, and the addition of uniting substances, before we can
decide upon the relation of aliments to each other, and the influence of
that relation upon health. The olla podrida of Spain is said to be a
pleasant and wholesome dish. It is probably rendered so, by a previous
tendency of all its ingredients to putrefaction, or by means of heat
producing a new arrangement, or additional new relations of all its
parts. I suspect heat to be a powerful agent in disposing heterogeneous
aliments to unite with each other; and hence the mixture of aliments is
probably less unhealthy in France and Spain, than in England, where so
much less fire is used in preparing them, than in the former countries.

As too great a mixture of glaring colours, which are related to each
other, becomes painful to the eye, so too great a mixture of related
aliments oppresses the stomach, and debilitates the powers of the
system. The original colours of the sky, and of the surface of the
globe, have ever been found the most permanently agreeable to the
eye. In like manner, I am disposed to believe that there are certain
simple aliments which correspond, in their sensible qualities, with the
intermediate colours of _blue_ and _green_, that are most permanently
agreeable to the tongue and stomach, and that every deviation from them,
is a departure from the simplicity of health and nature.

11. While nature seems to have limited us to simplicity in aliment, is
not this restriction abundantly compensated by the variety of tastes
which she allows us to impart to it, in order to diversify and increase
the pleasure of eating? It is remarkable that salt, sugar, mustard,
horse-radish, capers, and spices of all kinds, according to Mr. Gosse's
experiments, related by Abbé Spallanzani[58], all contribute not only to
render aliments savoury, but to promote their digestion.

  [58] Dissertations, vol. I. p. 326.

12. When we consider, that part of the art of cookery consists in
rendering the taste of aliments agreeable, is it not probable that the
pleasure of eating might be increased beyond our present knowledge upon
that subject, by certain new arrangements or mixtures of the substances
which are used to impart a pleasant taste to our aliment?

13. Should philosophers ever stoop to this subject, may they not
discover and ascertain a table of the relations of sapid bodies to each
other, with the same accuracy that they have ascertained the relation of
the numerous objects of chemistry to each other?

14. When the tongue and stomach agree in the same kinds of aliment,
may not the increase of the pleasure of eating be accompanied with an
increase of health and prolongation of life?

15. Upon the pleasure of eating, I shall add the following remarks.
In order to render it truly exquisite, it is necessary that all the
senses, except that of taste, should be as _quiescent_ as possible.
Those persons mistake the nature of the appetite for food, who attempt
to whet it by accompanying a dinner by a band of music, or by connecting
the dining table, with an extensive and delightful prospect. The undue
excitement of one sense, always produces weakness in another. Even
conversation sometimes detracts from the pleasure of eating: hence
great feeders love to eat in silence, or alone; and hence the speech
of a passionate Frenchman, while dining in a talkative company, was
not so improper as might be at first imagined. "Hold your tongues
(said he); I cannot taste my dinner." I know a physician, who, upon
the same principle, always shuts his eyes, and requests silence in a
sick chamber, when he wishes to determine by the pulse the propriety
of blood-letting, in cases where its indication is doubtful. His
perceptions become more distinct, by confining his whole attention to
the sense of feeling.

It is impossible to mention the circumstance of the senses acting only
in succession to each other in the enjoyment of pleasure, without being
struck with the impartial goodness of Heaven, in placing the rich and
the poor so much upon a level in the pleasures of the table. Could the
numerous objects of pleasure, which are addressed to the ears and the
eyes, have been possessed at the same time with the pleasure of eating,
the rich would have commanded three times as much pleasure in that
enjoyment as the poor; but this is so far from being the case, that a
king has no advantage over a beggar, in eating the same kind of aliment.




                                  THE

                       NEW METHOD OF INOCULATING

                                FOR THE

                               SMALL-POX.

       DELIVERED IN A LECTURE IN THE UNIVERSITY OF PENNSYLVANIA,

                     ON THE 20TH OF FEBRUARY, 1781.


GENTLEMEN,

It must afford no small pleasure to a benevolent mind, in the midst of a
war which daily makes so much havoc with the human species, to reflect
that the small-pox, which once proved equally fatal to thousands, has
been checked in its career, and in a great degree subdued, by the
practice of INOCULATION.

It is foreign to my purpose to deliver to you the history of this
art, and to mark the various steps that have attended its progress to
its present state of improvement. We have yet to lament the want of
uniformity and of equal success in the practice of it among physicians.
A great number of pamphlets have been written upon the subject without
exhausting it. There is still ample room left for the man of genius to
exercise his talents for observation and reasoning upon it. The facts I
mean to lay before you are so inconsiderable, compared with what still
remain to be known upon this subject, that I have to request, when your
knowledge in it is completed, that you would bury my name in silence,
and forget that ever I ventured to lay a single stone in this part of
the fabric of science.

In treating upon this subject, I shall

I. Consider the proper subjects, and seasons for inoculation.

II. I shall describe the method of communicating the disease.

III. I shall consider the method of preparing the body for the small-pox.

IV. I shall mention the treatment proper during the eruptive fever. And,

V. Point out a few cautions that are necessary after the disease is
over.

I. Formerly there were great difficulties in the choice of subjects for
inoculation. But experience teaches us, that it may be practised in
every stage of life, and in almost every condition of the human body. In
infancy, the periods before and after dentition are to be preferred. But
we seldom see any great inconveniences from submitting to the general
necessity of inoculating children between the ages of three months, and
two years. Indeed we often see children cut three or four teeth during
the preparation and eruptive fever, without the least addition being
made to any of the troublesome symptoms which accompany the small-pox.
There is one inconvenience attending the choice of the first months
of infancy for inoculating, and that is, the matter often fails of
producing the disease in such young subjects. I have frequently failed
in two or three attempts to communicate it to children under four months
old, with the same matter that has succeeded in a dozen other patients,
inoculated at the same time. When the inoculation succeeds in such
tender subjects, they generally have less fever, and fewer pustules,
than are common in any future period of life.

Although a physician would prefer a patient in good health to any other
as a subject for inoculation, yet cases often occur in which it is
necessary to communicate the small-pox while the body is affected with
some other disease. I can with pleasure inform you, that the small-pox
is rendered so perfectly safe by inoculation, that there are few chronic
diseases which should be considered as obstacles in the way of it. I
have inoculated patients labouring under a tertian fever, obstructed
viscera, the hooping cough, the hypochondriasis, the asthma, the itch,
and other cutaneous diseases, and even pregnant women, with the same,
and, in some instances, with greater success, than persons in perfect
health. Doctor Cullen informs us, that he has seen inoculation succeed
in scrophulous patients. A physician in Jamaica informed me, that he
had inoculated negroes with success in the worst stage of the yaws. To
these facts I must add one more extraordinary than any that has been yet
mentioned: Doctor Brown, my late colleague in the care of the military
hospitals, informed me, that he had seen inoculation succeed in patients
who were seized, after the infection was communicated, with the hospital
fever. The preparation of the body should be accommodated to the disease
which affects it. Some physicians have thought the small-pox, received
in this way, was a remedy for other diseases; but my experience has not
confirmed this opinion: on the contrary, I am inclined to think that
no other change is produced by inoculation, than by the regimen and
medicines that are used to prepare the body for the small-pox. Nor does
the small-pox, during its continuance, afford any security against the
attacks of other diseases. I have seen the most alarming complication of
the small-pox and measles taken in _succession_ to each other, in the
same person.

The seasons commonly preferred for inoculation, in this country, are the
spring and fall. It may be practised with equal safety in the winter, a
due regard being had to the temperature of the air in the preparation of
the body.

The principal objection to inoculating in the summer months in this
climate, arises from the frequency of bilious diseases at that season,
to which the preparation necessary for the small-pox probably disposes
the body. This caution applies more directly to children, who, at a
certain age, are more subject than grown people to a disease in their
bowels in warm weather.

II. The methods of communicating the small-pox by inoculation, have
been different in different countries, and in the different æras of its
progress towards its present stage of improvement. The scab, dossel of
lint, and the thread impregnated with variolous matter, and bound up in
a gash in the arm, have been laid aside.

We are indebted to Mr. Sutton for the mode of communicating it by a
slight puncture with the point of a lancet, or needle, dipt in fresh
matter. As it is difficult sometimes to procure matter in a fresh
state, I have been led to use it with equal success by preserving
it on lint in a box, and moistening it with cold water just before
I used it. Matter may be kept in this way for a month, without
losing its infectious quality, provided it be not exposed to heat or
moisture. The former destroys its power of infecting as certainly
as the salt of tartar destroys the acidity of vinegar. Moisture, by
remaining long upon the matter, probably destroys its virulence, by
subjecting it to fermentation. The longer matter has been kept in
a general way, the longer the distance will be between the time of
communicating the disease, and the eruptive fever. It will be proper
always to yield to the prejudices of our patients in favour of matter
taken from persons who have but few pustules. But I am persuaded from
repeated observations, that the disease is no ways influenced by this
circumstance. I am satisfied likewise that there is no difference
between the effects of the matter, whether it be taken in its watery and
purulent state. The puncture should not be larger than is sufficient
to draw one drop of blood, but it should always be made by a _sharp_
lancet, for the sudden inflammation and suppuration, excited by a dull
lancet, sometimes throw off the matter, so as to prevent its infecting
the body[59]. No plaster or bandage should be applied over the puncture.
It should be made in the left arm of all subjects. The objections to
inoculating in the leg are too obvious to be mentioned. I have heard of
the disease being communicated by rubbing the dry skin with the matter.
My own observations upon this subject, give me reason to suspect the
facts that are contained in books relative to this mode of infecting
the body. I have bound large pieces of lint dipt in fresh matter for
twenty-four hours upon the arm, without producing the disease. A
practitioner of physic in New-Jersey informed me, that he once gave a
considerable quantity of fresh variolous matter in a dose of physic,
without infecting his patient. I suspect the matter that produces the
disease is of the same nature with certain poisons, which require to be
brought in contact with a wound or sore in the body, before they produce
their effects. I deliver this opinion with diffidence. The subject
stands in need of more experiments and investigation.

  [59] I am disposed to believe that the external applications which are
       used by the Indians for the cure of the bite of poisonous
       snakes act only by exciting inflammation and suppuration, which
       discharge the poison from the wound before it is absorbed. All
       their external remedies are of a _stimulating_ nature.

III. I come now to consider the best method of preparing the body for
the small-pox. This must be done, 1st, by DIET, and 2dly, by MEDICINE.
The DIET should consist chiefly of vegetables. I have never seen any
inconvenience from the free use of milk, as a part of the preparative
diet. In some habits, where a morbid acid prevails in the stomach, we
may indulge our patients in a little weak flesh broth two or three times
a week with safety. A little salted meat may likewise be taken daily
in such cases. Tea, coffee, and even weak chocolate, with biscuit or
dry toast, may be used as usual, by persons accustomed to that kind
of aliment. Wine and spirits of all kinds should be withheld from our
patients, during the preparation. The more acescent their drinks are,
the better. It is unnecessary that this change in the diet should take
place till a day or two before the time of communicating the disease.
The system accommodates to a vegetable and low diet in the course of
three weeks or a month, so as to defeat in some measure the advantages
we expected from it. The good effects of it appear to depend in a
great degree upon the _suddenness_ with which we oblige our patients to
conform to it. For this reason, when we are called upon to inoculate
persons who have lived more than three or four weeks upon a low diet, we
should always direct them to live a few days upon animal food, before
we communicate the disease to them. By these means we may produce all
the good effects of the _sudden_ change in the diet I have already
mentioned. 2. The MEDICINES most commonly used to prepare the body
for the small-pox are antimony and mercury. The latter has had the
preference, and has been given in large quantities, under a notion of
its being a specific antidote to the variolous matter. Many objections
might be made to this opinion; I shall mention only three.

1. We often see the disease in a high degree, after the system is fully
impregnated with mercury.

2. We often see the same salutary effects of mercury, when given before
the disease is communicated to the body, that we perceive when it is
given after inoculation; in which case we are sure the mercury cannot
enter into the mixture with the variolous matter so as to destroy it.

3. If mercury acted specifically in destroying the variolous matter,
it would render every other part of the preparation unnecessary: but
this we know is not the case, for the neglect or improper use of the
vegetable diet or cool regimen is often attended with an extraordinary
number, or virulence of the small-pox, even in those cases where mercury
is given in the largest quantity.

The way in which mercury prepares the body for the small-pox, seems
to be by promoting the several excretions, particularly that by
perspiration, which, by diminishing the quantity of the fluids, and
weakening the tone of the solids, renders the system less liable to a
plentiful eruption of the small-pox. But I object to the use of this
medicine for the following reasons:

1. It effectually deprives us of all the benefits of the cool regimen;
for mercury, we know, always _disposes_ the system to take cold.

2. All the good effects of mercury may be produced by PURGES, which do
not subject the body to the above-mentioned inconvenience.

The PURGES may be suited to the constitutions, and in some cases, even
to the inclinations of our patients. I have seen jalap, rhubarb,
senna, manna, aloes, soluble tartar, glauber and Epsom salts, and the
butter-nut pill, all given with equal success. The quantity should be
sufficient to procure three or four stools every day. A little magnesia
should always be mixed with rhubarb and jalap in preparing children.
It will be sufficient for the mothers and nurses of infants to conform
strictly to the vegetable diet. I have never seen any advantages from
giving them even a single dose of physic.

It is hardly necessary to observe, that the quality, dose, and number of
purges are to be determined by the age, sex, and habits of our patients.
A constitution enfeebled by a previous disease forbids the use of
purges, and requires medicines of a restorative kind. Patients afflicted
with cutaneous diseases bear larger and more frequent doses of physic,
than are indicated in more healthy subjects.

In adult subjects of a plethoric habit, blood-letting is very useful on
the third or fourth day after inoculation. We are not to suppose, that
every fat person labours under a plethora. A moderate degree of fat is
so far from rendering the disease more violent, especially in children,
that I think I have generally found such subjects have the small-pox
more favourably than others.

Moderate exercise in the open air should be used during the preparation.
But hard labour, and every thing that promotes sweat or fatigue, as also
the extremes of heat and cold, should be avoided.

IV. We come now to consider the treatment of the body during the
eruptive fever. On the eighth day after inoculation our patients are
_generally_ seized with the common symptoms of fever. Sometimes this
fever appears on the sixth and seventh day after inoculation. But when
it is irregular, it is often delayed till the ninth and tenth days. I
have seen many instances of it on the fourteenth, a few on the fifteenth
and sixteenth, and _one_ case in which it did not come on till the
eighteenth day after the infection was communicated to the body[60]. The
place where the puncture was made with the lancet, or needle, generally
serves as a harbinger of the approaching fever. A slight inflammation
appears about it, and a pock rises up in the centre. But this remark is
liable to some objections. I have seen _four_ instances in which the
fever came on at the expected time, and the disease went through all
its stages with the greatest regularity, and yet there was no sign of
an inflammation or pock near the spot where the puncture was made: even
the puncture itself became invisible. On the other hand, we sometimes
see an inflammation and pock on the arm appear on the eighth and ninth
days, without any fever accompanying them. Some physicians suppose that
this inflammation and solitary pock are sufficient to constitute the
disease; but repeated experience has taught me to be very cautious in
relying upon these equivocal marks. It is true, I have sometimes seen
patients secured against the small-pox, both in the natural way and by
inoculation, where these marks have appeared; but I have as often seen
such patients seized afterwards with the small-pox in the natural way,
to the great distress of families, and mortification of physicians.
Upon this account, I make it a constant practice to advise a second
or third inoculation, where a fever and eruption have been wanting. As
the absence of these symptoms is probably occasioned by the weakness or
age of the variolous matter, or the too high state of preparation of
the body, we should always guard against both, by making the puncture
the second time with _fresh_ matter, by subjecting our patients to a
_less_ abstemious diet, and by giving fewer doses of physic. I have
heard it remarked, that if a slight redness and a small pimple appeared
on the arm on the third day after inoculation, it was a sign the matter
had infected the whole constitution. I acknowledge I have often seen
a greater degree of redness on the third than on the second day after
inoculation, but I have not been able to establish a diagnostic mark
from it; for I have seen the disease produced on the usual days where
the redness has appeared on the second day, and in some cases where it
has not appeared until the eruptive fever.

