LIB PI -A. PI "ST 
 
 PRINCETOK, X. J. 
 
 The Stephen Collins Donation, 
 
 _. . . — ' II " 
 
 No. Case, ^j/!hl^i 
 
 No. Shel f, '.^^ 
 J\"o. Book, ;%^ ' 
 . ~Tin:r,, -- 
 
 I 
 
 c 
 
.™4U Lemmon-r-^o 
 
AN 
 
 ACCOUNT 
 
 OF THE 
 
 Bilious remitting and intermitting 
 
 YELLOW FEVER, 
 
 AS IT APPEARED IN 
 
 PHILADELPHIA, 
 
 IN THE TMAR 1794' 
 
MED I C A L 
 Inquiries and Obfervations : 
 
 CONTAINING 
 
 AN ACCOUNT 
 
 OF THE 
 
 Bilious remitting and intermitting 
 YELLOW FEVER, 
 
 AS /r APPEARED IN PHILADELPHIA IN THE TEAR 1 794. 
 
 TOGETHER WITH 
 
 A N I N Q^U I R Y 
 
 INTO THE ' 
 
 PROXIMATE CAUSE OF FEVER; 
 
 AND 
 
 A Defence of Blood-letting 
 
 AS A 
 
 REMEDY 
 
 FOR 
 
 CERTAIN DISEASES. 
 
 •' By Benjamin Rufh, M. d. 
 
 PROFESSOR OF THE INSTITUTES, AND OF CLINICAL MEDICINS, 
 IN THE UNIVERSITY OF PENNSYLVANIA. 
 
 VOLUME IV. 
 
 PHILADELPHIA; 
 
 PRINTED BY THOMAS DOBSON, AT THE STONE-HOUSi, 
 
 N** 41, SOUTH SECOND-STREET. 
 
 1796. 
 
THE PREFACE. 
 
 XT is common in the Preface to 
 Medical books to extol fads, at the expence of 
 theory. Were I difpofed to confider the com^ 
 parative merit of each of them, 1 fliould derive 
 moft of the evils of medicine from fuppofed 
 fadts, and afcribe all the remedies which have 
 been uniformly and extenfively ufeful, to fuch 
 theories as are true. Fadts are combined and 
 rendered nfefuU only by means ot theories ; and 
 the more difpofed men are to reafon, the more 
 minute and extenfive they become in their ob- 
 fervations. Under the influence of thefe opi- 
 nions, 1 have ventured to deliver, in the follow- 
 ing pages, fome new principles in medicine. I 
 wifh it had been convenient to have kept 
 them a few years longer from the public eye, 
 in order to have improved them by flow and 
 frequent revifions; but the importunities of 
 
 b my 
 
VI THE PREFACE. 
 
 my pupils, added to a fenfe of the precarious 
 tenure by which I hold a laborious life, have 
 induced me to publifh them in their prefent 
 concife and immature ftate. If they lead the 
 reader to exercife his reafon in examining 
 them carefully, he v^^ill readily fupply my de- 
 ficiency of time and ftudy in preparing them 
 for the prefs. He will reject what is erro- 
 neous in them, and apply what is not fo, to 
 all the difeafes of the human body. 
 
 The Account of the Yellow Fever, as it 
 appeared in Philadelphia in 1794, will, I 
 hope, be ufeful, by bringing more fa£ts to 
 light upon the fubjed: of its origin, and by 
 exhibiting that variety in the fymptoms and 
 method of cure, which is produced by the dif- 
 ference of feafon in all epidemics* 
 
 In ftating the conduft, and oppofmg the 
 opinions of my medical brethren, I have not 
 been ad;uated by the leaft unkindnefs to any 
 one of them. I lament being called to this 
 painful duty, but it muft be performed by 
 fomebody, and in this way only can we dif- 
 
 charge 
 
THE PREFACE. VU 
 
 charge our obligations to thofe men who, at 
 the expenfe of character and fortune, have 
 put us in the peaceable pofleffion of all our 
 knowledge in medicine ; for, however ftrange 
 it may appear, I believe we have not admitted 
 a ufeful medical principle, or remedy of any 
 kind, but what has coft the authors of them 
 more or lefs conflicts with cotemporary phy- 
 ficians. 
 
 If the principles contained in this volume 
 fhould be received with candour, they fhall be 
 followed (life and health permitting) by an 
 application of them to the cure of the gout, 
 and of the difeafes of the mind. 
 
 BENJAMIN RUSH. 
 
 id July, 1796. 
 
(^ The reader is defired to correal the following mijlakes ,*— 
 
 In page 3, line 14 from the top, for them^ read the earth. In 
 line the laft of the fame page, for hct read become, 
 
 — p. 71, line 12, infert the word hot^ before climates. 
 
 — the laft line of p. 96, infert ivithout malignant fy^ptotns^ after 
 the word intermittent t and erafe the fame in the firft line 
 of p. 97. 
 
 — p. 103, line the 8th from the bottom, infert though it nvas 
 performed fparingly towards its clofe^ after the Vf or d fever. 
 
 — p. no, line the 3d from the top, inftead of appear to have 
 thronvn, m^trl probably threw. In line 4th, inftead oi and, 
 rea-d for. And in lines 8 and 9, inftead of and I thinks 
 read or perhaps. 
 
 * — p* 232, line 14th from the top, inftead oi conneiled auith, 
 read confined to. 
 
CONTENTS. 
 
 A Page 
 CCOUNT of the weather and difeafes which 
 
 preceded the yellow fever in 1794, - - i 
 
 Names given to it by feme of the phyficians of the city, 13 
 
 Conduct of the Committee of Health, and their report 
 
 from an examination of fome of the phyficians, 15 
 Reafons why the prevalence of the yellow fever in a city 
 
 fhould always be made public, - - 23 
 
 Its predifpofing and exciting caufes, - - 25 
 
 Its fymptoms, . - _ 27 
 
 Its forms or type, • - - 44 
 
 Its predominance over all other difeafes, - 50 
 Its contagious quality, and its peculiar effe<5ts upon the 
 
 body, where it did not excite fever, . - 53 
 
 Methods of obviating the contagion of the yellow fever, 56 
 
 Methods of preventing its fpreading in a city, - ^^ 
 Difference in its degrees and extent of contagion, at 
 
 different times, and in different countries, - 61 
 
 Of the origin of the fever of 1794, - - 63 
 
 An exception to the influence of rain in checking it, 67 
 
 Obfervauons 
 
Vlll CONTENTS. 
 
 Obfervations on the (late of the atmofphere which dif- 
 
 pofes to malignant or inflammatory fevers, 75 
 
 The influence of marfii exhalations on the bodies of 
 
 certain domeftic animals, - - 79 
 
 Comparative view of the relative contagious nature, 
 diftance of infedion, and mortality of contagious 
 fevers, - - - ,* 80 
 
 Method of treating the yellow fever of 1794, - 83 
 
 Appearances of the blood, - - - 86 
 
 Comparative view of the fuccefs of the Philadelphia 
 and Baltimore methods of treating it, with that 
 Tk'hich has been common in the Wefl: Indies, 114 
 
 AN Inquiry into the Proximate Cause of Fever, 121 
 
 Of the fymptoms of fever, - - 141 
 
 Of the ftates of fever, - - - 149 
 
 Of the nofological arrangement of difeafes, 150 
 A table of fevers, according to their different degrees 
 
 of inflammatory adion, . * 153 
 
 Of ftates of fever which are general, * 155 
 
 which are general and local, 167 
 
 Of mifplaced ftates of fevers, - - 174 
 
 A DsFENCE OF Blood-letting, * • jS^ 
 
 its natural indications, ». - J 86 
 
 Its advantages, - - - J 88 
 
 The objeclions to it ftated and anfvvered, - 195 
 Comparative view of the effeds of blood-letting, and 
 
 other depleting remedies, - ^ 214 
 
 Of 
 
CONTENTS. IX 
 
 Of the indications of blood-letting from the (late of 
 
 the pulfe, - - - 223 
 
 from the chara(5ler of the reigning epidemic, 228 
 
 • from the conftitution of the patient, - 229 
 
 , from the place from which perfons have lately 
 
 arrived, or in which they have been born, ibidem 
 
 from the appearances of the blood, - 230 
 
 Of the quantity of blood which may be drawn in in- 
 flammatory fever, - - - 234 
 Of the quantity which fliould be drawn at one time, 239 
 Of arteriotomy, - - - - 241 
 The place from which blood fliould be drawn, 242 
 Of cupping, - - - - 245 
 Of the time for bleeding in fevers, - ibid. 
 The effefls of blood-letting about the celTation of men- 
 
 ftruation, - - - - 246 
 
 Of its effedts in faciHtating parturition, - - ibid. 
 
 in hydrophobia, - - 247 
 
 . in diilocations, - - ibid. 
 
 in certain difeafes of old people, 248 
 
 Oppofition to blood-leiting in the United Stares, ibid. 
 
 Its origin derived in part from a political caufe, 251 
 
 "General refle<^ions and conclufion, - 254 
 
AN 
 
 ACCOUNT, &c. 
 
 1 CONCLUDED the Hiftory of the fymp« 
 toms of the Bilious Remitting Yellow Fever as 
 it appeared in Philadelphia in the year 1793, by 
 taking notice that the difeafes which fucceeded that 
 fatal epidemic, were all of a highly inflammatory 
 nature. 
 
 I have formerly defcribed the weather and dif- 
 eafes of the months of March and April in the 
 fpring of 1794. 
 
 The weather during the firfl: three weeks of the 
 month of May was dry and temperate, with now 
 and then a cold day and night. The ftrawberries 
 were ripe on the 15th, and cherries on the 2 2d 
 day of the month in feveral of the city gardens* 
 
 VOL. IV. A A (liower 
 
a AN ACCOUNT OF THE 
 
 A fliower of hail fell on the afternoon of the 2 2d, 
 which broke the glafs windows of many houfes. A 
 Ungle flone of this hail was found to weigh two 
 drachms. Several people collected a quantity of it, 
 and preferved it till the next day in their cellars, 
 when they ufed it for the purpofe of cooling their 
 wine. The weather after this hail florm was rainy 
 during the remaining part of the month. The 
 difeafes were ftill inflammatory. Many perfons were 
 afflifted with a fore mouth in this month. 
 
 The weather in June was pleafant and tempe- 
 rate. Several intermittents, and two very acute 
 pleuriiies occurred in my praflice during this month. 
 The intermittents were uncommonly obllinate, and 
 would not yield to the largell dofes of the bark. 
 
 In a fon of Mr. Samuel Coates of feven years 
 old, the bark produced a fudden tranflation of this 
 ftate of fever to the head, where it produced all the 
 fymptoms of the firfl ftage of internal dropfy of 
 the brain. This once formidable diforder yielded 
 in this cafe to three bleedings, and other depleting 
 medicines. The blood drawn in every inftance 
 was fizy. 
 
 J'rom the inflamjnatory complexion of the dif- 
 eafes of the fpring, and of the beginning of June, 
 
 I cxpe^ed 
 
BILIOUS YELLOW FEVER, IN 1 794. 3 
 
 I expelled the fevers of the fummer and autumn 
 would be of a violent and malignant nature. I wa* 
 the more difpofed to entertain this opinion from 
 obferving the flagnating filth of the gutters of our 
 city ; for the citizens of Philadelphia having an in- 
 terefl in rejecting the proofs of the generation of 
 the epidemic of 1793 in their city, had negleci:ed to 
 introduce the regulations which were neceffary to 
 prevent the producSiion of a fimilar fever from do- 
 mefliic putrefafiion. They had, it is true, taken 
 pains to remove the earth and offal matters which 
 accumulated in the ftreets ^ but thefe, from their 
 being always dry, were inoffenfive as remote caufes 
 of difeafe. Perhaps the removal of them did harm, 
 by preventing the abforption of the miafmata which 
 were conftantly exhaled from the gutters. 
 
