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+*** START OF THE PROJECT GUTENBERG EBOOK 58859 ***
+
+
+
+Note: Project Gutenberg also has an HTML version of this
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+
+
+ Images of the original pages are available through
+ Internet Archive. See
+ https://archive.org/details/b21935142_0001
+
+
+ Project Gutenberg has the other three volumes of this work.
+ Volume II: see http://www.gutenberg.org/ebooks/58860
+ Volume III: see http://www.gutenberg.org/ebooks/58861
+ Volume IV: see http://www.gutenberg.org/ebooks/58862
+
+
+Transcriber's note:
+
+ The ligature oe has been marked as [oe].
+
+ Text in italics has been enclosed by underscores (_text_).
+
+ Text in bold face has been enclosed by equal signs (=text=).
+
+
+
+
+
+ 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.
+
+
+
+
+ * * * * *
+
+
+
+
+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.
+
+
+
+*** END OF THE PROJECT GUTENBERG EBOOK 58859 ***
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