  [60] Since the publication of the first edition of this lecture, I have
       heard of two cases, in one of which the fever did not come on
       till the twentieth, and in the other till the twenty-first day
       after the infection was communicated to the body. In some of
       these tedious cases, I have seen an inflammation and suppuration
       on the punctured part of the arm on the eighth day without any
       fever. Perhaps in these cases the inflammation and suppuration
       are only cuticular, and that the small-pox is taken from the
       matter which is formed by them.

I am led here unwillingly to discuss the old question, Is it possible
to have the small-pox in the natural way after inoculation?--In
many of the cases supposed to be the small-pox from inoculation, it
is probable the matter has been taken from the chicken-pox, which
resembles the small-pox in many of its peculiarities, but in none
more than that of leaving pits or marks on the skin. But there are
certainly cases where there are the most irrefragable proofs of the
infection implanted by inoculation being of a variolous nature, where
the disease has been afterwards taken in the natural way. In these
cases I would suppose the variolous matter produced only a topical or
cuticular disease. We see something analogous to this in nurses who
attend patients in the small-pox. But further, this topical or cuticular
infection may be produced by art in persons who have had the small-pox
in the natural way. Some years ago, I made a puncture on my left hand
with a lancet moistened with variolous matter. On the eighth day an
inflammation appeared on the place, accompanied by an efflorescence
in the neighbourhood of it, which extended about two inches in every
direction from the spot where the puncture was made. On the eleventh
day I was surprised to find two pocks (if I may venture to call them
such), the one on the outside of the fourth finger of my left hand,
and the other on my forehead. They remained there for several days,
but without filling with matter, and then dropped off, rather in the
form of a soft wart, than of a common scab. Doctor Way of Wilmington
repeated the same experiment upon himself, but with an issue to his
curiosity more extraordinary than that I have just now related. On the
eighth day after he had made a puncture on his hand, a pock appeared
on the spot, which in the usual time filled with matter, from which he
inoculated several children, who sickened at the usual time, and went
through all the common stages and symptoms of the small-pox. It would
seem from these facts, that it is necessary the small-pox should produce
some impression upon the _whole_ system, in order to render it ever
afterwards incapable of receiving an impression of a similar nature. A
fever and an eruption therefore seem necessary for this purpose. As the
inflammation of the arm on the eighth day is a sign of the _topical_
and cuticular infection, so an eruption (though ever so small) seems to
be the only certain sign of the infection of the _whole_ system. The
eruption is the more decisive in its report, in proportion as it comes
out and goes off in the usual manner of the small-pox in the natural
way. In those cases where patients have been secured against a second
attack of the disease, when there have been no _obvious_ fever or
_visible_ eruption, I think I have observed an unusual inflammation, and
a copious and long continued discharge of matter from the arm. Perhaps
this may serve as an outlet of the matter, which in other cases produces
the fever and eruption. I am the more disposed to embrace this opinion,
from the testimony which several authors have left us of the effects
of ulcers in securing the body from the infection of the plague. The
effects of issues are still more to our purpose. We observe a plentiful
discharge of matter from them every time the body is exposed to cold,
and the febrile effects of it upon the system are thereby frequently
obviated. How far a ratio exists between the degrees of inflammation
and the discharge of matter from the arm, and the degrees of fever and
eruption, must be determined by future and very accurate observations.
If it should appear, that there are the least inflammation and smallest
discharge, where there have been the highest fever and most copious
eruption; and, on the contrary, if it should appear that there are
the greatest inflammation and discharge, where there have been the
least fever and smallest eruption, I must beg leave to add, without
attempting in this place to explain the reasons of it, that the remark,
if generally true, is liable to some exceptions. But the subject is
involved in darkness; I shall be satisfied if I have brought you within
sight of the promised land. Your own ingenuity, like another Jewish
leader, must conduct you thither.

The indications in the treatment of the body during the eruptive fever
are,

I. To regulate the degree of fever.

II. To mitigate troublesome and alarming symptoms.

The fever which produces the eruption is generally of the inflammatory
kind. It sometimes, therefore, comes on with the symptoms of great heat,
preceded with chilliness, and determination to the head and breast, and
a full hard pulse. The remedies proper in this case are,

1. Blood-letting. The quantity to be drawn must be regulated by the
violence of the symptoms, the constitution, habits, and even country of
the patient, and by the season of the year. I have never found more than
one bleeding, to the quantity of twelve or fourteen ounces, necessary
in any stage or degree of the eruptive fever of the small-pox by
inoculation.

2. Cool air is of the utmost consequence in the eruptive fever. The
use of this remedy in fevers marks an æra, not only in the management
of the small-pox, but in medicine. The degrees of cold should always
be increased in proportion to the violence of the fever. Stove-rooms,
so common in this country, should be carefully avoided. The more we
oblige our patients to sit up and walk in the open air, the better. Even
in those cases where they languish most for the bed, they should be
encouraged rather to lie upon, than _under_ the bed-clothes. Children
should be stript of flannel petticoats that come in contact with their
skins; and even clouts should be laid aside, if possible without great
inconvenience, and at any rate they should be often removed. Great and
obvious as the advantages of cold air appear to be in the eruptive
fever, it has sometimes been used to an excess that has done mischief.
There are few cases where a degree of cold below fifty of _Fahrenheit's_
thermometer is necessary in this stage of the small-pox. When it has
been used below this, or where patients have been exposed to a damp
atmosphere some degrees above it, I have heard of inflammations of an
alarming nature being produced in the throat and breast.

3. The bowels, more especially of children, should be kept open with
gentle laxatives. And,

4. Cool subacid drinks should be plentifully used until the eruption be
completed.

Sometimes the small-pox comes on with a fever the reverse of that which
we have described. The heat is inconsiderable, the pulse is weak, and
scarcely quicker than ordinary, and the patient complains of but
slight pains in the back and head. Here the treatment should be widely
different from that which has been mentioned when the fever is of the
inflammatory kind. Bleeding in this case is hurtful, and even cool air
must be admitted with caution. The business of the physician in this
case is to excite a gentle action in the sanguiferous system, in order
to produce the degree of fever which is necessary to the eruption of the
pock. For this purpose he may recommend the use of warm drinks, and even
of a warm bed with advantage. If the eruption delay beyond the third
day, with all the circumstances of debility that have been mentioned, I
have frequently ordered my patients to eat a few ounces of animal food,
and to drink a glass or two of wine, with the most desirable success.
The effects of this indulgence are most obvious where the weakness
of the fever and the delay of the eruption in children, have made it
necessary to allow it to mothers and nurses.

The small-pox by inoculation so seldom comes on with the symptoms of
what is called a malignant fever, that little need be said of the
treatment proper in such cases. I shall only observe, that the cold
regimen in the highest degree, promises more success in these cases than
in any others. I have repeatedly been told, that when the small-pox
appears confluent among the Africans, it is a common practice for
mothers to rub their children all over with pepper, and plunge them
immediately afterwards into a spring of cold water. This, they say,
destroys a great part of the pock, and disposes the remainder to a
kindly suppuration. From the success that has attended the use of the
cold bath in malignant fevers in some parts of Europe[61], I am disposed
to believe in the efficacy of the African remedy.

  [61] In a dissertation entitled "_Epidemia verna quæ Wratislaviam,
       Anno. 1737 afflixit_," published in the appendix to the Acta Nat.
       Curios. Vol. X. it appears, that washing the body all over with
       cold water in putrid fevers, attended with great debility, was
       attended with success at _Breslaw_ in _Silesia_. The practice has
       since been adopted, we are told, by several of the neighbouring
       countries. CULLEN'S FIRST LINES OF THE PRACTICE OF PHYSIC.

The fever generally lasts three days, and the eruption continues for a
similar length of time, counting the last day of the fever, as the first
day of the eruption. But this remark is liable to many exceptions. We
sometimes observe the eruption to begin on the first, and often on the
second day of the fever; and we sometimes meet with cases in which a
second eruption comes on after the fever has abated for several days,
and the first eruption considerably advanced in its progress towards
a complete suppuration. This is often occasioned by the application of
excessive cold or heat to the body, or by a sudden and premature use of
stimulating drinks, or animal food.

I come now to treat of the best method of mitigating troublesome and
alarming symptoms.

The only _alarming_ symptom is convulsions, to which children are
subject during the time of dentition. These have been less frequent,
since the liberal and judicious use of cool air in the eruptive fever
than formerly. They are often relieved by putting the feet in warm
water. But a more effectual and speedy method of curing them, is to
expose our patients suddenly to the open air. The colder the air the
quicker relief it affords in these cases. To prevent the return of the
fits, as well as to allay any disagreeable and troublesome startings, a
few drops of laudanum should be given. They generally yield in a little
while to this excellent remedy.

The next symptom which demands the aid of our art, is the inflammation
and sore on the arm. Poultices of all kinds should be laid aside, as
tending to increase the inflammation and sore. Instead of these, the
part affected should be washed three or four times a day with cold
water[62]. This application is not only agreeable to our patients, but
soon checks the progress of the inflammation, and disposes the sore to
heal about the time the eruption is completed. The eyes should likewise
be washed frequently with cold water, to secure them from pustules and
inflammation. With respect to those alarming or troublesome symptoms
which occur in those cases where the pocks are numerous, or confluent,
they happen so seldom in inoculation, that they do not come properly
under our notice in this place. They are moreover fully discussed by
Doctors Boerhaave, Huxham, Hillary, and other practical writers.

  [62] Where the inflammation on the arm has been so considerable as not
       to yield immediately to the application of cold water, I have
       used the vegeto-mineral water with advantage.

V. I come now, in the last place, to deliver a few directions that are
necessary after the eruption and suppuration are over.

It is well known that eruptions of an obstinate nature sometimes follow
the small-pox. These I believe are often occasioned by a too _sudden_
and speedy use of animal food. To guard against these disagreeable
consequences of inoculation, it is of the utmost importance to enjoin a
cautious and _gradual_ return to the free use of an animal diet; and at
the same time it will be necessary to give our patients a dose or two of
purging physic.

Thus, gentlemen, have I delivered to you a short history of the new
method of inoculating for the small-pox. I am aware that prejudices are
entertained against some parts of it by physicians of the most ancient
name and character among us. I have witnessed the effects of the old and
new methods of preparing the body upon many thousand patients, and I am
satisfied, not only from my own observations, but from the experience
of gentlemen upon whose judgments I rely more than upon my own, that
the new method is by far the safest and most successful. Added to this,
I can assure my pupils, that I have never known a single instance of a
patient, prepared and treated in the manner I have described, that ever
had an abscess after the small-pox, or even such an inflammation or sore
upon the arm as required the application of a poultice.




                               AN INQUIRY

                                INTO THE

                      _EFFECTS OF ARDENT SPIRITS_

                                UPON THE

                          HUMAN BODY AND MIND.

                                  WITH

                 AN ACCOUNT OF THE MEANS OF PREVENTING,

                               AND OF THE

                      _REMEDIES FOR CURING THEM_.

                                PART I.


By ardent spirits, I mean those liquors only which are obtained by
distillation from fermented substances of any kind. To their effects
upon the bodies and minds of men, the following inquiry shall be
exclusively confined. Fermented liquors contain so little spirit, and
that so intimately combined with other matters, that they can seldom
be drunken in sufficient quantities to produce intoxication, and its
subsequent effects, without exciting a disrelish to their taste, or
pain, from their distending the stomach. They are moreover, when taken
in a moderate quantity, generally innocent, and often have a friendly
influence upon health and life.

The effects of ardent spirits divide themselves into such as are of
a prompt, and such as are of a chronic nature. The former discover
themselves in drunkenness, and the latter, in a numerous train of
diseases and vices of the body and mind.

I. I shall begin by briefly describing their prompt, or immediate
effects, in a fit of drunkenness.

This odious disease (for by that name it should be called) appears with
more or less of the following symptoms, and most commonly in the order
in which I shall enumerate them.

1. Unusual garrulity.

2. Unusual silence.

3. Captiousness, and a disposition to quarrel.

4. Uncommon good humour, and an insipid simpering, or laugh.

5. Profane swearing, and cursing.

6. A disclosure of their own, or other people's secrets.

7. A rude disposition to tell those persons in company, whom they know,
their faults.

8. Certain immodest actions. I am sorry to say, this sign of the first
stage of drunkenness, sometimes appears in women, who, when sober, are
uniformly remarkable for chaste and decent manners.

9. A clipping of words.

10. Fighting; a black eye, or a swelled nose, often mark this grade of
drunkenness.

11. Certain extravagant acts which indicate a temporary fit of madness.
These are singing, hallooing, roaring, imitating the noises of brute
animals, jumping, tearing off clothes, dancing naked, breaking glasses
and china, and dashing other articles of household furniture upon
the ground, or floor. After a while the paroxysm of drunkenness is
completely formed. The face now becomes flushed; the eyes project, and
are somewhat watery; winking is less frequent than is natural; the under
lip is protruded; the head inclines a little to one shoulder; the jaw
falls; belchings and hiccup take place; the limbs totter; the whole
body staggers. The unfortunate subject of this history next falls on
his seat; he looks around him with a vacant countenance, and mutters
inarticulate sounds to himself. He attempts to rise and walk; in this
attempt, he falls upon his side, from which he gradually turns upon
his back. He now closes his eyes, and falls into a profound sleep,
frequently attended with snoring, and profuse sweats, and sometimes with
such a relaxation of the muscles which confine the bladder and the lower
bowels, as to produce a symptom which delicacy forbids me to mention. In
this condition, he often lies from ten, twelve, and twenty-four hours,
to two, three, four, and five days, an object of pity and disgust to his
family and friends. His recovery from this fit of intoxication is marked
with several peculiar appearances. He opens his eyes, and closes them
again; he gapes and stretches his limbs; he then coughs and pukes; his
voice is hoarse; he rises with difficulty, and staggers to a chair; his
eyes resemble balls of fire; his hands tremble; he loathes the sight of
food; he calls for a glass of spirits to compose his stomach; now and
then he emits a deep-fetched sigh, or groan, from a transient twinge of
conscience, but he more frequently scolds, and curses every thing around
him. In this state of languor and stupidity he remains for two or three
days, before he is able to resume his former habits of business and
conversation.

Pythagoras we are told maintained that the souls of men after death,
expiated the crimes committed by them in this world, by animating
certain brute animals; and that the souls of those animals in their
turns, entered into men, and carried with them all their peculiar
qualities and vices. This doctrine of one of the wisest and best of the
Greek philosophers, was probably intended only to convey a lively idea
of the changes which are induced in the body and mind of man by a fit of
drunkenness. In folly, it causes him to resemble a calf; in stupidity,
an ass; in roaring, a mad bull; in quarrelling, and fighting, a dog;
in cruelty, a tiger; in fetor, a skunk; in filthiness, a hog; and in
obscenity, a he-goat.

It belongs to the history of drunkenness to remark, that its paroxysms
occur, like the paroxysms of many diseases, at certain periods, and
after longer or shorter intervals. They often begin with annual, and
gradually increase in their frequency, until they appear in quarterly,
monthly, weekly, and quotidian or daily periods. Finally they afford
scarcely any marks of remission, either during the day or the night.
There was a citizen of Philadelphia, many years ago, in whom drunkenness
appeared in this protracted form. In speaking of him to one of his
neighbours, I said,

"Does he not _sometimes_ get drunk?" "You mean," said his neighbour, "is
he not _sometimes_ sober?"

It is further remarkable, that drunkenness resembles certain hereditary,
family, and contagious diseases. I have once known it to descend from a
father to four out of five of his children. I have seen three, and once
four brothers who were born of sober ancestors, affected by it, and I
have heard of its spreading through a whole family composed of members
not originally related to each other. These facts are important, and
should not be overlooked by parents, in deciding upon the matrimonial
connections of their children.

Let us next attend to the chronic effects of ardent spirits upon the
body and mind. In the body, they dispose to every form of acute disease;
they moreover _excite_ fevers in persons predisposed to them, from other
causes. This has been remarked in all the yellow fevers which have
visited the cities of the United States. Hard drinkers seldom escape,
and rarely recover from them. The following diseases are the usual
consequences of the habitual use of ardent spirits, viz.

1. A decay of appetite, sickness at stomach, and a puking of bile, or a
discharge of a frothy and viscid phlegm by hawking, in the morning.

2. Obstructions of the liver. The fable of Prometheus, on whose liver a
vulture was said to prey constantly, as a punishment for his stealing
fire from heaven, was intended to illustrate the painful effects of
ardent spirits upon that organ of the body.