 On the 6th of June Dr. Phyfick called upon 
 me, and informed me that he had a woman in the 
 yellow fever under his care. The information did 
 not furprife me, but it awakened fuddenly in my 
 mind the mod diflreffmg emotions. I advifed him 
 to inform the mayor of the city of the cafe, but 
 by no means to make it more public, for I hoped 
 that it might be a fporadic inflance of the diforder, 
 and that it might not be general in the city. 
 
 A 2 On 
 
4 AN ACCOUNT OF THE 
 
 On the 1 2th of the month my fears 6f the re- 
 turn of the yellow fever were revived by vifiting 
 Mr. Ifaac Morris, whom I fouftd very ill with a 
 violent puking, great pain in his head, a red eyc^ 
 and a flow tenfe pulfe» I ordered him to ht bled, 
 and purged him plentifully with jalap and calomeL 
 His blood had that appearance which has been 
 compared by authors to the wafliings of raw ilefli 
 in water. Upon hk recovery he told me that he 
 *^ fufpefted he had had the yellow fever, for that 
 his feelings were exa£i:ly fuch as they had been in 
 the fall of 1793, at which time he had an attack 
 of that diforder." 
 
 On the 14th of June I was fent for in the ab- 
 fence of Dr. Meafe, to vifit his filler in a fever. Her 
 mother who had become intimately acquainted with 
 the yellow fever by nurfmg her fon and mother in 
 it, the year before, at once decided upon the name 
 of her daughter's diforder. Her fymptoms were 
 violent, but they appeared in an intermitting form. 
 Each paroxyfm of her fever was like a hurricane to 
 her v/hole fyllem. It excited apprehenfions of im- 
 mediate diiTolution in the minds of all her friends^ 
 The lofs of fixty ounces of blood by five bleedings, 
 copious dofes of calomel and jalap, and a large blif- 
 ter to her neck, foon vanquiihed this malignant in- 
 termittent 
 
BILIOUS YELLOW FEVER, IN 1794. 5 
 
 termittent, without the aid of a fingle dofe of 
 bark. 
 
 During the remaining part of the month I was 
 called to feveral cafes of fever which had fymptoms 
 of malignity of a fufpicious nature. The fon of 
 Mr. Andrew Brown had an hcemorrhage from his 
 nofe in a fever, and a cafe of menorrhagia occurred 
 in a woman who was affefled with but a flight de- 
 gree of fever. 
 
 In the courfe of this month I met with feveral 
 cafes of fwelled tefticles, which had fucceeded fevers 
 fo flight as to have required no medical aid. Dr. 
 Defportes records fimilar inllances of a fwelling in 
 the teft^icles which appeared during the prevalence 
 of the yellow fever in St. Domingo in the year 
 1741. * 
 
 In the month of July I viflted James Lefferty and 
 William Adams, both of whom had, with the ufual 
 fymptoms of yellow fever, a yellow colour on their 
 flcin. I likevv^ife attended three women, in whom I 
 difcovered the difeafe under forms in which I had 
 often (een it in the year 1793. In two or them it 
 iippeared with fymptoms of a violent colic, whicli 
 
 ' Hiiloire des Maladies d-e Saint Domingue, p. 1*2. 
 
 A 3 yielded 
 
6 ^ AN ACCOUNT OF THE 
 
 yielded only to frequent bleedings. In the third, 
 it appeared with fymptoms of preurify, which was 
 attended with a conflant haemorrhage from the ute- 
 rus, although blood was drawn almofl daily from 
 her arm for fix or feven days. About the middle 
 of this month many people complained of a ficknefs 
 at ftomach, which in fome cafes produced a puking, 
 without any fymptoms of fever. 
 
 During the month of Auguft, I was called to 
 Peter Denham, Mrs. Bruce, a fon of Jacob Crib- 
 ble's, Mr. Cole, John Madge, Mrs. Gardiner, Mifs 
 Purdon, Mrs. Gavin, and Benjamin Cochran, each 
 of whom had all the ufual fymptoms of the yellow 
 fever. I found Mr. Cochran fitting on the fide of 
 his bed, with a pot in his hand, into which he was 
 difcharging black bile from his flomach, on the 6th 
 day of the diforder. He died on the next day. 
 Mrs. Gavin died on the 6th day of her diforder, 
 from a want of fufficient bleeding, to which llie ob- 
 je<!led from the influence of her friends. Befides 
 the above perfons, I vifited Mr. George Eyre at 
 Kenfmgton, Mr. Thomas Fitzfimons, and Thomas 
 M'Kean, jun. fon of the chief juflice of Pennfyl- 
 yania, all of whom had the diforder, but in a mo- 
 derate degree. From none of them had 1 as yet 
 obferved the fever to be propagated by contagion, 
 ?.Vid therefore I took no ileps to alarm my fellow- 
 citizens 
 
BILIOUS YELLOW FEVER, IN 1 794. 7 
 
 citizens wftb. the mrwelcome news of its being in 
 town. But my mind was not eafy in this fituation, 
 for I daily heard of perfons who died of the difor- 
 der, who might probably have been faved had they 
 applied early for relief, or had a fufpicion become 
 general among all our phyficians of the exiflence of 
 the yellow fever in the city. The colera infantum 
 was common during this, and part of the preceding 
 month. It was more obilinate and more fatal than 
 in common years. 
 
 On the 1 2th of this month a letter from Baltimore 
 announced the exiflence of the yellow fever in that 
 city. One of the patients whom I vifited in this 
 month, in the fever, Mr. Cole, brought the conta- 
 gion of it in his body from that place. 
 
 On the 25th of the month two members of a 
 committee lately appointed by the government of 
 the flate, for taking care of the health of the city, 
 called upon mc to know v/hether the yellow fever 
 was in town. I told them it was, and mentioned 
 fome of the cafes that had come under my notice ; 
 but informed them at the ftime time, that 1 had 
 fecn no cafe in which it had been contagious, and 
 that in every cafe where I had been called early, 
 . and where my prefcriptions had been followed, the 
 dii^?afe had yielded to medicine. 
 
 A 4 On 
 
S AK ACCOUNT OF THl 
 
 On the 29th of the month, I received an invita- 
 tion to attend a meeting of the Committee of 
 Health, at their office in Walnut Street. They 
 interrogated me refpe6ling the intelligence I had 
 given to two of their members on the 25th. I re- 
 peated it to them, and mentioned the names of all 
 the perfons I had attended in the yellow fever fmce 
 the 9 th of June. 
 
 As I confidered the filth of the gutters, and the 
 ftagnating water in the neighbourhood of the city 
 to be the remote caufes of this fever, I advifed the 
 Committee to have them both removed, and thereby 
 to prevent the fpreading of the diforder. 
 
 On the firfl week in September the difeafe ap- 
 peared to be contagious in feverai families, and the 
 number of my patients w^as thereby daily multi- 
 plied. I now confidered it as criminal to conceal 
 any longer the prevalence of the difeafe in our city, 
 or to elude the inquiries that were diredted to me 
 by my fellow-citizens, refpec):ing it. In vain did I 
 "wait for the alarm to come from another quarter. 
 I recollected the flanders to which I had expofed 
 myfelf the year before, by giving the firll notice of 
 the prevalence of the fever in our city. But I did 
 not hefitate in this fituation, to offer up my reputa- 
 tion a fecQiid time as a facrifice for the lives of my 
 
 fellovv' 
 
BILIOUS YELLOW FEVER, IN 1 794. 9 
 
 fellow-citizens. In order to render the information 
 as public as polTible, I addreifed a letter to the 
 mayor of the city on the 2d of September, in which 
 I dated the exillence, and rgntagious nature of 
 the difeafe. The contents of this letter, and my 
 information to the Committee of Health refpe<5ling 
 the yellow fever, drew upon me the following at- 
 tack in Mr. Fcnno's newfpaper. 
 
 For the Gazette of the United States. 
 
 '^ Mr. Fenno, 
 
 "I BEG leave, through the channel of 
 your paper, to enquire of the phyfician who re- 
 ported to the infpeiflors of health lail Friday, that 
 '' the yellow fever had again made its appearance 
 in this city, but that it was not at prefent conta- 
 gious," what could have induced him to make fuch 
 a report ? No benefit can arife to the public from 
 a knowledge of fuch a fa£l:, admittinq^ it to be as 
 ftated ; but a great deal of damage : becaufe fuch 
 reports cannot fail of alarming and filling with 
 dread, the minds of thofe who are not poiTciTed of 
 the Do(^or's fine difcernment and capacity of fplit- 
 ting difeafes into grades, fub-grades, and femi- 
 grades ; therefore fuch a report will not only ren- 
 der multitudes uneafy, and interrupt the ufual courfe 
 
 of 
 
lO AN ACCOUNT OF THE 
 
 of buHnefs, but injure the interefl and reputation of 
 the city in fever al other refpefts. 
 
 " If the difeafe really exifled, it would be com- 
 mendable to found the alarm — it would be crimi- 
 nal to be filent ; but if it is not in the city, or if 
 being in the city, it is not contagious, it is the 
 height of cruelty to create ufelefs terror and alarm 
 in the minds of the citizens. 
 
 *^ But Mr. Fenno, is it not very extraordinary, 
 if the difeafe is in the city, and the phyfician allu- 
 ded to has had twenty-fix cafes of it fmce June, 
 fhat it has appeared to none of the other phyfi- 
 cians, not even to thofe who attend the Difpenfary, 
 wliich I am aifured from the befl authority is the 
 cafe ? 
 
 *^ A phyfician who has great weight with the cre- 
 dulous and ignorant, has already attempted to ruin 
 the reputation of this flourifliing and delightful 
 city, by publilhing an opinion that the late pefti- 
 lential fever was generated in it ; and that its fitua- 
 tion and climate is favourable to the generation of. 
 the moil malignant maladies. If fuch an opinion 
 was not believed by every man who knows the cha- 
 rafter of that phyfician to be a mere invention to 
 fupport a miltaken theory, or that it proceeded 
 
 from 
 
BILIOUS YELLOW FEVER, IN 1 794. II 
 
 from a rage for being efleemed the mofi: learned 
 man in the univcrfe ; the author would in a few 
 years have the divine fatisfa^flion of feeing this po- 
 pulous and profperous city deferted by all its opu- 
 lent inhabitants, and become a folitary waile where 
 he might fit alone, ' fmiling ghaftly o*er its ruins, 
 and enjoying the fruits of his lingular opinion.* 
 
 " If the opinion of that phyfician was founded 
 in fa£t, Mr. Fenno, fuch would be the blelTed con- 
 fequence ; for who that has any regard for health 
 or life would venture to remain in a city notorious 
 for generating plagues which put hfe in perpetual 
 jeopardy ? 
 
 *' This, however, fortunately is not credited, and 
 the city, in fpite of the reveries of philofophers, 
 phylicians, and conjurers, will flourilli for ages yet 
 to come ; and when all the fources of ilagnant w^a- 
 ter in its fuburbs come to be removed or corrected,, 
 it will be one of the moll healthy fituations in Ame- 
 rica. Open on every fide to the accefs of the 
 winds — with a dry foil — flreets favourably arran- 
 ged — the inhabitants induflrious, cleanly, and well 
 informed — it cannot in the nature of things be un- 
 healthy. Compare its bills of mortality with thofe 
 of Paris, London, Edinburgh, Vienna, or Stocks 
 
 holm. 
 
lij AN ACCOUNT O^ THE 
 
 holm, and you will at once be convinced how much 
 more healthful it is than either of thofe. 
 
 " Be under no concern my fellow-citizens, the 
 yellow fever is not in our city, nor is it poffible for 
 it to be generated in it, in its prefent fituation. 
 