3. Jaundice and dropsy of the belly and limbs, and finally of every
cavity in the body. A swelling in the feet and legs is so characteristic
a mark of habits of intemperance, that the merchants in Charleston, I
have been told, cease to trust the planters of South-Carolina, as soon
as they perceive it. They very naturally conclude industry and virtue
to be extinct in that man, in whom that symptom of disease has been
produced by the intemperate use of distilled spirits.

4. Hoarseness, and a husky cough, which often terminate in consumption,
and sometimes in an acute and fatal disease of the lungs.

5. Diabetes, that is, a frequent and weakening discharge of pale, or
sweetish urine.

6. Redness and eruptions on different parts of the body. They generally
begin on the nose, and after gradually extending all over the face,
sometimes descend to the limbs in the form of leprosy. They have been
called "rum-buds," when they appear in the face. In persons who have
occasionally survived these effects of ardent spirits on the skin, the
face after a while becomes bloated, and its redness is succeeded by a
death-like paleness. Thus the same fire which produces a red colour in
iron, when urged to a more intense degree, produces what has been called
a white heat.

7. A fetid breath, composed of every thing that is offensive in putrid
animal matter.

8. Frequent and disgusting belchings. Dr. Haller relates the case of a
notorious drunkard having been suddenly destroyed, in consequence of the
vapour discharged from his stomach by belching, accidentally taking fire
by coming in contact with the flame of a candle.

9. Epilepsy.

10. Gout, in all its various forms of swelled limbs, colic, palsy, and
apoplexy.

Lastly, 11. Madness. The late Dr. Waters, while he acted as house
pupil and apothecary of the Pennsylvania hospital, assured me, that in
one-third of the patients confined by this terrible disease, it had been
induced by ardent spirits.

Most of the diseases which have been enumerated are of a mortal nature.
They are more certainly induced, and terminate more speedily in death,
when spirits are taken in such quantities, and at such times, as to
produce frequent intoxication: but it may serve to remove an error with
which some intemperate people console themselves, to remark, that ardent
spirits often bring on fatal diseases without producing drunkenness. I
have known many persons destroyed by them, who were never completely
intoxicated during the whole course of their lives. The solitary
instances of longevity which are now and then met with in hard drinkers,
no more disprove the deadly effects of ardent spirits, than the solitary
instances of recoveries from apparent death by drowning, prove that
there is no danger to life from a human body lying an hour or two under
water.

The body after its death, from the use of distilled spirits, exhibits
by dissection certain appearances which are of a peculiar nature. The
fibres of the stomach and bowels are contracted; abscesses, gangrene,
and schirri are found in the viscera; the bronchial vessels are
contracted; the blood-vessels and tendons, in many parts of the body,
are more or less ossified; and even the hair of the head possesses a
crispness which renders it less valuable to wig-makers than the hair of
sober people.

Not less destructive are the effects of ardent spirits upon the human
mind. They impair the memory, debilitate the understanding, and pervert
the moral faculties. It was probably from observing these effects of
intemperance in drinking, upon the mind, that a law was formerly passed
in Spain, which excluded drunkards from being witnesses in a court of
justice. But the demoralizing effects of distilled spirits do not stop
here. They produce not only falsehood, but fraud, theft, uncleanliness,
and murder. Like the demoniac mentioned in the New Testament, their name
is "legion," for they convey into the soul, a host of vices and crimes.

A more affecting spectacle cannot be exhibited, than a person into whom
this infernal spirit, generated by habits of intemperance, has entered.
It is more or less affecting, according to the station the person fills
in a family, or in society, who is possessed by it. Is he a husband? How
deep the anguish which rends the bosom of his wife! Is she a wife? Who
can measure the shame and aversion which she excites in her husband! Is
he the father, or is she the mother of a family of children? See their
averted looks from their parent, and their blushing looks at each other!
Is he a magistrate? or has he been chosen to fill a high and respectable
station in the councils of his country? What humiliating fears of
corruption in the administration of the laws, and of the subversion of
public order and happiness, appear in the countenances of all who see
him! Is he a minister of the gospel? Here language fails me.----If
angels weep,--it is at such a sight.

In pointing out the evils produced by ardent spirits, let us not pass
by their effects upon the estates of the persons who are addicted to
them. Are they inhabitants of cities? Behold their houses stripped
gradually of their furniture, and pawned, or sold by a constable, to
pay tavern debts! See their names upon record in the dockets of every
court, and whole pages of newspapers filled with advertisements of
their estates for public sale! Are they inhabitants of country places?
Behold their houses with shattered windows! their barns with leaky
roofs! their gardens over-run with weeds! their fields with broken
fences! their hogs without yokes! their sheep without wool! their cattle
and horses without fat! and their children filthy, and half clad,
without manners, principles, and morals! This picture of agricultural
wretchedness is seldom of long duration. The farms and property thus
neglected, and depreciated, are seized and sold for the benefit of a
group of creditors. The children that were born with the prospect of
inheriting them, are bound out to service in the neighbourhood; while
their parents, the unworthy authors of their misfortunes, ramble into
new and distant settlements, alternately fed on their way by the hand of
charity, or a little casual labour.

Thus we see poverty and misery, crimes and infamy, diseases and death,
are all the natural and usual consequences of the intemperate use of
ardent spirits.

I have classed death among the consequences of hard drinking. But it
is not death from the immediate hand of the Deity, nor from any of the
instruments of it which were created by him. It is death from SUICIDE.
Yes! thou poor degraded creature, who art daily lifting the poisoned
bowl to thy lips, cease to avoid the unhallowed ground in which the
self-murderer is interred, and wonder no longer that the sun should
shine, and the rain fall, and the grass look green upon his grave.
Thou art perpetrating gradually, by the use of ardent spirits, what
he has effected suddenly, by opium, or a halter. Considering how many
circumstances, from a sudden gust of passion, or from derangement, may
palliate his guilt, or that (unlike yours) it was not preceded and
accompanied by any other crime, it is probable his condemnation will be
less than yours at the day of judgment.

I shall now take notice of the occasions and circumstances which are
supposed to render the use of ardent spirits necessary, and endeavour
to show that the arguments in favour of their use in such cases are
founded in error, and that, in each of them, ardent spirits, instead of
affording strength to the body, increase the evils they are intended to
relieve.

1. They are said to be necessary in very cold weather. This is far from
being true; for the temporary warmth they produce, is always succeeded
by a greater disposition in the body to be affected by cold. Warm
dresses, a plentiful meal just before exposure to the cold, and eating
occasionally a little gingerbread, or any other cordial food, is a much
more durable method of preserving the heat of the body in cold weather.

2. They are said to be necessary in very warm weather. Experience proves
that they increase instead of lessening the effects of heat upon the
body, and thereby dispose to diseases of all kinds. Even in the warm
climate of the West-Indies, Dr. Bell asserts this to be true. "Rum
(says this author) whether used habitually, moderately, or in excessive
quantities, in the West-Indies, always diminishes the strength of the
body, and renders men more susceptible of disease, and unfit for any
service in which vigour or activity is required[63]." As well might
we throw oil into a house, the roof of which was on fire, in order to
prevent the flames from extending to its inside, as pour ardent spirits
into the stomach, to lessen the effects of a hot sun upon the skin.

  [63] Inquiry into the causes which produce, and the means of preventing
       diseases among British officers, soldiers, and others in the
       West-Indies.

3. Nor do ardent spirits lessen the effects of hard labour upon the
body. Look at the horse: with every muscle of his body swelled from
morning till night in the plough, or a team, does he make signs for
a draught of toddy or a glass of spirits, to enable him to cleave the
ground, or to climb a hill? No; he requires nothing but cool water,
and substantial food. There is no nourishment in ardent spirits. The
strength they produce in labour is of a transient nature, and is always
followed by a sense of weakness and fatigue.

But are there no conditions of the human body in which ardent spirits
may be given? I answer, there are. 1st. When the body has been suddenly
exhausted of its strength, and a disposition to faintness has been
induced. Here a few spoonsful, or a wine-glassful of spirits, with
or without water, may be administered with safety and advantage. In
this case we comply strictly with the advice of Solomon, who restricts
the use of "strong drink" only "to him who is ready to perish." 2dly.
When the body has been exposed for a long time to wet weather, more
especially if it be combined with cold. Here a moderate quantity of
spirits is not only safe, but highly proper to obviate debility, and to
prevent a fever. They will more certainly have those salutary effects,
if the feet are at the same time bathed with them, or a half pint of
them poured into the shoes or boots. These I believe are the only two
cases in which distilled spirits are useful or necessary to persons in
health.


                                PART II.

But it may be said, if we reject spirits from being a part of our
drinks, what liquors shall we substitute in their room? I answer, in the
first place,

1. SIMPLE WATER. I have known many instances of persons who have
followed the most laborious employments for many years in the open air,
and in warm and cold weather, who never drank any thing but water, and
enjoyed uninterrupted good health. Dr. Moseley, who resided many years
in the West-Indies, confirms this remark. "I aver (says the doctor),
from my own knowledge and custom, as well as the custom and observations
of many other people, that those who drink nothing but water, or make
it their principal drink, are but little affected by the climate, and
can undergo the greatest fatigue without inconvenience, and are never
subject to troublesome or dangerous diseases."

Persons who are unable to relish this simple beverage of nature, may
drink some one, or of all the following liquors, in preference to ardent
spirits.

2. CYDER. This excellent liquor contains a small quantity of spirit,
but so diluted, and blunted by being combined with a large quantity of
saccharine matter, and water, as to be perfectly wholesome. It sometimes
disagrees with persons subject to the rheumatism, but it may be made
inoffensive to such people, by extinguishing a red hot iron in it, or by
mixing it with water. It is to be lamented, that the late frosts in the
spring so often deprive us of the fruit which affords this liquor. The
effects of these frosts have been in some measure obviated by giving an
orchard a north-west exposure, so as to check too early vegetation, and
by kindling two or three large fires of brush or straw, to the windward
of the orchard, the evening before we expect a night of frost. This last
expedient has in many instances preserved the fruit of an orchard, to
the great joy and emolument of the ingenious husbandman.

3. MALT LIQUORS. The grain from which these liquors are obtained, is
not liable, like the apple, to be affected by frost, and therefore they
can be procured at all times, and at a moderate price. They contain
a good deal of nourishment; hence we find many of the poor people in
Great-Britain endure hard labour with no other food than a quart or
three pints of beer, with a few pounds of bread in a day. As it will be
difficult to prevent small beer from becoming sour in warm weather, an
excellent substitute may be made for it by mixing bottled porter, ale,
or strong beer with an equal quantity of water; or a pleasant beer may
be made by adding to a bottle of porter, ten quarts of water, and a
pound of brown sugar, or a pint of molasses. After they have been well
mixed, pour the liquor into bottles, and place them, loosely corked, in
a cool cellar. In two or three days, it will be fit for use. A spoonful
of ginger added to the mixture, renders it more lively, and agreeable to
the taste.

3. WINES. These fermented liquors are composed of the same ingredients
as cyder, and are both cordial and nourishing. The peasants of France,
who drink them in large quantities, are a sober and healthy body of
people. Unlike ardent spirits, which render the temper irritable, wines
generally inspire cheerfulness and good humour. It is to be lamented
that the grape has not as yet been sufficiently cultivated in our
country, to afford wine to our citizens; but many excellent substitutes
may be made for it, from the native fruits of all the states. If
two barrels of cyder fresh from the press, are boiled into one, and
afterwards fermented, and kept for two or three years in a dry cellar,
it affords a liquor which, according to the quality of the apple from
which the cyder is made, has the taste of Malaga, or Rhenish wine. It
affords when mixed with water, a most agreeable drink in summer. I have
taken the liberty of calling it POMONA WINE. There is another method
of making a pleasant wine from the apple, by adding four and twenty
gallons of new cyder to three gallons of syrup made from the expressed
juice of sweet apples. When thoroughly fermented, and kept for a few
years, it becomes fit for use. The blackberry of our fields, and the
raspberry and currant of our gardens, afford likewise an agreeable and
wholesome wine, when pressed and mixed with certain proportions of sugar
and water, and a little spirit, to counteract their disposition to an
excessive fermentation. It is no objection to these cheap and home-made
wines, that they are unfit for use until they are two or three years
old. The foreign wines in common use in our country, require not only a
much longer time to bring them to perfection, but to prevent their being
disagreeable, even to the taste.

4. MOLASSES and WATER, also VINEGAR and WATER, sweetened with sugar
or molasses, form an agreeable drink in warm weather. It is pleasant
and cooling, and tends to keep up those gentle and uniform sweats, on
which health and life often depend. Vinegar and water constituted the
only drink of the soldiers of the Roman republic, and it is well known
they marched and fought in a warm climate, and beneath a load of arms
which weighed sixty pounds. Boaz, a wealthy farmer in Palestine, we find
treated his reapers with nothing but bread dipped in vinegar. To such
persons as object to the taste of vinegar, sour milk, or butter-milk, or
sweet milk diluted with water, may be given in its stead. I have known
the labour of the longest and hottest days in summer supported, by means
of these pleasant and wholesome drinks, with great firmness, and ended,
with scarcely a complaint of fatigue.

5. The SUGAR MAPLE affords a thin juice, which has long been used by the
farmers in Connecticut, as a cool and refreshing drink, in the time of
harvest. The settlers in the western counties of the middle states will
do well to let a few of the trees which yield this pleasant juice remain
in all their fields. They may prove the means, not only of saving their
children and grand-children many hundred pounds, but of saving their
bodies from disease and death, and their souls from misery beyond the
grave.

6. COFFEE possesses agreeable and exhilarating qualities, and might be
used with great advantage to obviate the painful effects of heat, cold,
and fatigue upon the body. I once knew a country physician, who made it
a practice to drink a pint of strong coffee previously to his taking a
long or cold ride. It was more cordial to him than spirits, in any of
the forms in which they are commonly used.

The use of the cold bath in the morning, and of the warm bath in the
evening, are happily calculated to strengthen the body in the former
part of the day, and to restore it in the latter, from the languor and
fatigue which are induced by heat and labour.

Let it not be said, ardent spirits have become necessary from habit in
harvest, and in other seasons of uncommon and arduous labour. The habit
is a bad one, and may be easily broken. Let but half a dozen farmers
in a neighbourhood combine to allow higher wages to their labourers
than are common, and a sufficient quantity of _any_ of the pleasant
and wholesome liquors I have recommended, and they may soon, by their
example, abolish the practice of giving them spirits. In a little while
they will be delighted with the good effects of their association. Their
grain and hay will be gathered into their barns in less time, and in a
better condition than formerly, and of course at a less expense, and a
hundred disagreeable scenes from sickness, contention, and accidents
will be avoided, all of which follow in a greater or less degree the use
of ardent spirits.

Nearly all diseases have their predisposing causes. The same thing may
be said of the intemperate use of distilled spirits. It will, therefore,
be useful to point out the different employments, situations, and
conditions of the body and mind, which predispose to the love of those
liquors, and to accompany them with directions to prevent persons being
ignorantly and undesignedly seduced into the habitual and destructive
use of them.

1. Labourers bear with great difficulty, long intervals between their
meals. To enable them to support the waste of their strength, their
stomachs should be constantly, but moderately stimulated by aliment, and
this is best done by their eating four or five times in a day during
the seasons of great bodily exertion. The food at this time should be
_solid_, consisting chiefly of salted meat. The vegetables used with
it, should possess some activity, or they should be made savoury by
a mixture of spices. Onions and garlic are of a most cordial nature.
They composed a part of the diet which enabled the Israelites to
endure, in a warm climate, the heavy tasks imposed upon them by their
Egyptian masters; and they were eaten, Horace and Virgil tell us, by
the Roman farmers, to repair the waste of their strength, by the toils
of harvest. There are likewise certain sweet substances, which support
the body under the pressure of labour. The negroes in the West-Indies
become strong, and even fat, by drinking the juice of the sugar cane,
in the season of grinding it. The Jewish soldiers were invigorated by
occasionally eating raisins and figs. A bread composed of wheat flour,
molasses, and ginger (commonly called gingerbread), taken in small
quantities during the day, is happily calculated to obviate the debility
induced upon the body by constant labour. All these substances, whether
of an animal or vegetable nature, lessen the desire, as well as the
necessity, for cordial drinks, and impart equable and durable strength
to every part of the system.

2. Valetudinarians, especially those who are afflicted with diseases of
the stomach and bowels, are very apt to seek relief from ardent spirits.
Let such people be cautious how they make use of this dangerous remedy.
I have known many men and women of excellent characters and principles,
who have been betrayed, by occasional doses of gin and brandy, into a
love of those liquors, and have afterwards fallen sacrifices to their
fatal effects. The different preparations of opium are much more safe
and efficacious than distilled cordials of any kind, in flatulent or
spasmodic affections of the stomach and bowels. So great is the danger
of contracting a love for distilled liquors, by accustoming the stomach
to their stimulus, that as few medicines as possible should be given in
spiritous vehicles, in chronic diseases. A physician, of great eminence
and uncommon worth, who died towards the close of the last century,
in London, in taking leave of a young physician of this city, who had
finished his studies under his patronage, impressed this caution with
peculiar force upon him, and lamented at the same time, in pathetic
terms, that he had innocently made many sots, by prescribing brandy and
water in stomach complaints. It is difficult to tell how many persons
have been destroyed by those physicians who have adopted Dr. Brown's
indiscriminate practice in the use of stimulating remedies, the most
popular of which is ardent spirits, but, it is well known, several
of them have died of intemperance in this city, since the year 1790.
They were probably led to it, by drinking brandy and water, to relieve
themselves from the frequent attacks of debility and indisposition,
to which the labours of a physician expose him, and for which rest,
fasting, a gentle purge, or weak diluting drinks would have been safe
and more certain cures.

None of these remarks are intended to preclude the use of spirits in
the low state of short, or what are called acute diseases, for, in such
cases, they produce their effects too soon to create a habitual desire
for them.

3. Some people, from living in countries subject to intermitting
fevers, endeavour to fortify themselves against them, by taking two or
three wine-glasses of bitters, made with spirits, every day. There is
great danger of contracting habits of intemperance from this practice.
Besides, this mode of preventing intermittents is far from being a
certain one. A much better security against them, is a tea-spoonful of
the jesuits bark, taken every morning during a sickly season. If this
safe and excellent medicine cannot be had, a gill or half a pint of a
strong watery infusion of centaury, camomile, wormwood, or rue, mixed
with a little of the calamus of our meadows, may be taken every morning,
with nearly the same advantage as the jesuits bark. Those persons who
live in a sickly country, and cannot procure any of the preventives of
autumnal fevers which have been mentioned, should avoid the morning and
evening air; should kindle fires in their houses, on damp days, and in
cool evenings, throughout the whole summer; and put on winter clothes,
about the first week in September. The last part of these directions
applies only to the inhabitants of the middle states.

4. Men who follow professions, which require constant exercise of
the faculties of their minds, are very apt to seek relief, by the
use of ardent spirits, from the fatigue which succeeds great mental
exertions. To such persons, it may be a discovery to know, that TEA
is a much better remedy for that purpose. By its grateful and gentle
stimulus, it removes fatigue, restores the excitement of the mind, and
invigorates the whole system. I am no advocate for the excessive use
of tea. When taken too strong, it is hurtful, especially to the female
constitution; but when taken of a moderate degree of strength, and in
moderate quantities, with sugar and cream, or milk, I believe it is, in
general, innoxious, and at all times to be preferred to ardent spirits,
as a cordial for studious men. The late Anthony Benezet, one of the
most laborious schoolmasters I ever knew, informed me, he had been
prevented from the love of spiritous liquors, by acquiring a love for
tea in early life. Three or four cups, taken in an afternoon, carried
off the fatigue of a whole day's labour in his school. This worthy man
lived to be seventy-one years of age, and died of an acute disease, with
the full exercise of all the faculties of his mind. But the use of tea
counteracts a desire for distilled spirits, during great _bodily_, as
well as mental exertions. Of this, Captain Forest has furnished us with
a recent and remarkable proof, in his History of a Voyage from Calcutta,
to the Marqui Archipelago. "I have always observed (says this ingenious
mariner) when sailors drink TEA, it weans them from the thoughts of
drinking strong liquors, and pernicious grog; and with this, they are
soon contented. Not so with whatever will intoxicate, be it what it
will. This has always been my remark. I therefore always encourage it,
without their knowing why."

5. Women have sometimes been led to seek relief from what is called
breeding sickness, by the use of ardent spirits. A little gingerbread,
or biscuit, taken occasionally, so as to prevent the stomach being
empty, is a much better remedy for that disease.

6. Persons under the pressure of debt, disappointments in worldly
pursuits, and guilt, have sometimes sought to drown their sorrows
in strong drink. The only radical cure for those evils, is to be
found in religion; but where its support is not resorted to, wine
and opium should always be preferred to ardent spirits. They are far
less injurious to the body and mind, than spirits, and the habits of
attachment to them are easily broken, after time and repentance have
removed the evils they were taken to relieve.

7. The sociable and imitative nature of man, often disposes him to
adopt the most odious and destructive practices from his companions.
The French soldiers who conquered Holland, in the year 1794, brought
back with them the love and use of brandy, and thereby corrupted the
inhabitants of several of the departments of France, who had been
previously distinguished for their temperate and sober manners. Many
other facts might be mentioned, to show how important it is to avoid
the company of persons addicted to the use of ardent spirits.

8. Smoking and chewing tobacco, by rendering water and simple liquors
insipid to the taste, dispose very much to the stronger stimulus of
ardent spirits. The practice of smoking cigars has, in every part of
our country, been more followed by a general use of brandy and water,
as a common drink, more especially by that class of citizens who have
not been in the habit of drinking wine, or malt liquors. The less,
therefore, tobacco is used in the above ways, the better.

9. No man ever became suddenly a drunkard. It is by gradually
accustoming the taste and stomach to ardent spirits, in the forms of
GROG and TODDY, that men have been led to love them in their more
destructive mixtures, and in their simple state. Under the impression
of this truth, were it possible for me to speak with a voice so loud
as to be heard from the river St. Croix to the remotest shores of the
Mississippi, which bound the territory of the United States, I would
say, Friends and fellow-citizens, avoid the habitual use of those two
seducing liquors, whether they be made with brandy, rum, gin, Jamaica
spirits, whiskey, or what is called cherry bounce. It is true, some
men, by limiting the strength of those drinks, by measuring the spirit
and water, have drunken them for many years, and even during a long
life, without acquiring habits of intemperance or intoxication, but many
more have been insensibly led, by drinking weak toddy and grog first at
their meals, to take them for their constant drink, in the intervals of
their meals; afterwards to take them, of an increased strength, before
breakfast in the morning; and finally to destroy themselves by drinking
undiluted spirits, during every hour of the day and night. I am not
singular in this remark. "The consequences of drinking rum and water,
or _grog_, as it is called (says Dr. Moseley), is, that habit increases
the desire of more spirits, and decreases its effects; and there are
very few grog-drinkers who long survive the practice of debauching with
it, without acquiring the odious nuisance of dram-drinkers' breath,
and downright stupidity and impotence[64]." To enforce the caution
against the use of those two apparently innocent and popular liquors
still further, I shall select one instance, from among many, to show
the ordinary manner in which they beguile and destroy their votaries.
A citizen of Philadelphia, once of a fair and sober character, drank
toddy for many years, as his constant drink. From this he proceeded to
drink grog. After a while, nothing would satisfy him but slings made
of equal parts of rum and water, with a little sugar. From slings he
advanced to raw rum, and from common rum to Jamaica spirits. Here he
rested for a few months, but at length, finding even Jamaica spirits
were not strong enough to warm his stomach, he made it a constant
practice to throw a table-spoonful of ground pepper in each glass of his
spirits, in order, to use his own words, "to take off their coldness."
He soon after died a martyr to his intemperance.

  [64] Treatise on Tropical Diseases.

Ministers of the gospel, of every denomination, in the United States!
aid me with all the weight you possess in society, from the dignity and
usefulness of your sacred office, to save our fellow men from being
destroyed, by the great destroyer of their lives and souls. In order
more successfully to effect this purpose, permit me to suggest to you
to employ the same wise modes of instruction, which you use in your
attempts to prevent their destruction by other vices. You expose the
evils of covetousness, in order to prevent theft; you point out the
sinfulness of impure desires, in order to prevent adultery; and you
dissuade from anger, and malice, in order to prevent murder. In like
manner, denounce, by your preaching, conversation, and examples, the
seducing influence of toddy and grog, when you aim to prevent all the
crimes and miseries, which are the offspring of strong drink.

We have hitherto considered the effects of ardent spirits upon
individuals, and the means of preventing them. I shall close this head
of our inquiry, by a few remarks on their effects upon the population
and welfare of our country, and the means of obviating them.

It is highly probable, not less than 4000 people die annually, from
the use of ardent spirits, in the United States. Should they continue
to exert this deadly influence upon our population, where will their
evils terminate? This question may be answered, by asking, where are
all the Indian tribes, whose numbers and arms formerly spread terror
among their civilized neighbours? I answer, in the words of the famous
Mingo chief, "the blood of many of them flows not in the veins of any
human creature." They have perished, not by pestilence, nor war, but by
a greater foe to human life than either of them--ardent spirits. The
loss of 4000 American citizens, by the yellow fever, in a single year,
awakened general sympathy and terror, and called forth all the strength
and ingenuity of laws, to prevent its recurrence. Why is not the same
zeal manifested in protecting our citizens from the more general and
consuming ravages of distilled spirits? Should the customs of civilized
life, preserve our nation from extinction, and even from an increase
of mortality, by those liquors; they cannot prevent our country being
governed by men, chosen by intemperate and corrupted voters. From such
legislators, the republic would soon be in danger. To avert this evil,
let good men of every class unite and besiege the general and state
governments, with petitions to limit the number of taverns; to impose
heavy duties upon ardent spirits; to inflict a mark of disgrace, or a
temporary abridgment of some civil right, upon every man convicted of
drunkenness; and finally to secure the property of habitual drunkards,
for the benefit of their families, by placing it in the hands of
trustees, appointed for that purpose, by a court of justice.

To aid the operation of these laws, would it not be extremely useful
for the rulers of the different denominations of christian churches
to unite, and render the sale and consumption of ardent spirits, a
subject of ecclesiastical jurisdiction? The methodists, and society of
friends, have, for some time past, viewed them as contraband articles,
to the pure laws of the gospel, and have borne many public and private
testimonies, against making them the objects of commerce. Their success
in this benevolent enterprise, affords ample encouragement for all other
religious societies to follow their example.


                               PART III.

We come now to the third part of this inquiry, that is, to mention the
remedies for the evils which are brought on by the excessive use of
distilled spirits.

These remedies divide themselves into two kinds.

I. Such as are proper to cure a fit of drunkenness, and

II. Such as are proper to prevent its recurrence, and to destroy a
desire for ardent spirits.

I. I am aware that the efforts of science and humanity, in applying
their resources to the cure of a disease, induced by an act of vice,
will meet with a cold reception from many people. But let such people
remember, the subjects of our remedies, are their fellow creatures, and
that the miseries brought upon human nature, by its crimes, are as much
the objects of divine compassion (which we are bound to imitate), as the
distresses which are brought upon men, by the crimes of other people, or
which they bring upon themselves, by ignorance or accidents. Let us not
then, pass by the prostrate sufferer from strong drink, but administer
to him the same relief, we would afford to a fellow creature, in a
similar state, from an accidental, and innocent cause.

1. The first thing to be done to cure a fit of drunkenness, is to open
the collar, if in a man, and remove all tight ligatures from every other
part of the body. The head and shoulders should at the same time be
elevated, so as to favour a more feeble determination of the blood to
the brain.

2. The contents of the stomach should be discharged, by thrusting a
feather down the throat. It often restores the patient immediately to
his senses and feet. Should it fail of exciting a puking,

3. A napkin should be wrapped round the head, and wetted for an hour or
two with cold water, or cold water should be poured in a stream upon the
head. In the latter way, I have sometimes seen it used, when a boy, in
the city of Philadelphia. It was applied, by dragging the patient, when
found drunk in the street, to a pump, and pumping water upon his head
for ten or fifteen minutes. The patient generally rose, and walked off,
sober and sullen, after the use of this remedy.

Other remedies, less common, but not less effectual for a fit of
drunkenness, are,

4. Plunging the whole body into cold water. A number of gentlemen who
had drunken to intoxication, on board a ship in the stream, near Fell's
point, at Baltimore, in consequence of their reeling in a small boat, on
their way to the shore, in the evening, overset it, and fell into the
water. Several boats from the shore hurried to their relief. They were
all picked up, and went home, perfectly sober, to their families.

5. Terror. A number of young merchants, who had drunken together, in a
compting-house, on James river, above thirty years ago, until they were
intoxicated, were carried away by a sudden rise of the river, from
an immense fall of rain. They floated several miles with the current,
in their little cabin, half filled with water. An island in the river
arrested it. When they reached the shore that saved their lives, they
were all sober. It is probable terror assisted in the cure of the
persons who fell into the water at Baltimore.

6. The excitement of a fit of anger. The late Dr. Witherspoon used to
tell a story of a man in Scotland, who was always cured of a fit of
drunkenness, by being made angry. The means chosen for that purpose, was
a singular one. It was talking against religion.

7. A severe whipping. This remedy acts by exciting a revulsion of the
blood from the brain, to the external parts of the body.

8. Profuse sweats. By means of this evacuation, nature sometimes cures
a fit of drunkenness. Their good effects are obvious in labourers, whom
quarts of spirits taken in a day, will seldom intoxicate, while they
sweat freely. If the patient be unable to swallow warm drinks, in order
to produce sweats, they may be excited by putting him in a warm bath,
or wrapping his body in blankets, under which should be placed half a
dozen hot bricks, or bottles filled with hot water.

9. Bleeding. This remedy should always be used, when the former ones
have been prescribed to no purpose, or where there is reason to fear
from the long duration of the disease, a material injury may be done to
the brain.

It is hardly necessary to add, that each of the above remedies, should
be regulated by the grade of drunkenness, and the greater or less
degree, in which the intellects are affected in it.

II. The remedies which are proper to prevent the recurrence of fits
of drunkenness, and to destroy the desire for ardent spirits, are
religious, metaphysical, and medical. I shall briefly mention them.

1. Many hundred drunkards have been cured of their desire for ardent
spirits, by a practical belief in the doctrines of the christian
religion. Examples of the divine efficacy of christianity for this
purpose, have lately occurred in many parts of the United States.

2. A sudden sense of the guilt contracted by drunkenness, and of
its punishment in a future world. It once cured a gentleman in
Philadelphia, who, in a fit of drunkenness, attempted to murder a wife
whom he loved. Upon being told of it when he was sober, he was so struck
with the enormity of the crime he had nearly committed, that he never
tasted spiritous liquors afterwards.

3. A sudden sense of shame. Of the efficacy of this deep seated
principle in the human bosom, in curing drunkenness, I shall relate
three remarkable instances.

A farmer in England, who had been many years in the practice of coming
home intoxicated, from a market town, one day observed appearances of
rain, while he was in market. His hay was cut, and ready to be housed.
To save it, he returned in haste to his farm, before he had taken his
customary dose of grog. Upon coming into his house, one of his children,
a boy of six years old, ran to his mother, and cried out, "O, mother!
father is come home, and he is not drunk." The father, who heard this
exclamation, was so severely rebuked by it, that he suddenly became a
sober man.

A noted drunkard was once followed by a favourite goat, to a tavern,
into which he was invited by his master, and drenched with some of his
liquor. The poor animal staggered home with his master, a good deal
intoxicated. The next day he followed him to his accustomed tavern.
When the goat came to the door, he paused: his master made signs to
him to follow him into the house. The goat stood still. An attempt was
made to thrust him into the tavern. He resisted, as if struck with
the recollection of what he suffered from being intoxicated the night
before. His master was so much affected by a sense of shame in observing
the conduct of his goat to be so much more rational than his own, that
he ceased from that time to drink spiritous liquors.

A gentleman, in one of the southern states, who had nearly destroyed
himself by strong drink, was remarkable for exhibiting the grossest
marks of folly in his fits of intoxication. One evening, sitting in his
parlour, he heard an uncommon noise in his kitchen. He went to the door,
and peeped through the key hole, from whence he saw one of his negroes
diverting his fellow servants, by mimicking his master's gestures and
conversation when he was drunk. The sight overwhelmed him with shame and
distress, and instantly became the means of his reformation.