 WALTER qUCERIST," 
 
 On the i3tli of September I wrote a fecond let- 
 ter to the Committee of Health, in which I de- 
 clared the difeafe to be contagious, and urged them 
 to make the information I gave them public. My 
 reafons for this advice were flated in the follow- 
 ing words : '' It will excite the citizens to apply 
 early for medical aid, and it will produce in the 
 minds of fuch of the phyficians as are unprejudiced, 
 nn early fufpicion of the prefence of the difeafe, in 
 thofe cafes where it comes on with its lefs obvious 
 -iymptoms.^ 
 
 >j 
 
 None of thefe communications produced the ef- 
 fect: that was intended by them. Dr. Phyfick and 
 Dr. Dev/ees fupported me in my declaration, but 
 ihtlr tellimony did not protedl me from the grolTefl 
 calumnies of my fellow-citizens. One of my friends 
 informed me tliat he had heard a propofal in a 
 
 public 
 
BILIOUS YELLOW FEVER, IN 1 794. I J 
 
 public company to " drum me out of the city." A 
 charge of infanity which had been made againft 
 me the year before, was now revived, and propa- 
 gated with fo much confidence, that one of my 
 patients who had believed it, exprefled her furprife 
 at perceiving no deviation from my ordinary man- 
 ner, in a fick-room. Several of the phyficians of 
 the city united in the llanders which were thrown 
 out againfl me j and notwithftanding they daily at- 
 tended, or lofl patients in the yellow fever, they 
 denied that any cafes of it had occurred in their 
 praftice. To thefe cafes they gave other names. 
 I fliall briefly enumerate thefe names, together 
 with the opinions of fome of the phyficians refpe<5l- 
 ing the fever. This detail will be ufeful ; for by 
 expofing the danger and fatal confequences of error 
 and deception, we fhall prevent their being repeat- 
 ed, and thereby prepare the vv^ay for the more 
 ready and univerfal admifilon of truth, upon the 
 fubje£l of the fever. Thus ignorance and vice will 
 appear, even in the fcience of medicine, not to have 
 exifted in vain. 
 
 It was called, 
 
 1. A common intermittent. 2. A bilious fever. 
 3, An inflammatory remitting fever. 4. A putrid 
 fever. 5. A nervous fever. 6. A dropfy of the 
 
 brain. 
 
14 AN ACCOUNT OP THE 
 
 brain. 7. A lethargy. 8. Pieurify. 9. Gout. 
 10. Rheumatifm. 11. Colic. 12. Dyfentery. 
 And 13. Sore throat.^ 
 
 It was faid further, not to be the yellow fever 
 becaufe it was not contagious, and becaufe forae 
 who had died of it, had not a fighing in the be- 
 ginning, and a black vomiting in the clofe of the 
 difeafe. Even where the black vomiting and yel- 
 low ikin occurred, they were faid not to conftitut^ 
 a yellow fever, for that thofe fymptoms occurred in 
 other fevers. 
 
 A further detail of the names of this fever, and 
 of the opinions of the phylicians will appear pre- 
 fently in their report to the Committee of Health 
 on the 30th of September. 
 
 Truth, it has often been faid, is an unit, but 
 this is not the cafe with error. While the phy- 
 ficians v/ho aiTerted that the yellow fever was in 
 town, agreed in fixing the fame name to every cafe 
 of it, the phyficians who propagated the contrary 
 opinion, gave diiferent names to the fame fever. 
 
 * A fore throat fometimes occurs as a fymptom of the yel- 
 low fever. It is taken notice of by Dr. Blane in his Hiftory 
 of the Fever in the Weft Indies. 
 
 In 
 
BILIOUS YELLOW FEVER, IK 1 794- 1$ 
 
 In one inflance a citizen of Philadelphia was faid 
 by one of his phyficians to have died of a lethargy, 
 and by another, of a nervous fever. To keep iip 
 the latter idea, his death was announced in the 
 public papers, to have occurred after an illnefs of 
 two weeks. 
 
 I hope to fliew hereafter, that it is not more im- 
 proper to fay that men are of different fpecies, be- 
 caufe they are tall and lliort, or becaufe fome are 
 long, and others iliort lived, than that fevers are 
 of different fpecies, becaufe they vary in their fymp- 
 toms and duration. 
 
 The conduct of the Committee of Health was 
 not lefs improper that that of the phyficians. Thej 
 not only refufed to make the exigence of the fever 
 in the city public, but refufed to open Bufli-hiii 
 hofpital for the reception of the poor, although that 
 convenient and fpacious building had been hired 
 by the city for that purpofe, and fent feverai poor 
 perfons to the hofpital at State IHand. This fitua- 
 tion was preferred to Bulh-hill, to prevent the citi- 
 zens being alarmed, and probably to favour the 
 opinion that the difeafe was imported. About the 
 fame time they fent invitations to all the phyficians 
 in the city (Dr. Phyfick, Dr. Dewees, and one more 
 excepted) to attend a meeting of the Board, at 
 
 the 
 
l6 AN ACCOUNT OF THE 
 
 the City Hall, in order to afcertain the ftate of 
 the city. The following publication was the refult 
 of that meeting. 
 
 HEALTH-OFFICE, 
 
 Port of Philadelphiay \Jl OBoher, 1794. 
 
 " The Board of Health, feeling, in common with 
 the reft of their fellow-citizens, a concern for the 
 intereft and fafety of the city, were induced to make 
 a general invitation to the Faculty, to meet them 
 at the City Hall, on Tuefday the 30th September, 
 in order that from their communications a juft ftate 
 of the health of the city might be obtained. Ac- 
 cordingly, the following phyficians were pleafed to 
 attend, viz. 
 
 Dr. Samuel Duffield, Dr. Kuhn, 
 
 Dr. Parke, Dr. Hodge, 
 
 Dr. Dunlap, Dr. Currie, 
 
 Dr. Wiftar, Dr. Benj. Duffield. 
 
 Dr. Porter, and 
 
 Dr. Annan, Dr. Woodhoufe. 
 
 *' From the whole of thefe gentlemen, to the 
 queftiox^ of a contagious difeafe (that is, a difeafe 
 which had been communicated from one perfon to 
 another) exifting at this time, there were anfwers 
 in the negative. 
 
 ± "It 
 
BILIOUS YELLOW FEVER, IN 1 794. I J 
 
 *' It was then propofed that cafes of autumnal 
 fevers, which were conlidered dangerous to the pa^^ 
 tkntSy fliould be mentioned. To this 
 
 " Dr. Currie anfwered, that an aged female in a 
 remittent fever, and a boy in the yellow fever, 
 were the only cafes apparently dangerous under his 
 care. 
 
 " Dr. Benjamin Duffield has two cafes of au- 
 tumnal remittent fevers, dangerous, without any 
 contagion annexed to it. 
 
 " Dr. Parke has one cafe, confidered dangerous. 
 
 " Dr. Wiftar. One cafe that may be dangerous. 
 
 " Dr. Hodge. Five cafes that probably will be- 
 come putrid and dangerous. 
 
 " Dr. Barton, though not prefent, communicated 
 through a member of the Board, that he has no 
 cafe of a contagious nature. 
 
 " Drs. Rufli and Say, not being prefent, were fo 
 obliging as to make their communications in writing, 
 which are hereto fubjoined. — From 
 
 VOL. IV, 2J. Dr. 
 
iS AN ACCOUNT or THE 
 
 " Dr. Rufli. ' Out of about thirty patients whom 
 I vifit daily, who are confined by bilious remitting 
 and intermitting fevers, twelve of them have fevers 
 of the higheft or mofl inflammatory degree, com- 
 monly called yellow fevers. All of them are tend- 
 ing to a favourable iiTue, and from the mode in 
 which they have been treated, I hope no contagion 
 will be generated by them.' 
 
 " From Dr. Say. ' Within the compafs of my 
 pra6lice there are a number of people labouring 
 under remitting and intermitting fevers : I have 
 had, I have no doubt, feveral cafes within the ten 
 days pail, of the malignant fever, though at pre- 
 fect I do not know that I have a decided cafe of 
 that kind.' 
 
 " The Board of Health, in addition to the fore- 
 going remark, that they are not acquainted with 
 any cafes of a dangerous nature, other than has 
 been already flated — and upon the whole, cannot 
 but felicitate their fellow-citizens, at a time when 
 alarms and injurious reports have been induflrioufly 
 circulated to the prejudice of the health of the city, 
 that amongfl the practice of fuch a number of phy- 
 ficians, there is not one cafe of a contagious nature 
 apparent, and fo very few who are dangeroully ill. 
 
 The 
 
BILIOUS YELLOW FEVER, IN 1 794. I9 
 
 " The board further ha\^e the plcafure to inform 
 the citizens that although the houfe at Buili-Hill 
 was prepared for the reception of fuch fick perfons 
 as were proper obje(fl:s for that place on the 26th 
 of lalt month, there is not now, nor has there been 
 a lingle patient there. 
 
 " By order, and on behalf of the Board of Health. 
 
 JACOB MORGAN, Chairman," 
 
 *' C^ The citizens are requefled to meet this evening 
 at 6 o'clock^ at the City Hall^ to take into confidera* 
 iion the alarming accounts of the progrefs of a conta- 
 gious dif order at Baltimore^ and to devife proper mea^ 
 fures toproted the citizens from the effects thereof^* 
 
 The reader will pleafe to take notice, that the 
 quellion by the Committee, was whether " a con- 
 tagious difeafe exiiled at this time in the city." 
 Why was not an inquiry made whether the yellow 
 fever exfiled at that time in the city ? or, Why was 
 that fever dcfignated by its being contagious, a 
 character which by no means belongs to it univer- 
 fally, and that does not conftitute its principal dan- 
 ger ; for it is well known that in the Weft Indies, 
 it aifedls fo feldom by contagion, as to furnifli a 
 controverfy among Weft Indian phyficians, con- 
 
 B 2 cerninj? 
 
^O AN ACCOUNT OF TflE 
 
 cerning its contagious nature ? Even in the city of 
 Philadelphia, it was not uniformly contagious in 
 1793, many having efcaped it who were conflant- 
 ly expofed to its contagion. But further. Why, 
 Was there no retrofpeci: in the inquiry into the (late 
 of the city, during the weeks or months that had 
 preceded the 30th of September? Two of the 
 phyficians who afferted that they then had no cafes 
 of yellow fever under their care, had acknowledg- 
 ed that they had had feveral cafes of it a few weeks 
 before. It is impoffible to review this report,, 
 without blufliing for the fliameful fubmiiTion made 
 by the fcience of medicine, to the commercial fpirit 
 of the city. 
 
 But let not the reader complain of the phylician? 
 and citizens of Philadelphia alone. A fimilar con- 
 du£i: has exifled in all cities, upon the appearance 
 of great and mortal epidemks* 
 
 It prevailed lately in Algiers, where the Dey 
 refufed to let fome American prifoners leave a town 
 infe^led by the plague, denying the exiftence of 
 the diforder in that place.* SuccelTive attempts by 
 numerous publications, were made to conceal the 
 prevalence of the yellow fever in the cities of New 
 
 * See Col. Humphries*s letter to the citizens of the United 
 
 States, dated Lifbon, July 11, 1794. 
 
 Yorkj 
 
BILIOUS YELLOW FEVER, IN 1 794. 21 
 
 York, Baltimore and Charlefton, for two years 
 pail:. Such was this felfifli difpofition in the Com- 
 mittee of Health in New York in the year 1795, 
 that they wrote to the Committee of Health in Phi- 
 ladelphia, to deliver up the names of feveral per- 
 fons who had in private letters to their friends, 
 which had been publiflied, aiTerted that the yellow 
 fever prevailed in that city. But the contradled 
 fpirit of this Committee did not end here. After 
 they were compelled to acknowledge the prevalence 
 of the fever among them, they endeavoured to 
 compofe the fears of their fellow citizens, by in- 
 forming them, that a " large proportion of the 
 deaths hitherto reported, had fallen among emi- 
 grants lately from Europe, flrangers, and other 
 tranfient perfons,'^t thereby intimating, that the 
 obligations to fympathy fhould be confined wholly 
 to permanent and wealthy citizens. 
 
 Nor is it any thing new for mortal difeafes to re- 
 ceive mild and harmlefs names from phyficians. 
 The plague was called a fpotted fever for feveral 
 months, by fome of the phyficians of London in the 
 year 1665. 
 
 f Report of the Committee of Health of New York, dated 
 Friday evening, September 18, 1795. 
 