4. The association of the idea of ardent spirits, with a painful or
disagreeable impression upon some part of the body, has sometimes cured
the love of strong drink. I once tempted a negro man, who was habitually
fond of ardent spirits, to drink some rum (which I placed in his way),
and in which I had put a few grains of tartar emetic. The tartar
sickened and puked him to such a degree, that he supposed himself to be
poisoned. I was much gratified by observing he could not bear the sight,
nor smell of spirits, for two years afterwards.

I have heard of a man, who was cured of the love of spirits, by
working off a puke, by large draughts of brandy and water, and I know
a gentleman, who in consequence of being affected with a rheumatism,
immediately after drinking some toddy, when overcome with fatigue and
exposure to the rain, has ever since loathed that liquor, only because
it was accidentally associated in his memory with the recollection of
the pain he suffered from his disease.

This appeal to that operation of the human mind, which obliges it to
associate ideas, accidentally or otherwise combined, for the cure of
vice, is very ancient. It was resorted to by Moses, when he compelled
the children of Israel to drink the solution of the golden calf (which
they had idolized) in water. This solution, if made, as it most
probably was, by means of what is called hepar sulphuris, was extremely
bitter, and nauseous, and could never be recollected afterwards, without
bringing into equal detestation, the sin which subjected them to the
necessity of drinking it. Our knowledge of this principle of association
upon the minds and conduct of men, should lead us to destroy, by means
of other impressions, the influence of all those circumstances, with
which the recollection and desire of spirits are combined. Some men
drink only in the _morning_, some at _noon_, and some only at _night_.
Some men drink only on a _market day_, some at _one_ tavern only, and
some only in _one kind_ of company. Now by finding a new and interesting
employment, or subject of conversation for drunkards at the usual times
in which they have been accustomed to drink, and by restraining them
by the same means from those places and companions, which suggested
to them the idea of ardent spirits, their habits of intemperance
may be completely destroyed. In the same way the periodical returns
of appetite, and a desire of sleep have been destroyed in a hundred
instances. The desire for strong drink differs from each of them, in
being of an artificial nature, and therefore not disposed to return,
after being chased for a few weeks from the system.

5. The love of ardent spirits has sometimes been subdued, by exciting
a counter passion in the mind. A citizen of Philadelphia had made many
unsuccessful attempts to cure his wife of drunkenness. At length,
despairing of her reformation, he purchased a hogshead of rum, and,
after tapping it, left the key in the door of the room in which it was
placed, as if he had forgotten it. His design was to give his wife an
opportunity of drinking herself to death. She suspected this to be his
motive, in what he had done, and suddenly left off drinking. Resentment
here became the antidote to intemperance.

6. A diet consisting wholly of vegetables cured a physician in Maryland,
of drunkenness, probably by lessening that thirst, which is always more
or less excited by animal food.

7. Blisters to the ankles, which were followed by an unusual degree of
inflammation, once suspended the love of ardent spirits, for one month,
in a lady in this city. The degrees of her intemperance may be conceived
of, when I add, that her grocer's account for brandy alone amounted,
annually, to one hundred pounds, Pennsylvania currency, for several
years.

8. A violent attack of an acute disease, has sometimes destroyed a habit
of drinking distilled liquors. I attended a notorious drunkard, in the
yellow fever, in the year 1798, who recovered with the loss of his
relish for spirits, which has, I believe, continued ever since.

9. A salivation has lately performed a cure of drunkenness, in a person
of Virginia. The new disease excited in the mouth and throat, while
it rendered the action of the smallest quantity of spirits upon them
painful, was happily calculated to destroy the disease in the stomach
which prompts to drinking, as well as to render the recollection of them
disagreeable, by the laws of association formerly mentioned.

10. I have known an oath, taken before a magistrate, to drink no more
spirits, produce a perfect cure of drunkenness. It is sometimes cured in
this way in Ireland. Persons who take oaths for this purpose are called
affidavit men.

11. An advantage would probably arise from frequent representations
being made to drunkards, not only of the certainty, but of the
_suddenness_ of death, from habits of intemperance. I have heard of
two persons being cured of the love of ardent spirits, by seeing
death suddenly induced by fits of intoxication; in the one case, in a
stranger, and in the other, in an intimate friend.

12. It has been said, that the disuse of spirits should be gradual, but
my observations authorize me to say, that persons who have been addicted
to them, should abstain from them _suddenly_, and _entirely_. "Taste
not, handle not, touch not," should be inscribed upon every vessel that
contains spirits, in the house of a man who wishes to be cured of habits
of intemperance. To obviate, for a while, the debility which arises
from the sudden abstraction of the stimulus of spirits, laudanum, or
bitters infused in water, should be taken, and perhaps a larger quantity
of beer or wine, that is consistent with the strict rules of temperate
living. By the temporary use of these substitutes for spirits, I have
never known the transition to sober habits to be attended with any bad
effects, but often with permanent health of body, and peace of mind.




                              OBSERVATIONS

                                 ON THE

                        _DUTIES OF A PHYSICIAN_,

                           AND THE METHODS OF

                          IMPROVING MEDICINE.

              ACCOMMODATED TO THE PRESENT STATE OF SOCIETY

                   AND MANNERS IN THE UNITED STATES.

  Delivered in the University of Pennsylvania, February 7, 1789, at the
  conclusion of a course of lectures upon chemistry and the practice of
                                physic.

                _PUBLISHED AT THE REQUEST OF THE CLASS._


GENTLEMEN,

I Shall conclude our course of lectures, by delivering to you a few
directions for the regulation of your future conduct and studies, in the
line of your profession.

I shall, _first_, suggest the most probable means of establishing
yourselves in business, and of becoming acceptable to your patients, and
respectable in life.

_Secondly_, I shall mention a few thoughts which have occurred to me on
the mode to be pursued, in the further prosecution of your studies, and
for the improvement of medicine.

I. Permit me, in the first place, to recommend to such of you as intend
to settle in the country, to establish yourselves as early as possible
upon _farms_. My reasons for this advice are as follow:

1. It will reconcile the country people to the liberality and dignity
of your profession, by showing them that you assume no superiority over
them from your education, and that you intend to share with them in
those toils, which were imposed upon man in consequence of the loss of
his innocence. This will prevent envy, and render you acceptable to your
patients as men, as well as physicians.

2. By living on a farm you may serve your country, by promoting
improvements in agriculture. Chemistry (which is now an important branch
of a medical education) and agriculture are closely allied to each
other. Hence some of the most useful books upon agriculture have been
written by physicians. Witness the essays of Dr. Home of Edinburgh, and
of Dr. Hunter of Yorkshire, in England.

3. The business of a farm will furnish you with employment in the
healthy seasons of the year, and thereby deliver you from the tædium
vitæ, or what is worse, from retreating to low or improper company.
Perhaps one cause of the prevalence of dram or grog drinking, with which
country practitioners are sometimes charged, is owing to their having no
regular or profitable business to employ them, in the intervals of their
attendance upon their patients.

4. The resources of a farm will create such an independence as will
enable you to practice with more dignity, and at the same time screen
you from the trouble of performing unnecessary services to your
patients. It will change the nature of the obligation between you and
them. While _money_ is the only means of your subsistence, your patients
will feel that they are the channels of your daily bread; but while your
farm furnishes you with the necessaries of life, your patients will feel
more sensibly, that the obligation is on their side, for health and life.

5. The exigencies and wants of a farm in _stock_ and _labour_ of all
kinds, will enable you to obtain from your patients a compensation for
your services in those articles. They all possess them, and men part
with that of which money is only the sign, much more readily than they
do with money itself.

6. The resources of a farm will prevent your cherishing, for a moment,
an impious wish for the prevalence of sickness in your neighbourhood.
A healthy season will enable you to add to the produce of your farm,
while the rewards of an unhealthy season will enable you to repair the
inconvenience of your necessary absence from it. By these means your
pursuits will be marked by that _variety_ and _integrity_, in which true
happiness is said to consist.

7. Let your farms be small, and let your _principal_ attention be
directed to grass and horticulture. These afford most amusement, require
only moderate labour, and will interfere least with your duties to your
profession.

II. Avoid singularities of every kind in your manners, dress,
and general conduct. Sir Isaac Newton, it is said, could not be
distinguished in company, by any peculiarity, from a common well-bred
gentleman. Singularity in any thing, is a substitute for such great or
useful qualities as command respect; and hence we find it chiefly in
little minds. The profane and indelicate combination of extravagant
ideas, improperly called wit, and the formal and pompous manner, whether
accompanied by a wig, a cane, or a ring, should be all avoided, as
incompatible with the simplicity of science, and the real dignity of
physic. There is more than one way of playing the quack. It is not
necessary, for this purpose, that a man should advertise his skill, or
his cures, or that he should mount a phaeton and display his dexterity
in operating, to an ignorant and gaping multitude. A physician acts the
same part in a different way, who assumes the character of a madman or
a brute in his manners, or who conceals his fallibility by an affected
gravity and taciturnity in his intercourse with his patients. Both
characters, like the quack, impose upon the public. It is true, they
deceive different ranks of people; but we must remember that there
are two kinds of vulgar, viz. the rich and the poor; and that the
rich vulgar are often upon a footing with the poor, in ignorance and
credulity.

III. It has been objected to our profession, that many eminent
physicians have been unfriendly to christianity. If this be true, I
cannot help ascribing it in part to that neglect of public worship
with which the duties of our profession are often incompatible; for
it has been justly observed, that the neglect of this religious and
social duty, generally produces a relaxation, either in principles or
morals. Let this fact lead you, in setting out in business, to acquire
such habits of punctuality in visiting your patients, as shall not
interfere with acts of public homage to the Supreme Being. Dr. Gregory
has observed, that a cold heart is the most frequent cause of deism.
Where this occurs in a physician, it affords a presumption that he is
deficient in humanity. But I cannot admit that infidelity is peculiar
to our profession. On the contrary, I believe christianity places among
its friends more men of extensive abilities and learning in medicine,
than in any other secular employment. Stahl, Hoffman, Boerhaave,
Sydenham, Haller, and Fothergill, were all christians. These enlightened
physicians were considered as the ornaments of the ages in which
they lived, and posterity has justly ranked them among the greatest
benefactors of mankind.

IV. Permit me to recommend to you a regard to all the interests of your
country. The education of a physician gives him a peculiar insight in
the principles of many useful arts, and the practice of physic favours
his opportunities of doing good, by diffusing knowledge of all kinds. It
was in Rome, when medicine was practised only by slaves, that physicians
were condemned by their profession "mutam exercere artem." But in modern
times, and in free governments, they should disdain an ignoble silence
upon public subjects. The American revolution has rescued physic from
its former slavish rank in society. For the honour of our profession
it should be recorded, that some of the most intelligent and useful
characters, both in the cabinet and the field, during the late war,
have been physicians. The illustrious Dr. Fothergill opposed faction
and tyranny, and took the lead in all public improvements in his
native country, without suffering thereby the least diminution of that
reputation, or business, in which, for forty years, he flourished almost
without a rival in the city of London.

V. Let me advise you, in your visits to the sick, _never_ to appear in
a hurry, nor to talk of indifferent matters before you have made the
necessary inquiries into the symptoms of your patient's disease.

VI. Avoid making light of any case. "Respice finem" should be the motto
of every indisposition. There is scarcely a disease so trifling, that
has not, directly or indirectly, proved an outlet to human life. This
consideration should make you anxious and punctual in your attendance
upon every acute disease, and keep you from risking your reputation by
an improper or hasty prognosis.

VII. Do not condemn, or oppose, unnecessarily, the simple prescriptions
of your patients. Yield to them in matters of little consequence, but
maintain an inflexible authority over them in matters that are essential
to life.

VIII. Preserve, upon all occasions, a composed or cheerful countenance
in the room of your patients, and inspire as much hope of a recovery
as you can, consistent with truth, especially in acute diseases. The
extent of the influence of the will over the human body, has not yet
been fully ascertained. I reject the futile pretensions of Mr. Mesmer to
the cure of diseases, by what he has absurdly called animal magnetism.
But I am willing to derive the same advantages from his deceptions,
which the chemists have derived from the delusions of the alchemists.
The facts which he has established, clearly prove the influence of
the imagination, and will, upon diseases. Let us avail ourselves of
the handle which those faculties of the mind present to us, in the
strife between life and death. I have frequently prescribed remedies of
doubtful efficacy in the critical stage of acute diseases, but never
till I had worked up my patients into a confidence, bordering upon
certainty, of their probable good effects. The success of this measure
has much oftener answered, than disappointed my expectations; and while
my patients have commended the vomit, the purge, or the blister which
was prescribed, I have been disposed to attribute their recovery to the
vigorous concurrence of the _will_ in the action of the medicine. Does
the will beget insensibility to cold, heat, hunger, and danger? Does
it suspend pain, and raise the body above feeling the pangs of Indian
tortures? Let us not then be surprised that it should enable the system
to resolve a spasm, to open an obstruction, or to discharge an offending
humour. I have only time to hint at this subject. Perhaps it would lead
us, if we could trace it fully, to some very important discoveries in
the cure of diseases.

IX. Permit me to advise you in your intercourse with your patients,
to attend to that principle in the human mind, which constitutes the
association of ideas. A chamber, a chair, a curtain, or even a cup, all
belong to the means of life or death, accordingly as they are associated
with cheerful or distressing ideas, in the mind of a patient. But this
principle is of more immediate application in those chronic diseases
which affect the mind. Nothing can be accomplished here, till we produce
a new association of ideas. For this purpose a change of place and
company are absolutely necessary. But we must sometimes proceed much
further. I have heard of a gentleman in South-Carolina who cured his
fits of low spirits by changing his clothes. The remedy was a rational
one. It produced at once a new train of ideas, and thus removed the
paroxysm of his disease.

X. Make it a rule never to be angry at any thing a sick man says or does
to you. Sickness often adds to the natural irritability of the temper.
We are, therefore, to bear the reproaches of our patients with meekness
and silence. It is folly to resent injuries at any time, but it is
cowardice to resent an injury from a sick man, since, from his weakness
and dependence upon us, he is unable to contend with us upon equal
terms. You will find it difficult to attach your patients to you by the
obligations of friendship or gratitude. You will sometimes have the
mortification of being deserted by those patients who owe most to your
skill and humanity. This led Dr. Turner to advise physicians never to
chuse their friends from among their patients. But this advice can never
be followed by a heart that has been taught to love true excellency,
wherever it finds it. I would rather advise you to give the benevolent
feelings of your hearts full scope, and to forget the unkind returns
they will often meet with, by giving to human nature----a tear.

XI. Avoid giving a patient over in an acute disease. It is impossible
to tell in such cases where life ends, and where death begins. Hundreds
of patients have recovered, who have been pronounced incurable, to the
great disgrace of our profession. I know that the practice of predicting
danger and death upon every occasion, is sometimes made use of by
physicians, in order to enhance the credit of their prescriptions if
their patients recover, and to secure a retreat from blame, if they
should die. But this mode of acting is mean and illiberal. It is not
necessary that we should decide with confidence at any time, upon the
issue of a disease.

XII. A physician in sickness is always a welcome visitor in a family;
hence he is often solicited to partake of the usual sign of hospitality
in this country, by taking a draught of some strong liquor, every time
he enters into the house of a patient. Let me charge you to lay an
early restraint upon yourselves, by refusing to yield to this practice,
especially in the _forenoon_. Many physicians have been innocently led
by it into habits of drunkenness. You will be in the more danger of
falling into this vice, from the great fatigue and inclemency of the
weather to which you will be exposed in country practice. But you have
been taught that strong drink affords only a temporary relief from those
evils, and that it afterwards renders the body more sensible of them.

XIII. I shall now give some directions with respect to the method of
charging for your services to your patients.

When we consider the expence of a medical education, and the sacrifices
a physician is obliged to make of ease, society, and even health, to
his profession; and when we add to these, the constant and painful
anxiety which is connected with the important charge of the lives of our
fellow-creatures, and above all, the inestimable value of that blessing
which is the object of his services, I hardly know how it is possible
for a patient sufficiently and justly to reward his physician. But when
we consider, on the other hand, that sickness deprives men of the means
of acquiring money; that it increases all the expenses of living; and
that high charges often drive patients from regular-bred physicians to
quacks; I say, when we attend to these considerations, we should make
our charges as moderate as possible, and conform them to the following
state of things.

Avoid measuring your services to your patients by scruples, drachms, and
ounces. It is an illiberal mode of charging. On the contrary, let the
number and _time_ of your visits, the nature of your patient's disease,
and his rank in his family or society, determine the figures in your
accounts. It is certainly just to charge more for curing an apoplexy,
than an intermitting fever. It is equally just, to demand more for
risking your life by visiting a patient in a contagious fever, than
for curing a pleurisy. You have likewise a right to be paid for your
anxiety. Charge the same services, therefore, higher, to the master or
mistress of a family, or to an only son or daughter, who call forth
all your feelings and industry, than to less important members of a
family and of society. If a rich man demand more frequent visits than
are necessary, and if he impose the restraints of keeping to hours, by
calling in other physicians to consult with you upon every trifling
occasion, it will be just to make him pay accordingly for it. As this
mode of charging is strictly agreeable to reason and equity, it seldom
fails of according with the reason and sense of equity of our patients.
Accounts made out upon these principles, are seldom complained of by
them. I shall only remark further upon this subject, that the sooner
you send in your accounts after your patients recover, the better. It
is the duty of a physician to inform his patient of the amount of his
obligation to him at least _once_ a year. But there are times when a
departure from this rule may be necessary. An unexpected misfortune in
business, and a variety of other accidents, may deprive a patient of the
money he had allotted to pay his physician. In this case, delicacy and
humanity require, that he should not know the amount of his debt to his
physician, till time had bettered his circumstances.

I shall only add, under this head, that the poor of every description
should be the objects of your peculiar care. Dr. Boerhaave used to say,
"they were his best patients, because God was their paymaster." The
first physicians that I have known, have found the poor the steps by
which they have ascended to business and reputation. Diseases among the
lower class of people are generally simple, and exhibit to a physician
the best cases of all epidemics, which cannot fail of adding to his
ability of curing the complicated diseases of the rich and intemperate.
There is an inseparable connection between a man's duty and his
interest. Whenever you are called, therefore, to visit a poor patient,
imagine you hear the voice of the good Samaritan sounding in your ears,
"Take care of him, and I will repay thee."

I come now to the second part of this address, which was to point out
the best mode to be pursued, in the further prosecution of your studies,
and the improvement of medicine.

I. Give me leave to recommend to you, to open all the dead bodies you
can, without doing violence to the feelings of your patients, or the
prejudices of the common people. Preserve a register of the weather,
and of its influence upon the vegetable productions of the year. Above
all, record the epidemics of every season; their times of appearing and
disappearing, and the connection of the weather with each of them. Such
records, if published, will be useful to foreigners, and a treasure
to posterity. Preserve, likewise, an account of chronic cases. Record
the name, age, and occupation of your patient; describe his disease
accurately, and the changes produced in it by your remedies; mention
the doses of every medicine you administer to him. It is impossible to
tell how much improvement and facility in practice you will find from
following these directions. It has been remarked, that physicians seldom
remember more than the two or three last years of their practice.
The records which have been mentioned, will supply this deficiency of
memory, especially in that advanced stage of life when the advice of
physicians is supposed to be most valuable.

II. Permit me to recommend to you further, the study of the anatomy (if
I may be allowed the expression) of the human mind, commonly called
metaphysics. The reciprocal influence of the body and mind upon each
other, can only be ascertained by an accurate knowledge of the faculties
of the mind, and of their various modes of combination and action. It is
the duty of physicians to assert their prerogative, and to rescue the
mental science from the usurpations of schoolmen and divines. It can
only be perfected by the aid and discoveries of medicine. The authors I
would recommend to you upon metaphysics, are, Butler, Locke, Hartley,
Reid, and Beattie. These ingenious writers have cleared this sublime
science of its technical rubbish, and rendered it both intelligible and
useful.

III. Let me remind you, that improvement in medicine is not to be
derived only from colleges and universities. Systems of physic are
the productions of men of genius and learning; but those facts which
constitute real knowledge, are to be met with in every walk of life.
Remember how many of our most useful remedies have been discovered by
quacks. Do not be afraid, therefore, of conversing with them, and of
profiting by their ignorance and temerity in the practice of physic.
Medicine has its Pharisees, as well as religion. But the spirit of
this sect is as unfriendly to the advancement of medicine, as it is to
christian charity. By conversing with quacks, we may convey instruction
to them, and thereby lessen the mischief they might otherwise do to
society. But further. In the pursuit of medical knowledge, let me advise
you to converse with nurses and old women. They will often suggest
facts in the history and cure of diseases, which have escaped the most
sagacious observers of nature. Even negroes and Indians have sometimes
stumbled upon discoveries in medicine. Be not ashamed to inquire into
them. There is yet one more means of information in medicine which
should not be neglected, and that is, to converse with persons who have
recovered from indispositions without the aid of physicians. Examine the
strength and exertions of nature in these cases, and mark the plain and
home-made remedy to which they ascribe their recovery. I have found this
to be a fruitful source of instruction, and have been led to conclude,
that if every man in a city, or a district, could be called upon to
relate to persons appointed to receive and publish his narrative, an
exact account of the effects of those remedies which accident or whim
has suggested to him, it would furnish a very useful book in medicine.
To preserve the facts thus obtained, let me advise you to record them
in a book to be kept for that purpose. There is one more advantage that
will probably attend the inquiries that have been mentioned: you may
discover diseases, or symptoms of diseases, or even laws of the animal
economy, which have no place in our systems of nosology, or in our
theories of physic.

IV. Study simplicity in the preparation of your medicines. My reasons
for this advice are as follow:

1. Active medicines produce the most certain effects in a simple state.

2. Medicines when mixed frequently destroy the efficacy of each other.
I do not include chemical medicines alone in this remark. It applies
likewise to Galenical medicines. I do not say, that all these medicines
are impaired by mixture, but we can only determine when they are not, by
actual experiments and observations.

3. When medicines of the same class, or even of different classes, are
given together, the _strongest_ only produces an effect. But what are
we to say to a compound of two medicines which give exactly the same
impression to the system? Probably, if we are to judge from analogy, the
effect of them will be such as would have been produced by neither, in a
simple state.

4. By observing simplicity in your prescriptions, you will always have
the command of a greater number of medicines of the _same_ class, which
may be used in succession to each other, in proportion as habit renders
the system insensible of their action.

5. By using medicines in a simple state you will obtain an exact
knowledge of their virtues and doses, and thereby be able to decide upon
the numerous and contradictory accounts which exist in our books, of the
character of the _same_ medicines.

Under this head, I cannot help adding two more directions.

1. Avoid sacrificing too much to the _taste_ of your patients in the
preparation of your medicines. The nature of a medicine may be wholly
changed by being mixed with sweet substances. The Author of Nature
seems to have had a design, in rendering medicines unpalatable. Had they
been more agreeable to the taste, they would probably have yielded long
ago to the unbounded appetite of man, and by becoming articles of diet,
or condiments, have lost their efficacy in diseases.

2. Give as few medicines as possible in tinctures made with distilled
spirits. Perhaps there are few cases in which it is safe to exhibit
medicines prepared in spirits, in any other form than in _drops_. Many
people have been innocently seduced into a love of strong drink, from
taking large or frequent doses of bitters, infused in spirits. Let not
our profession be reproached in a single instance, with adding to the
calamities that have been entailed upon mankind by this dreadful species
of intemperance.

V. Let me recommend to your particular attention, the indigenous
medicines of our country. Cultivate or prepare as many of them as
possible, and endeavour to enlarge the materia medica, by exploring the
untrodden fields and forests of the United States. The ipecacuanha,
the Seneka and Virginia snake-roots, the Carolina pink-root, the
spice-wood, the sassafras, the butter-nut, the thoroughwort, the poke,
and the stramonium, are but a small part of the medicinal productions
of America. I have no doubt but there are many hundred other plants
which now exhale invaluable medicinal virtues in the desert air.
Examine, likewise, the mineral waters, which are so various in their
impregnation, and so common in all parts of our country. Let not the
properties of the insects of America escape your investigation. We have
already discovered among some of them, a fly equal in its blistering
qualities to the famous fly of Spain. Who knows but it may be reserved
for America to furnish the world, from her productions, with cures for
some of those diseases which now elude the power of medicine? Who knows
but that, at the foot of the Allegany mountain, there blooms a flower
that is an infallible cure for the epilepsy? Perhaps on the Monongahela,
or the Potomac, there may grow a root that shall supply, by its tonic
powers, the invigorating effects of the savage or military life in the
cure of consumptions. Human misery of every kind is evidently on the
decline. Happiness, like truth, is a unit. While the world, from the
progress of intellectual, moral, and political truth, is becoming a more
safe and agreeable abode for man, the votaries of medicine should not
be idle. All the doors and windows of the temple of nature have been
thrown open by the convulsions of the late American revolution. This
is the time, therefore, to press upon her altars. We have already drawn
from them discoveries in morals, philosophy, and government; all of
which have human happiness for their object. Let us preserve the unity
of truth and happiness, by drawing from the same source, in the present
critical moment, a knowledge of antidotes to those diseases which are
supposed to be incurable.

I have now, gentlemen, only to thank you for the attention with which
you have honoured the course of lectures which has been delivered to
you, and to assure you, that I shall be happy in rendering you all the
services that lie in my power, in any way you are pleased to command
me. Accept of my best wishes for your happiness, and may the blessings
of hundreds and thousands that were ready to perish, be your portion in
life, your comfort in death, and your reward in the world to come.




                                   AN

                    INQUIRY INTO THE CAUSE AND CURE

                                   OF

                              _SORE LEGS_.


However trifling these complaints may appear, they compose a large
class of the diseases of a numerous body of people. Hitherto, the
persons afflicted by them have been too generally abandoned to the care
of empirics, either because the disease was considered as beneath the
notice of physicians, or because they were unable to cure it. I would
rather ascribe it to the latter, than to the former cause, for pride has
no natural fellowship with the profession of medicine.

The difficulty of curing sore legs has been confessed by physicians in
every country. As far as my observations have extended, I am disposed
to ascribe this difficulty to the uniform and indiscriminate mode of
treating them, occasioned by the want of a theory which shall explain
their proximate cause. I shall attempt in a few pages to deliver one,
which, however imperfect, will, I hope, lay a foundation for more
successful inquiries upon this subject hereafter.

I shall begin my observations upon this disease, by delivering and
supporting the following propositions.

I. SORE LEGS are induced by general debility. This I infer from the
occupations and habits of the persons who are most subject to them. They
are day-labourers, and sailors, who are in the habit of lifting great
weights; also washer-women, and all other persons, who pass the greatest
part of their time upon their feet. The blood-vessels and muscular
fibres of the legs are thus overstretched, by which means either a
rupture, or such a languid action in the vessels is induced, as that
an accidental wound from any cause, even from the scratch of a pin, or
the bite of a mosquito, will not easily heal. But labourers, sailors,
and washer-women are not the only persons who are afflicted with sore
legs. Hard drinkers of every rank and description are likewise subject
to them. Where strong drink, labour, and standing long on the feet are
united, they more certainly dispose to sore legs, than when they act
separately. In China, where the labour which is performed by brutes
in other countries, is performed by men, varices on the legs are very
common among the labouring people. Perhaps, the reason why the debility
is induced in the legs produces varices instead of ulcers in these
people, may be owing to their not adding the debilitating stimulus of
strong drink to that of excessive labour.

It is not extraordinary that the debility produced by intemperance in
drinking ardent spirits, should appear first in the lower extremities.
The debility produced by intemperance in the use of wine, makes its
first appearance in the form of gout, in the same part of the body.
The gout, it is true, discovers itself most frequently in pain only,
but there are cases in which it has terminated in ulcers, and even
mortification on the legs.

II. Sore legs are connected with a morbid state of the whole system.
This I infer,

1. From the causes which induce them, all of which act more or less upon
every part of the body.

2. From their following or preceding diseases, which obviously belong
to the whole system. Fevers and dysenteries often terminate critically
in this disease; and the pulmonary consumption and apoplexy have often
been preceded by the suppression of a habitual discharge from a sore
leg. The two latter diseases have been ascribed to the translation of
a morbific matter to the lungs or brain: but it is more rational to
ascribe them to a previous debility in those organs, by which means
their vessels were more easily excited into action and effusion by the
stimulus of the plethora, induced upon the system in consequence of the
confinement of the fluids formerly discharged from the leg in the form
of pus. This plethora can do harm only where there is previous debility;
for I maintain that the system (when the solids are exactly toned)
will always relieve itself of a sudden preternatural accumulation of
fluids by means of some natural emunctory. This has been often observed
in the menorrhagia, which accompanies plentiful living in women, and
in the copious discharges from the bowels and kidneys, which follow a
suppression of the perspiration.

3. I infer it, from their appearing almost universally in one disease,
which is evidently a disease of the whole system, viz. the scurvy.

4. From their becoming in some cases the outlets of menstrual blood,
which is discharged in consequence of a plethora, which affects more or
less every part of the female system.

5. I infer it from the _symptoms_ of sore legs, which are in some
cases febrile, and affect the pulse in every part of the body with
preternatural frequency or force. These symptoms were witnessed, in
an eminent degree, in two of the patients who furnished subjects for
clinical remarks in the Pennsylvania hospital some years ago.

6. I infer that sore legs are a disease of the whole system, from the
manner in which they are sometimes cured by nature and art. They often
prove the outlets of many general diseases, and all the remedies which
cure them, act more or less upon the whole system.

In all cases of sore legs there is a tonic and atonic state of the whole
system. The same state of excessive or weak morbid action takes place in
the parts which are affected by the sores. The remedies to cure them,
therefore, should be _general_ and _local_.

In cases where the arterial system is affected by too much tone, the
general remedies should be,

I. BLOOD-LETTING. Of the efficacy of this remedy in disposing ulcers
suddenly to heal, the two clinical patients before-mentioned exhibited
remarkable proofs, in the presence of all the students of medicine in
the university. The blood drawn was sizy in both cases. I have not the
merit of having introduced this remedy into practice in the cure of
ulcers. I learned it from Sir John Pringle. I have known it to be used
with equal success in a sore breast, attended by pain and inflammation,
after all the usual remedies in that disease had been used to no purpose.

II. GENTLE PURGES.

III. NITRE. From fifteen to twenty grains of this medicine should be
given three times a-day.

IV. A TEMPERATE DIET, and a total abstinence from fermented and
distilled liquors.

V. COOL and PURE AIR.

VI. Rest in a recumbent posture of the body.

The _local_ remedies in this state of the system should be,

I. Cold water. Dr. Rigby has written largely in favour of this remedy
when applied to local inflammations. From its good effects in allaying
the inflammation which sometimes follows the puncture which is made in
the arm in communicating the small-pox, and from the sudden relief it
affords in the inflammatory state of the ophthalmia and in the piles, no
one can doubt of its efficacy in sore legs, accompanied by inflammation
in those vessels, which are the immediate seat of the disease.

II. Soft poultices of bread and milk, or of bread moistened with lead
water. Dr. Underwood's method of making a poultice of bread and milk
should be preferred in this case. He directs us first to boil the milk,
then to powder the bread, and throw it into the milk, and after they
have been intimately mixed, by being well stirred and boiled together,
they should be poured out and spread upon a rag, and a knife dipped in
sweet oil or lard, should be run over them. The solidity and consistence
of the poultice is hereby better preserved, than when the oil or lard is
mixed with the bread and milk over the fire.

III. When the inflammation subsides, adhesive plasters so applied as to
draw the sound edges of the sores together. This remedy has been used
with great success by Dr. Physick, in the Pennsylvania hospital, and in
his private practice.

IV. Above all, rest, and a horizontal posture of the leg. Too much
cannot be said in favour of this remedy in this species of sore legs.
Nannoni, the famous Italian surgeon, sums up the cure of sore legs in
three words, viz. "Tempo, riposo, e pazienza;" that is, in time, rest,
and patience. A friend of mine, who was cured by this surgeon of a sore
leg, many years ago, informed me, that he confined him to his bed during
the greatest part of the time that he was under his care.

In sore legs, attended by too little general and local action, the
following remedies are proper.