 B 3 Added 
 
22 AN ACCOUNT OF THE 
 
 Added to that fervility to wealth, which difpofes 
 phyficians to deny the exiftence of peftilential fever? 
 in cities, there were two other reafons which led fome 
 of the phyficians of Philadelphia, to deny the pre- 
 valence of the yellow fever in our city ; thefe reafons 
 were; firfl. The change which they had made in their 
 practice, for they had adopted the depleting fyftem 
 in a certain degree ; but they declared that they ufed 
 it not in the yellow fever, but in an inflammatory 
 bilious remittent ; and fecondly, Their inability to 
 derive the difeafe from importation. To have ac- 
 knowledged the exiflence of the difeafe in our city, 
 therefore, would have been a direli6i:ion of two of 
 the principal errors held by them in the year 
 
 1793- 
 
 Thus while nurfes, bleeders, clergymen and oc- 
 cafional vifitors of the fick, and in fome inftances, 
 the fick themfelves, united in deciding upon the cha- 
 racter and name of our fever, a majority of the 
 phyficians united in perfuading the citizens that it 
 exifled only in the imaginations of two or three 
 men. 
 
 From a review of the conduct of cities upon the 
 fubjeCl of difeafes, an important inference may be 
 made j and that is, to confider their public reports in 
 
 favour 
 
BILIOUS YELLOW FEVER, IN 1 794. 23 
 
 favour of the health of their inliabitants, as the 
 precurfors of great and mortal epidemics. 
 
 It has been alked, why I am more anxious to have 
 the exiilence of the yellow fever believed, than any 
 of the other phyficians of the city ; and why I did 
 not cure it, without calling it by its unpopular 
 name ? To this I anfwer, that I confider the making 
 the difeafe public, as foon as it appears in a city, 
 and the calling it by its common and vulgar name, 
 to be a duty, indire^lly included in that divine pre- 
 cept which forbids the taking away a human life. 
 Dr. Sydenham acknowledges that he generally lofl 
 the firil four or five patients he met with in a new 
 difeafe, and all candid phyficians mud confefs the 
 want of the fame fuccefs in the beginning, that 
 they have in the clofe of a new epidemic. Now this 
 want of fuccefs may at all times be prevented from 
 becoming general, by notice being given of the 
 exiflence of a new difeafe as foon as it makes its 
 appearance. The propagation of the difeafe when 
 contagious, may moreover be checked, or its malig- 
 nity mitigated, by means of diet, or medicine, 
 when its prevalence is generally known, and thereby 
 many thoufand lives may be faved. There was 
 once a law in Pennfylvania, which puniihed the 
 concealment of a malignant and contagious difeafe 
 m the city of Philadelphia. Such a law would be a 
 
 B 4 bleifing 
 
24 AN ACCOUNT OF THE 
 
 bleiTing In every country. Whole communities 
 might be faved by it. 
 
 Notwithftanding the pains which were taken to 
 difcredit the report of the exiflcnce of the yellow 
 fever in the city, it was finally believed by many 
 citizens, and a number of families in confequence 
 of it, left the city. And in fpite of the harmlcfs 
 names of intermitting and remitting fever, and the 
 like, which were given to the diforder, the bodies 
 of perfons who had died with it, were conveyed 
 to the grave in feveral inflances upon a hearfe, 
 the way in which thofe who died of the yellow fever 
 were buried the year before. 
 
 From the influence of occafional fliowers of rain, 
 in the months of September and October, the difeafe 
 was frequently checked, fo as to difappear alto- 
 gether for two or three days in my circle of pra61ice. 
 It was obferved that while fliowers of rain checked 
 it, moiil or damp weather without rain, favoured 
 its propagation. It was further kept from becoming 
 general by the mode of treating it ; for nearly all 
 the phyficians purged, and bled more or lefs, in 
 every cafe of fever they were called to, by which 
 means the produ£tion of a large mafs of contagion, 
 was prevented. This peculiarity in the practice of 
 the oppofmg phyficians, did not efcape the notice 
 
BILIOUS YELLOW FEVER, IN 1 794. 25 
 
 of feveral of the reflc^ling citizens of Philadelphia, 
 who remarked very properly, that two or three 
 bleedings, and purges of calomel and jalap were not 
 the ufual remedies for intermitting and remitting fe- 
 vers of common years. 
 
 The cold weather In 0(^ober checked the fever, 
 but it did not banilli it from the city. It appeared 
 in November, and in all the fucceeding winter and 
 fpring months. The weather during thefe months 
 being uncommonly moderate, will account for its 
 not being deflroyed at the time in which the difeafe 
 ufually difappeared in former years. 
 
 The caufes which predifpofed to this fever were 
 the fame as in the year 1793. Perfons of full ha- 
 bits, (Irangers, and negroes were moil fubje£i: to it. 
 It may feem flrange to thofe perfons who have read 
 that the negroes are feldom alfe^led with this fever 
 in the Weil Indies, that they were fo much affected 
 by it in Philadelphia. There were two reafons for 
 it. Their manner of living was as plentiful as that 
 of white people in the Weft Indies, and they gene- 
 rally refided in alleys and on the fivirts of the city, 
 where they were more expofed to noxious exhala- 
 tion, than in its more open and central parts. 
 
 The fummer fruits, from being eaten before they 
 were ripe, or in too large a quantity, became fre- 
 quently 
 
'26 AN ACCOUNT OF THE 
 
 queiitly exciting caufes of this fever. It was awa- 
 Icened in one of my patients by a flipper of peaches 
 and milk. Cucumbers in feveral inftances gave vi- 
 gor to the miafmata which had been previoufly re- 
 ceived into the fydem. Terror excited it in tv^^o of 
 my patients* In one of them, a young v^^oman, 
 
 this terror was produced by hearing,, while flie fat 
 at dinner, that a hearfe had pafTed by her door with 
 a perfon on it who had died of the yellow fever. 
 Vexation excited it in a foreign mafler of a veffel 
 in confequence of a young woman fuddenly break- 
 ing an engagement to marry him. The difeafe ter- 
 minated fatally in this inflance. 
 
 It was fometimes unfortunate for patients when 
 the difeafe was excited by an article of diet, or by 
 any other caufe which acled fuddenly upon the fyf- 
 tem ; for it led both them., and in fome inflances 
 their phyficians, to confound thofe exciting caufes 
 with its remote caufe, and to view the difeafe with- 
 out the leafl relation to the prevailing epidemic. It 
 was from this millake that many perfons were faid 
 to die of intemperance, of eating ice creams, and 
 of trifling colds, who certainly died of the yellow 
 fever. The rum, the ice creams, and the changes 
 in the air, in all thefe cafes afted like fparks 
 of fire v/hich fet in motion the quiefcent particles 
 of tinder or gunpowder. 
 
 Ifhall 
 
BILIOUS YELLOW FEVER, IN 1 794. 2/ 
 
 I (liall now proceed to defcribe the fymptoms 
 which this fever afuimed during the periods which 
 have been mentioned. This detail will be interefl- 
 ing to pliyficians who wifli to fee how little nature 
 regards the nofological arrangement of authors in 
 the formation of the fymptoms of difeafes, and how 
 much the feafons influence epidemics. A phyfician 
 who had orafticed medicine near fixty years in the 
 city of Philadelphia, declared that he had never feen 
 the dyfentery alTume the fame fymptoms in any two 
 fuccejjivc years. The fame may be faid probably 
 of nearly all epidemic difeafes. 
 
 In the arrangement of the fymptoms of this fever, 
 I fhall follow the order I adopted in my Account 
 of the Yellow Fever of 1793, and defcribe them. 
 as they appeared in the fanguiferous fyflem — the 
 liver, lungs, and brain — the alimentary canal — the 
 fecretions and excretions — the nervous fyflem — the 
 fenfes and appetites — upon the fkin, and in the blood. 
 
 Two premonitory fymptoms llruck me this year 
 which I did not obferve in 1793. One of them 
 was a frequent difcharge of pale urine for a day 
 or two before the commencement of the fever ; the 
 other was fleep unufually found, the night before the 
 attack of the fever. The former fymptom was a pre- 
 curfor of the plague of Baffora in the year 1773. 
 
 I. I 
 
^S AN ACCOUNT OF THE 
 
 I. I obferved but few fymptoms in the fanguife- 
 raus fyftem dilTerent from what I have mentioned 
 in the fever of the preceding year* The (low and 
 intcnnitting pulfe occurred in many, and a pulfe 
 nearly imperceptible, in three inftances. It was fel- 
 dom very frequent. In John Madge, an Englifli 
 fai-mer who had jufl arrived in our city, it beat only 
 64 flrokes in a minute for feveral days, while 
 jhe was fo ill as to require three bleedings a-day, 
 and at no time of his fever did his pulfe exceed 
 96 flrokes in a minute. In Mifs Sally Eyre the 
 pulfe at one time was at 176, and at another time 
 it was at 1 40 ; but this frequency of pulfe was 
 very rare. In a majority of the cafes which came 
 Under my notice, where the danger was great, it 
 feldom exceeded 80 ftrokes in a minute. I have 
 been thus particular in defcribing the frequency of 
 the pulfe, becaufe cuilom has created an expectation 
 of that part of the hiflory of fevers ; but my at- 
 tention was direCled chiefly to the different degrees 
 of force in the pulfe as manifefled by its tenfion, 
 fulnefs, intermifTions, and inequality of aftion. The 
 hobbling pulfe was common. In John Geraud, I 
 perceived a quick flroke to fucceed every two 
 ftrokes of an ordinary healthy pulfe. The inter- 
 mitting and deprelTed pulfe occurred in many cafes. 
 I called it the year before 2.fidky pulfe. One of my 
 pupils, Mr. Alexander, called it more properly a 
 
 locked 
 
BILIOUS YELLOW FEVER, IN 1794. ^29 
 
 iocked piilfe. I think I obferved this Hate of the 
 pulfe to occur chiefly in perfons in whom the fever 
 came on without a chilly fit. ^ 
 
 Hcemorrhages occurred in all the grades of this 
 fever, but lefs frequently in my practice this year 
 than in the year before. It occurred after a ninth 
 bleeding in Mifs Sally Eyre from the nofe and bowels. 
 It occurred from the nofe after a fixth bleeding in 
 Mrs. Gardiner, who was at that time in the fixtk 
 month of her pregnancy. This fymptom, which 
 was accompanied by a tenfe and quick pulfe, in- 
 duced me to repeat the bleeding a feventh time. 
 The blood was very fizy. I mention this fa^ to 
 eflabliih the opinion that haemorrhages depend upon 
 too much a£lion in the blood-veifels, and that they 
 are not occafioned by a diilblved idate of the blood. 
 
 There was a difpofition at this time to hcemor- 
 rhage in perfons who were in apparent good health. 
 A private in a company of volunteers commanded 
 by Major M'Pherfon, informed me that three of 
 his meifmates were affe(5led by a bleeding at the 
 nofe for feveral days after they left the city on their 
 way to quell the infurre£lion in the weflern coun- 
 ties of Pennfylvania. 
 
 11. The liver did not exhibit the ufual marks 
 of inflammation. Perhaps my mode of treating the 
 
 fever 
 
^O AN ACCOUNT OP THE 
 
 fever prevented thofe fymptoms of hepatic affet- 
 tioii which belong to the yellow fever in tropical 
 climates. The lungs were frequently aife(Sl:ed ; and 
 hence the difeafe was in many inflances called a 
 pleurify or a catarrh. This inflammation of the 
 hmgs occurred in a more efpecial manner in the 
 winter feafon. It was diiringuillied from the pleu- 
 riiics of common years by a red eye ; by a vomit- 
 ing of green or yellow bile ; by black flools ; and 
 by requiring very copious blood-letting to cure it. 
 
 The head was affected in this fever, not only 
 with com.a and delirium, but with mania. This 
 fymptom v/as fo comm^on as to give rife to an opi- 
 nion that madnefs w^as epidemic in our city. I faw 
 no cafe of it which was not connedled with other 
 fymptoms of the bilious rem.itting fever. The Rev, 
 Mr. Keating, one of the minifters of the Roman 
 church, informed me that he had been called to 
 viiit feven deranged perfons in his congregation in 
 the courfe of one week, in the month of March. 
 Two of them had made attempts upon their lives. 
 This mania was probably, in each of the above 
 cai'cs, a fymptom only of general fever. The dila- 
 tation of the pupil was univerfal in this fever. 
 