I. BARK. It should be used plentifully, but with a constant reference
to the state of the system; for the changes in the weather, and other
accidental circumstances, often produce such changes in the system, as
to render its disuse for a short time frequently necessary.

II. MERCURY. This remedy has been supposed to act by altering the
fluids, or by discharging a morbid matter from them, in curing sore
legs. But this is by no means the case. It appears to act as a
universal stimulant; and if it prove most useful when it excites a
salivation, it is only because in this way it excites the most general
action in the system.

III. MINERAL TONICS, such as the different preparations of iron, copper,
and zinc.

IV. GENTLE EXERCISE. Rest, and a recumbent posture of the body, so
proper in the tonic, are both hurtful in this species of sore legs. The
efficacy of exercise, even of the active kind, in the cure of sore legs,
accompanied by deficient action in the vessels, may easily be conceived
from its good effects after gun-shot wounds which are mentioned by Dr.
Jackson[65]. He tells us, that those British soldiers who had been
wounded at the battle of Guilford, in North-Carolina, who were turned
out of the military hospitals and followed the army, soonest recovered
of their wounds. It was remarkable, that if they delayed only a few days
on the road, their wounds grew worse, or ceased to heal.

  [65] Medical Journal, 1790.

In the use of the different species of exercise, the same regard should
be had to the state of the system, which has been recommended in other
diseases.

V. A nutritious and moderately stimulating diet, consisting of milk,
saccharine vegetables, animal food, malt liquors, and wine.

Wort has done great service in sore legs. The manner in which I have
directed it to be prepared and taken is as follows: To three or four
heaped table-spoonsful of the malt, finely powdered and sifted, add two
table-spoonsful of brown sugar, and three or four of Madeira, sherry,
or Lisbon wine, and a quart of boiling water. After they have stood a
few hours, it may be drunken liberally by the patient, stirring it each
time before he takes it, so that the whole substance of the malt may
be conveyed into the stomach. A little lime-juice may be added, if the
patient requires it, to make it more pleasant. The above quantity may be
taken once, twice, or three times a-day at the pleasure of the patient,
or according to the indication of his disease.

VI. OPIUM. This remedy is not only useful in easing the pain of a sore
leg, but co-operates with other cordial medicines in invigorating the
whole system.

The _local_ applications should consist of such substances as are
gently escarotic, and which excite an action in the torpid vessels of
the affected part. Arsenic, precipitate, and blue vitriol, have all
been employed with success for this purpose. Dr. Griffitts informed me,
that he has frequently accomplished the same thing in the Dispensary by
applications of tartar emetic. They should all be used, if necessary, in
succession to each other; for there is often the same idiosyncrasy in a
sore leg to certain topical applications, that there is in the stomach
to certain aliments. After the use of these remedies, astringents and
tonics should be applied, such as an infusion of Peruvian, or white-oak
bark; the water in which the smiths extinguish their irons, lime-water,
bread dipped in a weak solution of green vitriol (so much commended by
Dr. Underwood), compresses wetted with brandy, or ardent spirits of any
kind, and, above all, the adhesive plasters formerly mentioned.

Tight bandages are likewise highly proper here. The laced stocking
has been much used. It is made of strong coarse linen. Dr. Underwood
gives several good reasons for preferring a flannel roller to the linen
stocking. It sets easier on the leg, and yields to the swelling of the
muscles in walking.

In scorbutic sores on the legs, navy surgeons have spoken in high terms
of an application of a mixture of lime-juice and molasses. Mr. Gillespie
commends the use of lime or lemon-juice alone, and ascribes many cures
to it in the British navy during the late war, after every common
application had been used to no purpose[66].

  [66] Medical Journal, Vol. VI.

It is of the utmost consequence in the treatment of sore legs, to keep
them clean, by frequent dressings and washings. The success of old women
is oftener derived from their great attention to cleanliness, in the
management of sore legs, than to any specifics they possess which are
unknown to physicians.

When sore legs are kept from healing by affections of the bone, the
treatment should be such as is recommended by practical writers on
surgery.

I shall conclude this inquiry by four observations, which are naturally
suggested by what has been delivered upon this disease.

1. If it has been proved that sore legs are connected with a morbid
state of the whole system, is it not proper to inquire, whether many
other diseases supposed to be local, are not in like manner connected
with the whole system; and if sore legs have been cured by general
remedies, is it not proper to use them more frequently in local diseases?

2. If there be two states of action in the arteries in sore legs, it
becomes us to inquire, whether the same opposite states of action do not
take place in many diseases in which they are not suspected. It would be
easy to prove, that they exist in several other local diseases.

3. If the efficacy of the remedies for sore legs which have been
mentioned, depend upon their being accommodated exactly to the state of
the arterial system, and if this system be liable to frequent changes,
does it not become us to be more attentive to the state of the pulse in
this disease than is commonly supposed to be necessary by physicians?

4. It has been a misfortune in medicine, as well as in other sciences,
for men to ascribe effects to one cause, which should be ascribed
to many. Hence diseases have been attributed exclusively to morbid
affections of the fluids by some, and of the muscles and nerves by
others. Unfortunately the morbid states of the arterial system, and
the influence of those states upon the brain, the nerves, the muscles,
the lymphatics, the glands, the viscera, the alimentary canal, and the
skin, as well as the reciprocal influence of the morbid states of each
of those parts of the body upon the arteries, and upon each other, have
been too much neglected in most of our systems of physic. I consider the
pathology of the arterial system as a mine. It was first discovered by
Dr. Cullen. The man who attempts to explore it, will probably impoverish
himself by his researches; but the men who come after him, will
certainly obtain from it a treasure which cannot fail of adding greatly
to the riches of medicine.




                               AN ACCOUNT

                                 OF THE

                      _STATE OF THE BODY AND MIND_

                              IN OLD AGE;

                                  WITH

                    _OBSERVATIONS ON ITS DISEASES_,

                          AND THEIR REMEDIES.


Most of the facts which I shall deliver upon this subject, are the
result of observations made during the term of five years, upon persons
of both sexes, who had passed the 80th year of their lives. I intended
to have given a detail of the names, manner of life, occupations, and
other circumstances of each of them; but, upon a review of my notes,
I found so great a sameness in the history of most of them, that I
despaired, by detailing them, of answering the intention which I have
purposed in the following essay. I shall, therefore, only deliver
the facts and principles which are the result of the inquiries and
observations I have made upon this subject.

I. I shall mention the circumstances which favour the attainment of
longevity.

II. I shall mention the phenomena of body and mind which attend it; and,

III. I shall enumerate its peculiar diseases, and the remedies which are
most proper to remove, or moderate them.

I. The circumstances which favour longevity, are,

1. _Descent from long-lived ancestors._ I have not found a single
instance of a person, who has lived to be 80 years old, in whom this was
not the case. In some instances I found the descent was only from one,
but, in general, it was from both parents. The knowledge of this fact
may serve, not only to assist in calculating what are called the chances
of lives, but it may be made useful to a physician. He may learn from it
to cherish hopes of his patients in chronic, and in some acute diseases,
in proportion to the capacity of life they have derived from their
ancestors[67].

  [67] Dr. Franklin, who died in his 84th year, was descended from
       long-lived parents. His father died at 89, and his mother at 87.
       His father had 17 children by two wives. The doctor informed
       me, that he once sat down as one of 11 adult sons and daughters
       at his father's table. In an excursion he once made to that
       part of England from whence his family migrated to America, he
       discovered, in a grave-yard, the tomb-stones of several persons
       of his name, who had lived to be very old. These persons he
       supposed to have been his ancestors.

2. _Temperance in eating and drinking._ To this remark I found several
exceptions. I met with one man of 84 years of age, who had been
intemperate in eating; and four or five persons who had been intemperate
in drinking ardent spirits. They had all been day-labourers, or had
deferred drinking until they began to feel the languor of old age. I did
not meet with a single person who had not, for the last forty or fifty
years of their lives, used tea, coffee, and bread and butter twice a day
as part of their diet. I am disposed to believe that those articles of
diet do not materially affect the duration of human life, although they
evidently impair the strength of the system. The duration of life does
not appear to depend so much upon the strength of the body, or upon the
quantity of its excitability, as upon an exact accommodation of stimuli
to each of them. A watch spring will last as long as an anchor, provided
the forces which are capable of destroying both, are always in an exact
ratio to their strength. The use of tea and coffee in diet seems to be
happily suited to the change which has taken place in the human body, by
sedentary occupations, by which means less nourishment and stimulus are
required than formerly, to support animal life.

3. The _moderate exercise of the understanding_. It has long been an
established truth, that literary men (other circumstances being equal)
are longer lived than other people. But it is not necessary that the
understanding should be employed upon philosophical subjects to produce
this influence upon human life. Business, politics, and religion, which
are the objects of attention of men of all classes, impart a vigour to
the understanding, which, by being conveyed to every part of the body,
tends to produce health and long life.

4. _Equanimity of temper._ The violent and irregular action of the
passions tends to wear away the springs of life.

Persons who live upon annuities in Europe have been observed to be
longer lived, in equal circumstances, than other people. This is
probably occasioned by their being exempted, by the certainty of their
subsistence, from those fears of want which so frequently distract the
minds, and thereby weaken the bodies of old people. Life-rents have been
supposed to have the same influence in prolonging life. Perhaps the
_desire of life_, in order to enjoy for as long a time as possible,
that property which cannot be enjoyed a second time by a child or
relation, may be another cause of the longevity of persons who live
upon certain incomes. It is a fact, that the desire of life is a very
powerful stimulus in prolonging it, especially when that desire is
supported by hope. This is obvious to physicians every day. Despair of
recovery, is the beginning of death in all diseases.

But obvious and reasonable as the effects of equanimity of temper are
upon human life, there are some exceptions in favour of passionate men
and women having attained to a great age. The morbid stimulus of anger,
in these cases, was probably obviated by less degrees, or less active
exercises of the understanding, or by the defect or weakness of some of
the other stimuli which keep up the motions of life.

5. _Matrimony._ In the course of my inquiries I met with only one person
beyond eighty years of age who had never been married. I met with
several women who had borne from ten to twenty children, and suckled
them all. I met with one woman, a native of Herefordshire, in England,
who was in the 100th year of her age, who had borne a child at 60,
menstruated till 80, and frequently suckled two of her children (though
born in succession to each other) at the same time. She had passed the
greatest part of her life over a washing-tub.

6. _Emigration._ I have observed many instances of Europeans who have
arrived in America in the decline of life, who have acquired fresh
vigour from the impression of our climate, and of new objects upon their
bodies and minds; and whose lives, in consequence thereof, appeared
to have been prolonged for many years. This influence of climate
upon longevity is not confined to the United States. Of 100 European
Spaniards, who emigrate to South-America in early life, 18 live to be
above 50, whereas but 8 or 9 native Spaniards, and but 7 Indians of the
same number, exceed the 50th year of human life.

7. I have not found _sedentary employments_ to prevent long life, where
they are not accompanied by intemperance in eating or drinking. This
observation is not confined to literary men, nor to women only, in whom
longevity, without much exercise of body, has been frequently observed.
I met with one instance of a weaver; a second of a silver-smith; and a
third of a shoe-maker, among the number of old people, whose histories
have suggested these observations.

8. I have not found that _acute_, nor that all _chronic_ diseases
shorten human life. Dr. Franklin had two successive vomicas in his
lungs before he was 40 years old. I met with one man beyond 80, who had
survived a most violent attack of the yellow fever; a second who had had
several of his bones fractured by falls, and in frays; and many who had
been frequently affected by intermittents. I met with one man of 86, who
had all his life been subject to syncope; another who had for 50 years
been occasionally affected by a cough[68]; and two instances of men who
had been afflicted for forty years with obstinate head-achs[69]. I met
with only one person beyond 80, who had ever been affected by a disease
in the _stomach_; and in him it arose from an occasional rupture. Mr.
John Strangeways Hutton, of this city, who died in 1793, in the 109th
year of his age, informed me, that he had never puked in his life. This
circumstance is the more remarkable, as he passed several years at sea
when a young man[70]. These facts may serve to extend our ideas of the
importance of a healthy state of the stomach in the animal economy; and
thereby to add to our knowledge in the prognosis of diseases, and in the
chances of human life.

  [68] This man's only remedy for his cough was the fine powder of dry
       Indian turnip and honey.

  [69] Dr. Thiery says, that he did not find the itch, or slight degrees
       of the leprosy, to prevent longevity. Observations de Physique,
       et de Medecine faites en differens lieux de L'Espagne. Vol II.
       p. 17 i.

  [70] The venerable old man, whose history first suggested this remark,
       was born in New-York in the year 1684. His grandfather lived
       to be 101, but was unable to walk for thirty years before he
       died, from an excessive quantity of fat. His mother died at 91.
       His constant drinks were water, beer, and cyder. He had a fixed
       dislike to spirits of all kinds. His appetite was good, and he
       ate plentifully during the last years of his life. He seldom
       drank any thing between his meals. He was never intoxicated but
       twice in his life, and that was when a boy, and at sea, where he
       remembers perfectly well to have celebrated, by a feu de joye,
       the birth-day of queen Anne. He was formerly afflicted with the
       head-ach and giddiness, but never had a fever, except from the
       small-pox, in the course of his life. His pulse was slow, but
       regular. He had been twice married. By his first wife he had
       eight, and by his second seventeen children. One of them lived to
       be 83 years of age. He was about five feet nine inches in height,
       of a slender make, and carried an erect head to the last year of
       his life.

9. I have not found the _loss of teeth_ to affect the duration of human
life, so much as might be expected. Edward Drinker, who lived to be 103
years old, lost his teeth thirty years before he died, from drawing the
hot smoke of tobacco into his mouth through a short pipe.

Dr. Sayre of New-Jersey, to whom I am indebted for several very valuable
histories of old persons, mentions one man aged 81, whose teeth began to
decay at 16, and another of 90, who lost his teeth, thirty years before
he saw him. The gums, by becoming hard, perform, in part, the office of
teeth. But may not the gastric juice of the stomach, like the tears and
urine, become acrid by age, and thereby supply, by a more dissolving
power, the defect of mastication from the loss of teeth? Analogies might
easily be adduced from several operations of nature, which go forward in
the animal economy, which render this supposition highly probable.

10. I have not observed _baldness_, or _grey hairs_, occurring in early
or middle life, to prevent old age. In one of the histories furnished
me by Dr. Sayre, I find an account of a man of 81, whose hair began to
assume a silver colour when he was but one and twenty years of age.

11. More women live to be old than men, but more men live to be _very_
old, than women.

I shall conclude this head by the following remark:

Notwithstanding there appears in the human body a certain capacity of
long life, which seems to dispose it to preserve its existence in every
situation; yet this capacity does not always protect it from premature
destruction; for among the old people whom I examined, I scarcely met
with one who had not lost brothers or sisters, in early and middle life,
and who were born under circumstances equally favourable to longevity
with themselves.

II. I now come to mention some of the phenomena of the body and mind
which occur in old age.

1. There is a great sensibility to _cold_ in all old people. I met
with an old woman of 84, who slept constantly under three blankets and
a coverlet during the hottest summer months. The servant of prince de
Beaufremont, who came from Mount Jura to Paris, at the age of 121, to
pay his respects to the first national assembly of France, shivered with
cold in the middle of the dog days, when he was not near a good fire.
The national assembly directed him to sit with his hat on, in order to
defend his head from the cold.

2. Impressions made upon the _ears_ of old people, excite sensation
and reflection much quicker than when they are made upon their eyes.
Mr. Hutton informed me, that he had frequently met his sons in the
street without knowing them, until they had spoken to him. Dr. Franklin
informed me, that he recognized his friends, after a long absence from
them, first by their voices. This fact does not contradict the common
opinion, upon the subject of memory, for the recollection, in these
instances, is the effect of what is called reminiscence, which differs
from memory in being excited only by the renewal of the impression which
at first produced the idea which is revived.