 Sore eyes were common during the prevalence 
 of this fever. In Mrs. Learning this affection of 
 the eyes was attended with a fever of a tertian type. 
 
 III. The 
 
BILIOUS YELLOW FEVER, IN 1 794- Jl 
 
 III. The alimentary canal fulFered as ufual in 
 this fever. A vomiting was common upon tlie 
 firfh attack of the diforder. I obferved this fymp- 
 tom to be lefs common after the cold and rainy 
 weather which took place about the firfl of Oc- 
 tober. 
 
 I have in another place mentioned the influence 
 of the weather upon the fymptoms of this difeafe. 
 In addition to the fafis which have been formerly 
 recorded, I fliall add one more from Dr. Defportes* 
 He tells us, that in dry weather the difeafe affects 
 the head, and that the bowels in this cafe are 
 more obftinately coflive than in moifl weather. 
 This influence of the atmofphere on the yellow 
 fever will not furprife thofe phyficians who recoiled 
 the remarkable paffage in Hippocrates in which 
 he fays, that in the violent heats of fummer, fevers 
 appeared, but without any fweat ; but if a ftiowcr, 
 though ever fo flight, appeared, a fweat broke 
 out in the beginning. * I obferved further, that 
 a vomiting rarely attended thofe cafes in which 
 there was an abfence of a chilly fit in the begin- 
 ning of the fever. The fame obfervation is made 
 by Dr. Defportes. t 
 
 * Epidemics, Book XL Se6l. i. 
 
 t Les Maladies de St. Domingue, Vol. I. p. 193. 
 
 The 
 
3 2 i\N ACCOUNT Oh' I'lilL 
 
 The matter difcharged by vomiting was green 
 or yellow bile in mod cafes. Mrs. Jones, the 
 wife of Captain Lloyd Jones, and one other per- 
 fon, difcharged black bile within one hour after 
 they were attacked by the fever. I have taken 
 notice in the fecond edition of my Account of the 
 Yellow Fever, that a difcharge of bile in the be- 
 ginnii,ig of this fever was always a favourable 
 fymptom. Dr. Davidfon of St. Vincents, in a let- 
 ter to me, dated the 2 2d July 1794, makes the 
 fame remark. It fliev/s that the biliary ducfts are 
 open J and that the bile is not in that vifcid and 
 impa£i:ed ftate which is defcribed in the difl'e^tions 
 vt Dr. Mitchel. A diftreffiDg pain in the fto- 
 mach, called by Dr. Cullen gaiirodynia, attended 
 in two inftanccG. A burning pain in the fcomach, 
 and a forenefs to tlie touch of its whole external 
 .region, occurred in three or four cafes. Two of 
 ilicni were in March 1795. In MrSo Vogles, who 
 ■had the fever in September 1794, the fenfibility 
 of tlie pit of the flomach w'as fo exquilite, that 
 fhe could not bear the weight of a flieet upon it. 
 
 Pains in the bovvxls were very comm.on. They 
 formed the true bilious colic, fo often mentioned 
 l)y \Vc(l India writers. In John Madge thefe pains 
 produced a hardneis and contraction of the whole 
 ..-.xternal region of the bowels. They were pt -"o- 
 I dical 
 
DlLIOUS YELLOW FEVER, IN 1 794. 33 
 
 dical in Mifs Nancy Eyre, and in Mrs Gardiner, 
 and in both cafes were attended with diarrhoea. 
 
 * 
 CosTivENEss without pain was common, and 
 in fome cafes fo extremely obflinate as to refifh for 
 feveral days the fucceffive and alternated ufe of 
 all the ufual purges of the fliops. 
 
 Flatulency was Icfs common in this fever tha.n in 
 the year 1793* 
 
 The difeafe appeared with fymptoms of dyfentery 
 in feveral cafes. 
 
 IV. The following is an account of the flate of 
 the Secretions and Excretions in this fever. 
 
 A puking of bile was more common this year^ 
 than in year 1793. It was generally, of a green 
 or yellow colour. I have remarked before, that two 
 of my patients difcharged black bile within an hour 
 after they were aiie^led by the fever, and many 
 difcharged that kind of matter which has been 
 Compared to coffee grounds, towards the clofe o£ 
 the difeafe. 
 
 The fseces were black, in mofl: cafes where the 
 
 fymptoms of the higheft grade of the fever attend- 
 
 VOL. IV, e ed" 
 
24 AN ACCOUNT OF THE 
 
 ed. In one very malignant cafe, the mofl draflic 
 purges brought away by fifty evacuations, nothing 
 but natural flools. The purges were continued, 
 and finally black fceces were difcharged which pro- 
 duced immediate relief. In one perfon, the fcTces 
 were of a light colour. In this patient the yellow- 
 nefs in the face was of an orange colour, and con- 
 tinued fo for feveral weeks after his recovery. 
 
 The urine was in mofl: cafes high coloured. It 
 was fcanty in quantity in Peter Brown, and totally 
 fuppreffed in John Madge for two days. I afcribed 
 this defect of natural adlion in the kidneys, to an 
 engorgement in their blood vefiels, fimilar to that 
 which takes place in the lungs and brain in this 
 fever. I had for fome time entertained this idea 
 of a morbid afte<9:ion of the kidneys, but I have 
 lately been confirmed in it by the account which 
 Dr. Chilliolm gives of the flate of one of the 
 kidneys in a man whom he lofl with the Beul- 
 1am fever at Grenada. " The right kidney (fays 
 the Po6tor) was mortified, although during his ill- 
 nefs no fymptom of inflammation of that organ was 
 p^ceived." * It would feem as if the want of 
 a£l:ion in the kidneys, and a defeft in their functions 
 
 * EiTiy on the Malignant Peftilentlal Fever introduced Into 
 tbe Weft Indies from BeuUam, p. 137. 
 
 were 
 
BILIOlJS YELLOW FEVER, IN 1794. ^^^ 
 
 Were not necefliirily attended with pain. I recollecfi: 
 to have met with feveral cafes in 1793, in which 
 there was a total abfence of pain in a fuppreflion 
 of urine, of feveral days' continuance. The fame 
 obfervation is made by Dr. Chiiholm, in his ac- 
 count of the Beullam fever of Grenada. * From 
 this facft it feems probable, that pain is not the 
 effeifl: of any determinate ftate of animal fibres, 
 but requires the concurrence of morbid, or pre- 
 ternatural excitement to produce it. I met with but 
 one cafe of ftrangury in this fever. It terminated 
 favourably in a few days. I have never feen death 
 in a fmgle inftance in a fever from any caufe, 
 where a flrangury attended, and I do not re- 
 collect ever to have feen a fatal ifTue to a fever 
 where this fymptom was accidentally produced by . 
 a blifler. From this faft there would feem to be 
 a connection between a morbid excitement in the 
 neck of the bladder, and the fafety of more vital 
 parts of the body. The idea of this connection 
 was firfl fuggeiled to me four-and-twenty years 
 ago, by the late Dr. James Leiper of Maryland, . 
 who informed me that he had fometimes cured the 
 mod dangerous cafes of pleurify after the ufual r-e-^ . 
 medies had failed, by exciting a flrangury by 
 means of the tinfture of Spanilli flies, mixed with^ 
 camphorated fpirit of wine* 
 
 * P. 224, 
 
 G 2. The- 
 
^,6 AN ACCOUNT OF THE 
 
 The tongue was always moifl in the beghming of 
 the fever, but it was generally of a darker colour than 
 lad year. When the difeafe was left to itfelf, or 
 treated with bark and wine, the tongue became of 
 a fiery red colour or dry and furrowed, as in tjie 
 typhus fever. 
 
 Sweats were more common in the remiffions of 
 this fever, than they v/ere in the year 1793, but 
 they feldom terminated the difeafe. During the 
 courfe of the fweats, I obferved a deadly coldnefs 
 over the whole body to continue in feveral in- 
 ilances, but without any danger or inconvenience 
 to the patient. In two of the Vv^orll cafes I at- 
 tended, there were remiilions, but no fweats un- 
 til the day on v/hich the fever terminated. In 
 feveral of my patients the fever wore away with- 
 out the lead mioiflure on the Pidn, The ??iilk in one 
 cafe was of a greenidi colour, fuch as fometimes appears 
 in the ferum of the blood. In another female pa- 
 'tlent who gave fuck, there was no diminution in 
 the quantity of her milk during the v/hole time of 
 her fever, nor did her infant fuffer the lead injury 
 from fucking her breads. 
 
 I obferved tears to flow from the ey^e of a young 
 woman in this fever, at a time when her mind feem.ed 
 free from didrefs of every kind. 
 
 V. I prc^ 
 
BILIOUS YELLOW FEVER, IN 1 794. 37 
 
 V. I proceed next to mention the fymptoms of 
 this fever in the nervous fyflem. 
 
 Delirium was lefs common than hid year. I 
 WHS much ftruck in obferving John Madge, who 
 had retained his reafon while he was fo ill as to 
 require three bleedings a day, to become delirious 
 as foon as he began to recover, at which time hi? 
 pulfe rofe from between 60, and 70 to 96 flrokes 
 in a minute. I faw one cafe of extreme dangler 
 in which an hyflerical laughing and weeping al- 
 ternately attended. 
 
 I have before mentioned the frequency of mania 
 as a fymptom of this difeafe. An obflinate v/akeful- 
 nefs attended the convalefcence from this fever in 
 Peter Brown, John Madge, and Mr. Cole. 
 
 Fainting was more common in this fever than 
 in the fever of 1793. It ulliered in the difeafe 
 in one of my patients, and it occurred in feveral 
 inflances after bleeding, where the quantity of 
 blood drawn v/as very moderate. 
 
 Several people complained of giddinefs in the 
 firft attaft of the fever, before they were confined 
 to their beds. Sighing was lefs common, but a 
 hiccup was more fo, than in the year before. 
 
 c 3 John 
 
•^.8 A-N ACCOUNT OF THE 
 
 Jolm Madge had an immobility in his limbs 
 bordering upon palfy. A weaknefs in the wrifls 
 in one cafe fucceeded a violent attack of the 
 fever. 
 
 Peter Brown complained of a mod acute pain 
 in the mufcles of one of his legs. It afterwards 
 became lo much inilamed as to require external 
 applications to prevent the inflammation terminating 
 in an abfcefs. Mrs. Mitchell complained of fever e 
 cramps in her legs. 
 
 The fenfations of pain in this fever were often 
 .exprelTed in extravagant language. The pain in the 
 head in a particular manner w as compared to repeat- 
 ed ilrokes of a hammer upon the brain, and in two 
 cafes in which this pain was accompanied by great 
 heat, it w as compared to the boiling of a pot. • 
 
 The more the pains were confined to the bones 
 and back, the lefs danger was to be apprehended 
 from the difeafc. I faw no cafe of death from the 
 yellow fever in 1793, where the patient complain- 
 ed much of pain in the back. It is eafy to conceive 
 hov/ this external determination of morbid a^lion, 
 fliould preferve more vital parts. The bilious fever 
 of J 780 was a harmdefs difeafe, only becaufe it 
 /pent its >vhole force chiefly upon the limbs. This 
 
 was 
 
BILIOUS YELLOW FEVER, IN 1 794. 39 
 
 was fo generally the cafe, that it acquired from the 
 pains in the bones which accompa.nied it, the name 
 of the " break bone fever.*' Hippocrates has re- 
 marked that pains which dcfcend, in a fever, are 
 more favourable than thofe which afcend.* This 
 is probably true, but, I did not obferve any fuch 
 pecuharity in the tranflation of pain in this fever. 
 The following fa6l from Dr. Grainger will add 
 weight to the above obfervations. He obferved 
 the pains in a malignant fever which were diffufed 
 through the whole head, though excruciating, were 
 much lefs dangerous, than when they were con- 
 lined to the temples, or forehead.f 
 
 I faw two cafes in which a locked jaw attended. 
 In one of them it occurred only during one parox- 
 yfm of the fever. In both it yielded in half an 
 hour to blood-letting. I met with one cafe in which 
 there was univerfal tetanus. I ihould have fufpecfl:- 
 cd this to have been the primary difeafe, had not 
 two perfons been infe6i:ed by the patient thus dif- 
 ordered, with the yellow fever. 
 
 The countenance fometimes put on a ghaflly ap- / 
 pearance in the height of a paroxyfm^ of the fever. 
 
 * Epidemics, book II. feclion 2. 
 
 \ Hiftoria iebris aiiomaia; Batavse Annorum 1746, 1747, 
 1748, cup. L 
 
 c 4 The 
 
40 AN ACCOUNT OF THE 
 
 The face of a lady admired when in health for un- 
 common beauty, was fo much diflorted by the 
 commotions of her whole fyftem in a fit of the fever, 
 as to be viewed with horror by all her friends. 
 
 VI. The fenfes and appetites were affected in this 
 fever in the following manner. 
 
 A total blindnefs occurred in two perfons during 
 the exacerbation of the fever, and ceafed during its 
 remiiTions. — A great intolerance of light occurred 
 in feveral cafes. It was moft obfervable in John 
 Madge during his convalefcence. 
 
 A forenefs in the fenfe of touch, was fo exquifite 
 in Mrs Kapper about the crifis of her fever, that 
 the prefTure of a piece of fine muflin upon her ikin 
 gave her pain. 
 
 Peter Brown with great heat in his fidn, and 
 a quick pulfe, had no thirft, but a mofh intenfe 
 degree of thiril was very common in this fever. It 
 produced the fame extravagance of exprefiTion that 
 I formerly faid was produced by pain. One of my 
 patients Mr. Cole faid he " could drink up the 
 ocean." I did not obferve thirfl to be connecSied 
 with any peculiar ftate of the pulfe. 
 
 Georr( 
 
BILIOUS YELLOW FEVER, IN I794. 41 
 
 George Eyre and Henry Clymer, had an unufual 
 degree of appetite jufl before the ufual time of the 
 return of a paroxyfm of fever. 
 
 A young man complained to me of being affli^led 
 with no6i:urnal emiiTions of feed during his conva- 
 lefcence. This fymptom is not a new one in malig- 
 nant fevers. Hippocrates takes notice of it.* I 
 met with one inflance of it among the fporadic cafes 
 of yellow fever which occurred in 1793. It fome- 
 times occurs according to Lomius in the commotions 
 of the whole fyllem which take place in epilepfy. 
 
 VII. The difeafe made an ImprefTion upon the 
 lymphatic fyflem. Four of my patients had glan- 
 dular fwellings : two of them were in the groin ; a 
 third was in the parotid ; and the fourth v/as in the 
 maxillary glands. Two of thefe fwellings fup. 
 purated. 
 
 VIII. The yellownefs of the ilvin which fometimes 
 attends this fever, was more univerfal, but more 
 faint than in the year 1793. It was in many cafes 
 compofed of fuch a mixture of colours as to rcfenible 
 polilhed mahogany. But in a few cafes, the yellow- 
 nefs was of a deep orange colour. The former went 
 off with the fever, but the latter often continued for 
 feveral weeks after the patients recovered. In fomc 
 * Epidemics, book IV. 
 
 in/lanccG 
 
42 AN ACCOUNT OF THE 
 
 inilances a red colour predominated to fuch a de- 
 gree in the face as to produce an appearance of in- 
 flammation. 
 
 In Mrs. Vogles a yellownefs appeared In her eyes 
 during the paroxyfm of her fever, and went oiT in 
 its remiiTions. 
 
 In James Lefferty the yellownefs aifefled every 
 part of his body, except his hands, which were as 
 pale as in a common fever. 
 
 Peter Brown tinged his flieets of a yellow colour 
 by night fweats, many v/eeks after his recovery. 
 
 There was an exudation from the foles of the 
 feet of Richard Wells's maid, which tinged a towel 
 of a yellow colour. 
 
 • In my Account of the Yellow Fever of 1793, I 
 afcribed the yellow colour of the ikin wholly to a 
 mixture of bile with the blood. I am fatisfied that 
 this is the caufc of it in thofe cafes where the colour 
 is deep, and endures for feveral weeks beyond the 
 crifis of the fever ; but where it is tranfitory, and 
 above all, where it is local, or appears only for a 
 few hours during the paroxyfm of the fever, it ap- 
 pears probable that it is connedled v^ith the mode 
 
 of 
 
BILIOUS YELLOW FEVER, IN 1 794. 43 
 
 of aggregation of the blood, and that it is produced 
 wholly by fome peculiar a£lion in the blood-velTels. 
 A fimiiar colour takes place from the bite of certain 
 animals, and from contufions of the fkin ; in nei- 
 ther of which cafes has a fufpicion been entertained 
 of an abforption or mixture of bile with the blood. 
 
 A troublcfome itching, with an eruption of red 
 blotches on the ficin, attended on the firll day of the 
 attack of the fever in Mrs. Gardiner. 
 
 A roughnefs of the Ikin, and a difpofition in it 
 to peel off, appeared about the crifis of the fever in 
 Mifs Sally Evre. 
 
 That fpecies of eruption which I have elfewhere 
 compared to mofcheto bites, appeared in Mrs. Sellers. 
 
 John Ray, a day labourer to whom I was called 
 in the laffc flage of the fever, had petechice on his 
 bread the day before he died. 
 
 That burning heat on the fkin, from which this 
 fever in fomc countries has derived the name of 
 Caufus^ was more common this year than lafl. 
 It was fometimes local, and fometimes general. I 
 perceived it in an exquifite degree in the cheeks 
 ; only of Mifs Sally Eyre, luid over the whole body 
 
 of 
 
 i'f^- 
 
44 ^N ACCOUNT OF THE 
 
 of John Ray. It had no conne£]:ion with the ra- 
 pidity, or force of the circulation of the blood in 
 the latter inftance, for it was moil intenfe at a time 
 w^hen he had no pulfe. 
 
 It is remarkable that the heat of the ilvin has no 
 conneflion with the flate of the pulfe. This fa6l 
 did not efcape Dr. Chiiliolm. He fays he found 
 the fkin to be warm while the pulfe was at 52, and 
 that it was fometimes difagreeably cold when the 
 pulfe was as quick as in ordinary fever. * 
 
 IX. I have in another place rejected putrefa£i:ion 
 from the blood as the caufe or efl'e£l of this fever. 
 I iliali mention the changes which were induced in 
 its appearances wiien I come to treat of the method 
 of cure. 
 
 Having defcribed the fymptoms of this fever as 
 they appeared in different parts of the body, I fliall 
 now add a few obfervations upon its type, or ge- 
 neral charader. 
 
 I fhall begin this part of the hiflory of the fever 
 by remarking, that we had but one reigning difeafe 
 in town during the autumn and winter ; that this 
 was a bilious remitting, or intermitting, and 
 
 * P. 117. 
 
 fometimes 
 
BILIOUS YELLOW FEVER, IN 1 794. 45 
 
 fometimes a yellow fever ; and that all the fevers 
 from other remote caufes than exhalation or conta- 
 gion, partook more or lefs of the fymptoms of the 
 prevailing epidemic. As well might we diftinguilh 
 the rain which falls in gentle fliowers in Great Bri- 
 tain, from that which is poured in torrents from the 
 clouds in the Weft Indies, by diiterent names and 
 qualities, as impofe fpecific names and characters 
 upon the different ftates of bilious fever. 
 
 The forms in which this fever appeared were as 
 follow. 
 
 1. A tertian fever. Several perfons died of the 
 third fit of tertians who were fo well as to go 
 abroad on the intermediate day of the fever. It is 
 no new thing for m.alignant fevers to put on the 
 form of a terti2.n. Hippocrates long ago remarked, 
 that intermittents fometimes degenerate into malig- 
 nant acute difeafes ; and hence he advifes phyficians 
 to be upon their guard on the 5th, 7th, 9th, and 
 even on the 14th day of fuch fevers. * 
 
 2. It appeared moft frequently in the form of a re- 
 mittent. Tlie exacerbations occurred moft commonly 
 m the evening. In fome there were exacerbations; 
 
 * Dsi Moib, Popular. L. VII, 
 
 m 
 
4-6 AM ACCOUNT OF THE 
 
 In the morning as well as in the evening. But I 
 met with feveral patients who appeared to be better 
 and worfe half a dozen times in a day. In each of 
 thefe cafes, there were evident remiiTions and exa- 
 cerbations of the fever. 
 
 It aiTumed in feveral inilances the fymptoms of a 
 colic, and colera morbus. In one cafe the fever, 
 after the colic was cured, ended in a regular inter- 
 mittent. In another, the colic was accompanied by 
 a haemorrhage from the nofe. I diftinguiihed this 
 bilious colic from that which is excited by lighter 
 caiifes, by its always coming on with more or lefs of 
 a chillinefs. * The fymptoms of colic and colera 
 morbus occurred m-ofi frequently in June and July* 
 
 4. It appeared in the form of a dyfentery In a 
 boy of William Corfield, and in a man whom my 
 pupil Mr. Alexander \ifited in the neighbourhood 
 of Harrowgate. 
 
 5. It appeared in one cafe in the form of an apo- 
 
 Dlexv. 
 
 6. It diiguifed iti'elf in the form of madnefs. 
 
 ■' See Syder.Iiam, Vol. T. p. 212.. 
 
 I 7. Durine 
 
BILIOUS YELLOW FEVER, IN I794. 47 
 
 7. During the month of Novembei, and in all 
 the winter months, it was accompanied with pains 
 in the fides and breafi:, conflituting what nofologifls 
 call the " pleuritis biliofa." 
 
 8. The puerperile fever was accompanied during 
 the fummer and autumn, with more violent fymptoms 
 than ufual. Dr. Phyfick informed me, that two 
 women to v/hom he was called foon after their deli- 
 very, died of uterine haemorrhages ; and that he had 
 with diiEcuIty recovered two other lying-in women, 
 who were aflli£led with that fymptom of a malig- 
 nant diathefis in the blood-veiTels. 
 
 9. Even dropfies partook more or lefs of the in- 
 flammatory and bilious chara<^er of this fever. 
 
 10. It blended itfelf with the fcarlatina. The 
 blood in this diforder, and in the puerperile fever, 
 had exa£i:ly the fame appearance that it had in the 
 yellow fever. A yellownefs in the eyes accompa- 
 nied the latter difeafe in one cafe that came under 
 my notice. 
 
 A flight Ihivering ufliered in the fever in fevcral 
 inftances. But the worft cafes I faw, came on 
 without a chilly fit^ or the leafl fenfe of coldnefs 
 in any p2.Tt o^ the body. 
 
 Such 
 
48 AN ACCOUNT OF THE 
 
 Such was the predominance of the intermitting^ 
 remitting, and bilious fever, that the mealies, the 
 fmall-pox, and even the gout itfelf, partook more or 
 lefs of its character. There were feveral inftances in 
 which the meafles, and one, in which the gout ap- 
 peared with quotidian exacerbations ; and two in 
 which madnefs appeared regularly in "the form of a 
 tertian. 
 
 I mentioned formerly that this fever fometimes 
 went oiT with a Aveat, when it appeared in a tertian 
 form. This was alv/ays the cafe with the fecond 
 grade of the fever, but never with- the firil degree 
 of it before the 3d or 4th paroxyfm of the fever ; 
 nor did a fweat occur on the 5th or 7th day, except 
 sfter the vSc of depleting remedies. This peculia-* 
 rity In the fever of this year was fo fixed, that it 
 gave occafion for my comparing it in my intercourfe 
 with my patients, to a lion on the firfl feven days, 
 and to a Iamb during the remaining part of its du-* 
 i*ation. 
 