3. The _appetite_ for food is generally increased in old age. The
famous Parr, who died at 152, ate heartily in the last week of his
life. The kindness of nature, in providing this last portion of earthly
enjoyments for old people, deserves to be noticed. It is remarkable,
that they have, like children, a frequent recurrence of appetite, and
sustain with great uneasiness the intervals of regular meals. The
observation, therefore, made by Hippocrates, that middle-aged people
are more affected by abstinence than those who are old, is not true.
This might easily be proved by many appeals to the records of medicine;
but old people differ from children, in preferring _solid_ to liquid
aliment. From inattention to this fact, Dr. Mead has done great mischief
by advising old people, as their teeth decayed or perished, to lessen
the quantity of their solid, and to increase the quantity of their
liquid food. This advice is contrary to nature and experience, and I
have heard of two old persons who destroyed themselves by following it.
The circulation of the blood is supported in old people chiefly by the
stimulus of aliment. The action of liquids of all kinds upon the system
is weak, and of short continuance, compared with the durable stimulus
of solid food. There is a gradation in the action of this food upon the
body. Animal matters are preferred to vegetable; the fat of meat to the
lean, and salted meat to fresh, by most old people. I have met with but
few old people who retained an appetite for milk. It is remarkable, that
a less quantity of _strong drink_ produces intoxication in old people
than in persons in the middle of life. This depends upon the recurrence
of the same state of the system, with respect to excitability, which
takes place in childhood. Many old people, from an ignorance of this
fact, have made shipwreck of characters which have commanded respect in
every previous stage of their lives. From the same recurrence of the
excitability of childhood in their systems, they commonly drink their
tea and coffee much weaker than in early or middle life.

4. The _pulse_ is generally full, and frequently affected by pauses in
its pulsations when felt in the wrists of old people. A regular pulse in
such persons indicates a disease, as it shows the system to be under the
impression of a preternatural stimulus of some kind. This observation
was suggested to me above thirty years ago by Morgagni, and I have often
profited by it in attending old people. The pulse in such patients is an
uncertain mark of the nature, or degree of an acute disease. It seldom
partakes of the quickness or convulsive action of the arterial system,
which attends fever in young or middle-aged people. I once attended a
man of 77 in a fever of the bilious kind, which confined him for eight
days to his bed, in whom I could not perceive the least quickness or
morbid action in his pulse until four and twenty hours before he died.

5. The marks of old age appear earlier, and are more numerous in persons
who have combined with hard labour, a vegetable or scanty diet, than
in persons who have lived under opposite circumstances. I think I have
observed these marks of old age to occur sooner, and to be more numerous
in the German, than in the English or Irish citizens of Pennsylvania.
They are likewise more common among the inhabitants of country places,
than of cities, and still more so among the Indians of North-America,
than among the inhabitants of civilized countries.

6. Old men tread upon the _whole base_ of their feet at once in
_walking_. This is perhaps one reason why they wear out fewer shoes,
under the same circumstances of constant use, than young people, who,
by treading on the posterior, and rising on the anterior part of
their feet, expose their shoes to more unequal pressure and friction.
The advantage derived to old people from this mode of walking is
very obvious. It lessens that disposition to totter, which is always
connected with weakness: hence we find the same mode of walking is
adopted by habitual drunkards, and is sometimes from habit practised by
them, when they are not under the influence of strong drink.

7. The breath and perspiration of old people have a peculiar acrimony,
and their urine, in some instances, emits a f[oe]tor of an offensive
nature.

8. The eyes of very old people sometimes change from a dark and blue, to
a light colour.

9. The _memory_ is the first faculty of the mind which fails in the
decline of life. While recent events pass through the mind without
leaving an impression upon it, it is remarkable that the long forgotten
events of childhood and youth are recalled and distinctly remembered.

I met with a singular instance of a German woman, who had learned to
speak the language of our country after she was forty years of age, who
had forgotten every word of it after she had passed her 80th year, but
spoke the German language as fluently as ever she had done. The memory
decays soonest in hard drinkers. I have observed some studious men to
suffer a decay of their memories, but never of their understandings.
Among these was the late Anthony Benezet of this city. But even this
infirmity did not abate the cheerfulness, nor lessen the happiness of
this pious philosopher, for he once told me, when I was a young man,
that he had a consolation in the decay of his memory, which gave him
a great advantage over me. "You can read a good book (said he) with
pleasure but _once_, but when I read a good book, I so soon forget
the contents of it, that I have the pleasure of reading it over and
over; and every time I read it, it is alike new and delightful to me."
The celebrated Dr. Swift was one of those few studious men, who have
exhibited marks of a decay of understanding in old age; but it is
judiciously ascribed by Dr. Johnson to two causes which rescue books,
and the exercise of the thinking faculties from having had any share
in inducing that disease upon his mind. These causes were, a rash vow
which he made when a young man, never to use spectacles, and a sordid
seclusion of himself from company, by which means he was cut off from
the use of books, and the benefits of conversation, the absence of
which left his mind without its usual stimulus: hence it collapsed
into a state of fatuity. It is probably owing to the constant exercise
of the understanding, that literary men possess that faculty of the
mind in a vigorous state in extreme old age. The same cause accounts
for old people preserving their intellects longer in cities, than in
country places. They enjoy society upon such easy terms in the former
situation, that their minds are kept more constantly in an excited state
by the acquisition of new, or the renovation of old ideas, by means of
conversation.

10. I did not meet with a single instance in which the moral or
religious faculties were impaired in old people. I do not believe, that
these faculties of the mind are preserved by any supernatural power, but
wholly by the constant and increasing exercise of them in the evening
of life. In the course of my inquiries, I heard of a man of 101 years of
age, who declared that he had forgotten every thing he had ever known,
except his GOD. I found the moral faculty, or a disposition to do kind
offices to be exquisitely sensible in several old people, in whom there
was scarcely a trace left of memory or understanding.

11. Dreaming is universal among old people. It appears to be brought on
by their imperfect sleep, of which I shall say more hereafter.

12. I mentioned formerly the sign of a _second childhood_ in the state
of the appetite in old people. It appears further, 1. In the marks
which slight contusions or impressions leave upon their skins. 2. In
their being soon fatigued by walking or exercise, and in being as soon
refreshed by rest. 3. In their disposition, like children, to detail
immediately every thing they see and hear. And, 4. In their aptitude to
shed tears; hence they are unable to tell a story that is in any degree
distressing without weeping. Dr. Moore takes notice of this peculiarity
in Voltaire, after he had passed his 80th year. He wept constantly at
the recital of his own tragedies. This feature in old age, did not
escape Homer. Old Menelaus wept ten years after he returned from the
destruction of Troy, when he spoke of the death of the heroes who
perished before that city.

13. It would be sufficiently humbling to human nature, if our bodies
exhibited in old age the marks only of a second childhood; but human
weakness descends still lower. I met with an instance of a woman between
80 and 90, who exhibited the marks of a _second infancy_, by such a
total decay of her mental faculties, as to lose all consciousness in
discharging her alvine and urinary excretions. In this state of the
body, a disposition to sleep, succeeds the wakefulness of the first
stages of old age. Dr. Haller mentions an instance of a very old man who
slept twenty, out of every twenty-four hours during the few last years
of his life.

14. The disposition in the system to _renew_ certain parts in extreme
old age, has been mentioned by several authors. Many instances are to be
met with in the records of medicine of the sight[71] and hearing having
been restored, and even of the teeth having been renewed in old people a
few years before death. These phenomena have led me to suspect that the
antediluvian age was attained by the frequent renovation of different
parts of the body, and that when they occur, they are an effort of the
causes which support animal life, to produce antediluvian longevity, by
acting upon the revived excitability of the system.

  [71] There is a remarkable instance of the sight having been restored
       after it had been totally destroyed in an old man near Reading,
       in Pennsylvania. My brother, Judge Rush, furnished me with the
       following account of him in a letter from Reading, dated June 23,
       1792.

       "An old man, of 84 years of age, of the name of Adam Riffle, near
       this town, gradually lost his sight in the 68th year of his age,
       and continued entirely blind for the space of twelve years.
       About four years ago his sight returned, without making use of
       any means for the purpose, and without any visible change in the
       appearance of the eyes, and he now sees as well as ever he did. I
       have seen the man, and have no doubt of the fact. He is at this
       time so hearty, as to be able to walk from his house to Reading
       (about three miles), which he frequently does in order to attend
       church. I should observe, that during both the gradual loss, and
       recovery of his sight, he was no ways affected by sickness, but,
       on the contrary, enjoyed his usual health. I have this account
       from his daughter and son-in-law, who live within a few doors of
       me."

15. The _fear_ of death appears to be much less in old age, than in
early, or middle life. I met with many old people who spoke of their
dissolution with composure, and with some who expressed earnest
desires to lie down in the grave. This indifference to life, and desire
for death (whether they arise from a satiety in worldly pursuits and
pleasures, or from a desire of being relieved from pain) appear to be a
wise law in the animal economy, and worthy of being classed with those
laws which accommodate the body and mind of man to all the natural
evils, to which, in the common order of things, they are necessarily
exposed.

III. I come now briefly to enumerate the diseases of old age, and the
remedies which are most proper to remove, or to mitigate them.

The diseases are chronic and acute. The CHRONIC are,

1. _Weakness_ of the _knees_ and _ancles_, a lessened ability to walk,
and tremors in the head and limbs.

2. _Pains in the bones_, known among nosological writers by the name of
rheumatalgia.

3. _Involuntary flow of tears_, and of mucus from the nose.

4. _Difficulty of breathing_, and a short _cough_, with copious
expectoration. A weak, or hoarse voice generally attends this cough.

5. _Costiveness._

6. An _inability to retain the urine_ as long as in early or middle
life. Few persons beyond 60 pass a whole night without being obliged
to discharge their urine[72]. Perhaps the stimulus of this liquor in
the bladder may be one cause of the universality of dreaming among old
people. It is certainly a frequent cause of dreaming in persons in early
and middle life: this I infer, from its occuring chiefly in the morning
when the bladder is most distended with urine. There is likewise an
inability in old people to discharge their urine as quickly as in early
life. I think I have observed this to be among the first symptoms of the
declension of the strength of the body by age.

  [72] I met with an old man, who informed me, that if from any accident
       he retained his urine after he felt an inclination to discharge
       it, he was affected by a numbness, accompanied by an uneasy
       sensation in the palms of his hands.

7. _Wakefulness._ This is probably produced in part by the action of the
urine upon the bladder; but such is the excitability of the system in
the first stages of old age, that there is no pain so light, no anxiety
so trifling, and no sound so small, as not to produce wakefulness in old
people. It is owing to their imperfect sleep, that they are sometimes
as unconscious of the moment of their passing from a sleeping to a
waking state, as young and middle-aged people are of the moment in which
they pass from the waking to a sleeping state. Hence we so often hear
them complain of passing sleepless nights. This is no doubt frequently
the case, but I am satisfied, from the result of an inquiry made upon
this subject, that they often sleep without knowing it, and that their
complaints in the morning, of the want of sleep, arise from ignorance,
without the least intention to deceive.

8. _Giddiness._

9. _Deafness._

10. _Imperfect vision._

The acute diseases most common among old people, are,

1. _Inflammation of the eyes._

2. The _pneumonia notha_, or bastard peripneumony.

3. The _colic_.

4. _Palsy_ and _apoplexy_.

5. The _piles_.

6. A _difficulty in making water_.

7. _Quartan fever._

All the diseases of old people, both chronic and acute, originate in
predisposing debility. The remedies for the former, where a feeble
morbid action takes place in the system, are stimulants. The first of
these is,

I. HEAT. The ancient Romans prolonged life by retiring to Naples, as
soon as they felt the infirmities of age coming upon them. The aged
Portuguese imitate them, by approaching the warm sun of Brazil, in
South-America. But heat may be applied to the torpid bodies of old
people artificially. 1st. By means of the _warm bath_. Dr. Franklin
owed much of the cheerfulness and general vigour of body and mind
which characterised his old age, to his regular use of this remedy. It
disposed him to sleep, and even produced a respite from the pain of the
stone, with which he was afflicted during the last years of his life.

2. Heat may be applied to the bodies of old people by means of
_stove-rooms_. The late Dr. Dewit, of Germantown, who lived to be near
100 years of age, seldom breathed an air below 72°, after he became an
old man. He lived constantly in a stove-room.

3. WARM CLOTHING, more especially warm bed-clothes, are proper to
preserve or increase the heat of old people. From the neglect of the
latter, they are often found dead in their beds in the morning, after a
cold night, in all cold countries. The late Dr. Chovet, of this city,
who lived to be 85, slept in a baize night-gown, under eight blankets,
and a coverlet, in a stove-room, many years before he died. The head
should be defended in old people, by means of woollen, or fur caps, in
the night, and by wigs and hats during the day, in cold weather. These
artificial coverings will be the more necessary, where the head has been
deprived of its natural covering. Great pains should be taken likewise
to keep the feet dry and warm, by means of thick shoes[73]. To these
modes of applying and confining heat to the bodies of old people, a
young bed-fellow has been added; but I conceive the three artificial
modes which have been recommended, will be sufficient without the use of
one, which cannot be successfully employed without a breach of delicacy
or humanity.

  [73] I met with one man above 80, who defended his feet from moisture
       by covering his shoes in wet weather with melted wax; and
       another who, for the same purpose, covered his shoes every
       morning with a mixture composed of the following ingredients
       melted together: lintseed oil a pound, mutton suet eight ounces,
       bees-wax six ounces, and rosin four ounces. The mixture should
       be moderately warmed, and then applied not only to the upper
       leather, but to the soles of the shoes. This composition, the
       old gentleman informed me, was extracted from a book entitled,
       "The Complete Fisherman," published in England, in the reign of
       queen Elizabeth. He had used it for twenty years in cold and wet
       weather, with great benefit, and several of his friends, who had
       tried it, spoke of its efficacy in keeping the feet dry, in high
       terms.

II. To keep up the action of the system, GENEROUS DIET and DRINKS should
be given to old people. For a reason mentioned formerly, they should be
indulged in eating between the ordinary meals of families. Wine should
be given to them in moderation. It has been emphatically called the milk
of old age.

III. YOUNG COMPANY should be preferred by old people to the company of
persons of their own age. I think I have observed old people to enjoy
better health and spirits, when they have passed the evening of their
lives in the families of their children, where they have been surrounded
by grand-children, than when they lived by themselves. Even the
solicitude they feel for the welfare of their descendants, contributes
to invigorate the circulation of the blood, and thereby to add fuel to
the lamp of life.

IV. GENTLE EXERCISE. This is of great consequence in promoting the
health of old people. It should be moderate, regular, and always in fair
weather.

V. CLEANLINESS. This should by no means be neglected. The dress of old
people should not only be clean, but more elegant than in youth or
middle life. It serves to divert the eye of spectators from observing
the decay and deformity of the body, to view and admire that which is
always agreeable to it.

VI. To abate the pains of the chronic rheumatism, and the uneasiness of
the old man's cough (as it is called); also to remove wakefulness, and
to restrain, during the night, a troublesome inclination to make water,
OPIUM may be given with great advantage. Chardin informs us, that this
medicine is frequently used in the eastern countries to abate the pains
and weaknesses of old age, by those people who are debarred the use of
wine by the religion of Mahomet.

I have nothing to say upon the acute diseases of old people, but what
is to be found in most of our books of medicine, except to recommend
BLEEDING in those of them which are attended with plethora, and an
inflammatory action in the pulse. The degrees of appetite which belong
to old age, the quality of the food taken, and the sedentary life which
is generally connected with it, all concur to produce that state of the
system, which requires the above evacuation. I am sure that I have seen
many of the chronic complaints of old people mitigated by it, and I have
more than once seen it used with obvious advantage in their inflammatory
diseases. These affections I have observed to be more fatal among
old people than is generally supposed. An inflammation of the lungs,
which terminated in an abscess, deprived the world of Dr. Franklin.
Dr. Chovet died of an inflammation in his liver. The blood drawn from
him a few days before his death was sizy, and such was the heat of
his body, produced by his fever, that he could not bear more covering
(notwithstanding his former habits of warm clothing) than a sheet in the
month of January.

Death from old age is the effect of a gradual palsy. It shows itself
first in the eyes and ears, in the decay of sight and hearing; it
appears next in the urinary bladder, in the limbs and trunk of the
body; then in the sphincters of the bladder and rectum; and finally in
the nerves and brain, destroying in the last, the exercise of all the
faculties of the mind.

Few persons appear to die of old age. Some one of the diseases which
have been mentioned, generally cuts the last thread of life.

                            END OF VOLUME I.




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Transcriber's note:

The original spelling and minor inconsistencies in the spelling and
formatting have been maintained.

Obvious misprints have been corrected.

Partly repeated chapter headings have been deleted.

The table on page 107 has been split to match the page size.