 The fever differed from the fever of -the prece-^ 
 ding year in an important particular. I faw or 
 heard of no cafe which terminated in death on the 
 firft or third day. In every cafe, the fever cam^e on 
 fraught v/ith paroxyfms. The moderate degrees of 
 it were of fo chronic a nature as to continue for 
 
 ^ feveral 
 
BILIOUS YELLOW FEVEk, IN 1 794. 4^ 
 
 ieveral weeks when left to themfelves. I willi thi^ 
 peculiarity in the epidemic which I am now de- 
 fcribing, to be remembered ; for it will ferve here- 
 after to explain the reafon why a treatment appa-' 
 rently different, flionld be alike fuccefsful in differ- 
 ent feafons and in different countries. 
 
 The crifis of the fever occurred on uneven days 
 more frequently than in the fever of the year 1793* 
 
 I remarked formerly * that remifTions wer^ more 
 common in the yellow fever than in the common 
 bilious fever. The fame obfervation applies to 
 critical days. They were obfervable in almofl every 
 cafe in which the difeafe was not flrangled in its 
 birth. Dr. Chifholm defcribes the fame peculiarity 
 in the Boullam fever. " 1 have not met with any 
 difeafe (fays the Do6lor) in which the periods were 
 more accurately afcertained." f 
 
 The unity of the flates of fever of the autumn 
 appeared, not only in the famenefs of fome of their 
 mod charafleriilic fymptoms, but in their mutually 
 propagating each other. The rnofl malignant flates 
 of yellow fever were propagated from a moderate 
 remittentj in a fervant girl in Mr. Mitchell's family, 
 
 * Account of the Vellow Fever of 179$. f ^' ^4^* 
 VOL, IV. © and 
 
s^ 
 
 AN ACCOUNT OF THE 
 
 and a moderate remittent was created in two per- 
 fons by a man who died of the yellow fever. 
 
 In addition to the inftances formerly enumera- 
 ted *, of the predominance of powerful epidemics 
 over other difeafes, I fnall add two more, which I 
 have lately met v/ith in the courfe of my reading. 
 
 Dr. Chilliolm, in defer ibing the peflilential fever 
 introduced into the Well Indies from Boullam, has 
 the following remarks. " Mod other difeafes de- 
 generated into, or partook very much of this. Dy- 
 fenterics fuddenly flopped, and were immediately 
 fucceeded by the fymptoms of the peflilential fever. 
 Catarrhal complaints, fimple at firfl, foon changed 
 their nature : convalefcents from other difeafes were 
 very fubjecl to this, but it generally proved mild. 
 Thofe labouring at the fame time under chronic 
 complaints, particularly rheumatifm and hepatitis, 
 were very fubje£l to it. The puerperile fever be- 
 came malignant, and of courfe fatal ; and even preg- 
 nant negro women, who other wife might have had 
 it in the ufual mild degree peculiar to that defcrip- 
 tion of people, were reduced to a very dangerous 
 fituation by it. In fliort, every difeafe in which the 
 patient was liable to infection, fooner or later af- 
 
 * Account of the Yellow Fever, in 1793. 
 
 fumed 
 
BILIOtJS YELLOW FEVER, IN I794. yi 
 
 fumed the appearance, and acquired the danger of 
 the peftilential fever." * 
 
 It is worthy of notice, that the fever defcribed 
 by Dr. Chilholm did not infe£l beyond the diflance 
 of ten feet. Let us not be furprifed therefore^ 
 that the yellow fever which infe£i:s acrofs ftreets, 
 fliQuId impart its fy mptoms to all other difeafes. 
 
 Dr. Defportes afcrlbes the fame unlverfal empire 
 to the yellow fever which prevailed in St» Domingo 
 in the fumm.er of 1733. " The fever of Siam (fays 
 the Do£i:or) conveyed an infinite number of men to 
 the grave in a fliort time ; but I faw but one wo. 
 man who was attacked by it/' 
 
 " The violence of this difeafe was fuch, that it 
 fubjefled all other difeafes, and reigned alone. This 
 is the chara^ler of all contagious and peftilential 
 difeafes. Sydenham, and before him Diemerbroek, 
 have remarked this of the plague." f 
 
 In Baltimore the fmall-pox in the tiatural way 
 was attended with unufual malignity and morta- 
 
 * P. 129, 130. 
 
 f P. 40, 41, See alfo p. iii — 230) 231= Vol. 1, 
 
 D 2 Htyj, 
 
t* AN ACCOUNT OF THE 
 
 J 
 
 lity, occaiioned by its being combined with the reign- 
 ing yellow fever. 
 
 It has been urged as an obje£iion to the influence 
 of powerful epidemics chafmg away, or blending 
 with fevers of inferior force, that the meafles fome- 
 times fupplant the fmall-pox, and mild intermittents 
 take the place of fevers of great malignity. This 
 fa£l did not efcape the microfcopic eye of Dr. 
 Sydenham, nor is it difEcult to explain the caufe of 
 it. It is w^ell known that epidemics, like fimple 
 fevers, are moll violent at their firfl appearance, 
 and that they gradually lofe their force as they dif- 
 appear 5 now it is in their evanefcent and feeble ftate, 
 that they are jollied out of their order of danger or 
 force, and yield to the youthful flrength of epide- 
 mics, more feeble under equal circumftances of age 
 than tliemfelves. It would feem from this fa£l:, that 
 an inflammatory conflitution of the air, and power- 
 ful epidemics both in their aggregate and individual 
 forms, pqfTelTed a common charadler. They all in- 
 vade with the fury of a favage, and retire with the 
 gcn^lenefs of a civilized foe. 
 
 It is agreeable to difcover from thefe fafts and 
 obfervations, that epidemic difeafes, however irre- 
 gular they appear at £rfl fight, are all fubjedt to cer- 
 tain laws, and partake of the order and harmony of 
 
 the univerfe* 
 
 I have 
 
BILIOUS YELLOW FEVER, IN -I794. 53 
 
 I have remarked that this fever was contagious 
 in a very few inflances compared with the preceding 
 year, but its operation upon the body, where, from 
 the abfence of an exciting caufe, it did not produce 
 fever, was the fame as I have elfewhere defcribed» 
 The fenfations which I experienced in entering a 
 room where a perfon Was confined with this fever, 
 were fo exa<5i:ly the fame with thofe I felt the year 
 before, that I think I could have diflinguiflied the 
 prefence of the difeafe without the aiTiftance of my 
 eyes, or without afking a fmgle queftion. After 
 fitting a few minutes near a perfon ill with this fever 
 I became languid, and fainty. Weaknefs and chilli- 
 nefs, followed every vifit I paid to a gentleman at 
 Mr. Oeliers's hotel, which continued for half an 
 hour. A burning in my llomach, great heavinefs, 
 and a flight infiam.mation in my eyes with a conftant 
 difcharge of a watery humour from them for two 
 days, fucceeded the firfl vifit I paid to Mrs. Sellers. 
 Thefe fymptoms came on in lefs than ten minutes 
 after I left her room. They were probably excited 
 thus early, and in the degree which I have mention^ 
 ed, by my having received her breath in my face by 
 infpe^iingher tonfils, Vv^hich were ulcerated on the firfl 
 attack of the fever. Three days after my eyes re- 
 covered from their watery and inflamed fl:ate, I was 
 expofed to the acTtion of the contagion in a con- 
 centrated fl:ate by bleeding Mrs. Lloyd Jones. 
 
 D 3 One 
 
54' AN ACCOUNT OF TKE 
 
 One of my eyes again became fore, and difcliarged 
 water for tv/o or three days afterwards. I have 
 related thefe fa£!:s chiefly with a view of offering a 
 conjecture as to the caufe of the univerfal preva- 
 lence of opthahnias, or what are called fore eyes, 
 during the prevalence of great and powerful epi- 
 demics.* They were common in all the fickly parts 
 of the United States, in the year 1793, and ap- 
 peared in many places, as well as in Philadelphia 
 in the Autumn of 1794. They are probably oc- 
 cafioned by a feeble and partial action of exhalation 
 or contagion upon the fyflem. 
 
 I recolleift having more than once perceived a 
 fmell which had been familiar to me during the time 
 I was expcfed to the contagion of the yellow fever 
 in 1793. It refembled the fmell of the liver of 
 fulphur. I fufpecled for a while that it arofe from 
 the exhalations of the gutters of the city. But an 
 accident taught me that it was produced by the 
 perfpiration of my body. Upon rubbing my hands, 
 this odor was encreafed fo as to become not only 
 more perceptible to mjfelf, but in the m-oft fenfible 
 degree to my pupil Mr. Otto. From this h£t I 
 was fatisfied that I was flrongly impregnated with 
 tlie contagion, and I was led by it to live chiefly 
 
 * Hippocrates's Epidemics. 
 
 upon 
 
BILIOUS YELLOW FEVER, IN 1794. 55 
 
 upon vegetables, to drink no wine, and to avoid 
 with double care, all the ufual exciting caufes of 
 fever. 
 
 There was another mark by which I diflinguiilied 
 the prefence of the contagion of this fever in my 
 fyftem, and that was, wine imparted a burning fen- 
 fation to my tongue and throat, fuch as is felt 
 after it has been taken in excefs, or in the beginning 
 fo a fever. Several perfons who were expofed to 
 the contagion of this fever informed me that wine 
 even in the fmalleft quantity, afFeiSled them exactly 
 in the fame manner. 
 
 I faw one inflance in which the difeafe was ex- 
 cited in twelve hours after the contagion was taken 
 into the body. A lady lately from Rhode Illand 
 who laid fo near a fick gentleman in a public houfe 
 as to be diflurbed by his groans, humanely went 
 into his room in the mornino; to offer him all the 
 relief that lay in her power. She found him in the 
 a6i: of puking black matter, and was much fliocked 
 at the yellow colour of his face. She did not fufpccl 
 his diforder to be the yellow fever, for his phy- 
 ficians had denied or concealed it in the family. 
 The fpeedy death of this gentleman induced her to 
 change her lodgings. In the evening of the fame day 
 file went to the theatre, where fhe was feized with a 
 
 D 4 chilly 
 
56 AN ACCOUNT OF THE 
 
 chilly fit. The next day I was fent for to vifit her, 
 I found her ill with all the fymptoms of the yellow 
 fever. She was cured, but the danger and diflrefs 
 from which flie efcaped, furniilied an affecling in- 
 flance of the cruelty of concealing or denying the 
 exiftence of contagious ^^.nd malignant difeafes. 
 
 The contagious quality of this fever I have re- 
 marked, was not confined to its moll malignant de- 
 grees. Malignity in a fever is not eiTential to the 
 generation of contagion. Under certain circum- 
 fiances of the atmofphere, the mildell intermittentg 
 are fometimes propagated by contagion. 
 
 I attended four perfons in this fever who had had 
 ijt, the year before. 
 
 I have mentioned elfewhere that the comm.on 
 modes of preventing the a6lion of contagion on 
 the fyftem had not only failed, but had probably 
 favoured the fpreading of the fever in 1793. I was 
 made happy by obferving th9,t Dr. Chifholm had 
 hovnc a teilimony againit them, in his account of the 
 jail fever of Grenada, It is by deflroying a con- 
 fidence in fuppofed preventives of the difeafe, that 
 we iliall lead people to the more rational ones of tem^ 
 perance and gentle dofes of phyfic. To a vegetable 
 diet may be added fuch. a mixture of pepper as fh^Il 
 
 keep 
 
BILIOUS YELLOW FEVER, IN 1 794. 57 
 
 keep up a conftant and vigorous tone in the ftomacli 
 and bowels, without imparting the leafl new a(^ion 
 to the blood velTels. Mr. Bruce fays in his travels, 
 that in one of the fickly countries which he vifited, 
 the inhabitants obviated malignant fevers, by this 
 practice. The quantity of pepper mixed with their 
 rice was fo great (he fays), as to inflame the throats 
 of perfons who we^e not accuftomed to it. To this 
 preventive, they add, abflinence from ardent fpirits, 
 from weak broths, and decayed fruit. They 
 moreover eat their principal meat after fun-fet, 
 when the coolnefs of the night air imparts a tone 
 to the Homach and thereby facihtates digeftion. 
 
 It may appear paradoxical at lirfl fight, how 
 generous living fliould proteft frgm common bilious, 
 and low jail fevers, while it encreafes the predifpo- 
 fition to the yellow, and other peflilential fevers. 
 The reafon is plain. The action in the blood veiTels 
 in the common bilious and j^il fevers is fo feeble, 
 that a full diet creates an a£lion in the veffels fupe- 
 rior to it, while the a6i:ion excited by the contagion 
 of peflilential fevers is fo violent, as not only to 
 refufe to yield to the flimulus of diet, but to be 
 greatly increafed by it. 
 
 Mr. Bruce relates further that thofe perfons, who 
 lived in fmoky hcufes, efcaped bilious fevers. The 
 
58 AN ACCOUNT OF THE 
 
 cfFe<5i: of fmoke in checking contagion was evident, 
 in the hofpitals conflru6led without chimneys by Dr. 
 Tilton, during the late war. The fire was kindled 
 hi the middle of the earthen floor of the hofpital in 
 a hole made in the earth, and the fmoke after per- 
 vading the room, efcaped through a hole in the 
 roof of the building in a perpendicular dire£l:ion to 
 the fire place. Dr. Clark has added another facl 
 in favor of the prophylactic virtues of fmoke. In 
 one inftance which came under his notice, it pre- 
 ferved the cooks who worked in a galley from being 
 aire6i:ed by a contagious fever.* 
 
 I have hitherto mentioned the means of prevent- 
 ing the attack of this fever upon individuals. I 
 ihall now add a few dire6lions for preventing its ad- 
 miffion and propagation in cities. 
 
 ifl. Let a law be paiTed to compel phyficians, 
 under a fevere penalty, to report to a Committee ap- 
 pointed for that purpofe, the exifhence of a malignant 
 contagious fever, as foon as they difcover it in any 
 part of the city. Let this Committee call a council 
 of phyficians to examine the cafe fo reported ; and 
 if a majority of them concur in opinion of its con- 
 tagious and dangerous nature, let the following fleps 
 be taken. 
 
 * Vol. Lp. 166. 
 
 2d]y. 
 
BILIOUS YELLOW FEVER, IN 1794. 59 
 
 :2dl75 If t' e fever appear to have been Imported 
 from a foreign country, let the infeiTted veffel be 
 removed from the wharf, and carefully wafhed and 
 fumigated in the channel of the river, and let her 
 cargo, if any part of it has been landed, be conveyed 
 from the city. 
 
 3dly. If the fever appear to be of domeflic 
 origin, let the putrid matter which produced it be 
 removed, or covered, fo as efFe£lually to deilroy all 
 pofTibility of future exhalation from it. While thefe 
 precautions are going forv/ard, 
 
 4thly. Let all the families which are within 
 fifty yards of the infe(51:ed perfon or perfons be 
 ordered inflantly to remove into hcufes or tents, to 
 be provided for them at the public expenfe. Let 
 chains then be placed acrofs the ftreets which lead 
 to the fick, and let guards be appointed to prevent 
 all accefs to the infe^led parts of the city, except 
 by phyficians, and nurfes, and fuch other perfons as 
 are neceflary to be employed in a manner to be 
 jTientioned prefcntly. 
 
 The plan of removing the well inilead of the lick, 
 to prevent the progrefs of peftilential fevers is not 
 a new one. It has been pra^lifed with fuccefs m 
 RufTia, and it has the following circumftanccs to re- 
 commend 
 
6o AN ACCOUNT OF THE 
 
 commend It. i. It will prevent the contagion being 
 fpread by the Tick in paiTmg through the ftreets out 
 of the city. 2. It will not be repugnant to hu- 
 manity ; for if the fick be not fuddenly deflroyed by 
 being informed of the cruel fate which awaits them_, 
 they often perifli from the motion which is neceiTary 
 to remove them, or from the anguifli of being torn 
 from their families, or friends. 3. The difcovery, 
 and declaration of the exiilence of malignant and 
 contagious fevers will be early, and unequivocal^ 
 when an expulfion from the city will not be dreaded 
 from it, and when the danger of the difeafe will 
 thereby be leiTened, by the ceafmg of noifes of all 
 kinds in the neighbourhood, and the improbability 
 of the fiek creating a refle^led atmofphere of conta- 
 gion from the perfons who may be infefled by 
 them, 
 
 5. After the creation of the temporary defert in 
 the neighbourhood of the fick (which may be done 
 without their knowledge) let the procefs of nature 
 for deflroying contagion and morbid exhalations be 
 imitated. Let artificial fliowers of rain be poured 
 down by means of fire engines upon the infe61:ed 
 houfes and upon the adjacent parts of the flreets, 
 two or three times a day. This may be done by 
 means of the city engines ufed for extinguilhing 
 fire. 
 
 The 
 
BILIOUS YELLOW FEVER, IN I794. 6i 
 
 The wealthy inhabitants of Smyrna preferve 
 themfelves in health by thus wetting their houfes, 
 while the plague is deftroying thoufands of their leis 
 opulent, or provident neighbours. 
 
 Let it not be inferred from the enumeration of 
 the means of preventing the contagion of this fever, 
 that I admit a contagious nature to be one of its 
 chara<^eriflic marks. Far from it. It is an acci- 
 dental circumflance produced chiefly by the con- 
 currence of the weather. The following ftatement 
 of fafts relative to its contagious charadler in dif- 
 ferent feafons, and countries, is the refult of much 
 inquiry upon this fubjeft. 
 
 ifl. It is in no inilance contagious in fome cafes. 
 
 2dly. It is fometimes propagated by ftrangers, 
 to llrangers only, in the Well Indies. 
 
 3dly. It fometimes afFe£i:s the natives, as well as 
 ftrangers, in the Weil India lilands. 
 
 4thly. It affe^ls ftrangers, natives, and negroes 
 in fome inflances. This was the cafe in Philadel- 
 phia in 1793, and in Norfolk in 1795. 
 
 5thly. It afFecls adults only, and none under 
 puberty, as in Jamaica according to Dr, Hume. 
 
 6thly, 
 
£l AN ACCOUNT OF THE 
 
 (Jthly. It afFccTts adults and children of all ages. 
 This was evident in Philadelphia in 1793. 
 
 yihly. It affe£l:s other animals as well as the 
 Imman fpecies. It affecfted fowls and ducks in New 
 York in the year 1795, and it affe^bed cattle in 
 Yirgitiia. as I ihall fay prefently, in the year 1794. 
 
 Sthly. It .affefls the inhabitants of cities, and 
 Ti-ot of the country, as in Charleflon in the years 
 1732, 1739, 17455 and 1748, and in Philadelphia 
 in the year 1793. 
 
 9thly. It afFe<fl:3 the inhabitants of both cities^ 
 ^nd country, as in the flate of New York in the 
 year 1791.*^ 
 
 From thefe fa '51s it would appear, that to fuppofe 
 this fever ihould infeft uniformly in all cafes in order 
 to acquire a contagious character, is as abfurd as to 
 fuppofe that cold and heat do not produce inflam- 
 matory fevers, becaufe thoufands of people are con- 
 ftantly expofed to them, without being indifpofed. 
 An. aptkude or predifpofition from feafon, climate, 
 or conflitution, muft concur to render the contagion 
 of this, as well as other malignant fevers futHciently 
 
 * I>r, Addoms's Thefis^ 
 
BILIOUS YELLOW FEVER, IN 1 794. 63 
 
 ai^ive to produce a difeafe. As well might a tra- 
 veller attempt to defcribe the climate of a new- 
 country, from the hiftory of a fmgle feafon, as a 
 phyfician fix the character of an epidemic from its 
 appearance in one feafon, or in one country. To 
 know a difeafe perfectly, it fliould be feen, or 
 fludied in fucceffive feafons, and in different coun* 
 tries. 
 
 It remains now that I mention the origin of this; 
 fever. This was very evident. It was produced 
 by the exhalations from the gutters, and the flag- 
 nating ponds of water in the neighbourhood of the 
 city. Where there was moil exhalation, there were 
 moll perfons affefled by the fever. Hence the poor 
 people, who generally Hve in the neighbourhood of 
 the ponds in the fuburbs, were the greateil fufferers 
 by it. Four perfons had the fever in Spruce, be- 
 tween Fourth and Fifth Streets, in which part of 
 the city, the fmell from the gutters was extremely 
 offenfive every evening. In Water Street between 
 Market and Walnut Streets, many perfons had the 
 fever : now the filth of that confined part of the 
 city is well known to every citizen. — I have before 
 remarked that one reafon why mofl of our phyficians 
 refufed to admit the prefence of the yellov/ fever 
 in the city, was becaufe they could not fix upon a 
 veftige of its being imported. On the 25th of 
 
 Augufl 
 
^4 AN ACCOUNT OF TH£ 
 
 Augufl the Brig Commerce arrived in tlie river 
 from St. Mark, commanded by Captain ShirtliiE 
 After I]' ing five days at the Fort ftie came up to the 
 city. A boy who had been iliut out from his lodgings, 
 went in ailate of intoxication, and llept on her deck, 
 expofed to the night air, iii confequence of which 
 the fever was excited in him. This event gave oc- 
 cafion for a few days to a report that the difeafe was 
 imported, and feveral of the phyficians who had 
 negle£led to attend to all the circumftances that 
 have been flated, admitted the yellow fever to be 
 in town. An invefligation of this fuppofed origin 
 of the difeafe foon difcovered that it had no foun- 
 dation. At the time of the arrival of this fliip I 
 had attended nearly thirty pdffons with the fever, 
 and upwards of an hundred had had it, under the 
 care of other phyficians. 
 
 Since the publication of my proofs of the gene- 
 ration of the yellow fever, in our city in the year 
 1793, I have had many reafons to be confirmed in 
 the opinion I then defended. My arguments have 
 Carried canvi<Siion to the mJnds of evefy unpre- 
 judiced citizen of the United States. Dr. Prieillsy, 
 whofe knowledge and judgment upon fubje<5ls ccn- 
 flecked with volatile fluids, whether pure or impure, 
 itiuik be admitted by ail who know him, has admit* 
 ted my fae^s and reafonings, notwithflanding he fat 
 
 down 
 
BILIOUS YELLOW FEVER, IN I794. 63 
 
 down to read them under the influence of prejudiced 
 on the other fide of the queflion. Dr. Black the 
 father of modern chemiflry, has hkewife admitted 
 my opinion of the origin of the yellow fever, of 
 1793, in a converfation with my former pupil Dr, 
 Coxe in Edinburgh. The two following fadts wiii 
 help ftill further to eilablifli the origin of the bilious 
 fever in its different grades, from vegetable putre- 
 fadlion, and will fliew that in medicine, as well as 
 in government, great events, often fpring from httle 
 caufes. In a letter I received near two years ago 
 from Dr. George Davidfon of the ifland of St. Vin- 
 cents dated July 22d 1794, is the following com- 
 munication. 
 
 " The yellow fever is evidently produced by a 
 peculiar itate of the air, and by marih exhalations. 
 The fituation of thofe habitations where it firfl ap- 
 pears, near to ftagnant water, or fwamps, point out 
 this to be its origin. The governor's guard on this 
 Ifland was fliationed in an old bathing houfe. The 
 fhream of water which had run through it, had been 
 diverted from it, but a quantity of mud and filth 
 had been allowed to accumulate in a watering fl:one 
 trough near the door ; in confequence of which 
 feveral of the guards were feized before morning 
 with the ufual fymptom? of the yellow fever. Above 
 ten died before the caufe was difcovered, and im- 
 voL. IV. E mediately 
 
6^ AN ACCOUNT OF THE 
 
 mediately upon removing it, the guard becams 
 healthy/' 
 
 The children of a family in this city, were ob- 
 ferved for feveral fucceiTive years to be afFe<5ted by^ 
 a bilious remitting fever. The phyfician of the 
 family the late Dr. Phineas Bond, obferving no 
 other perfons to be aifciSled in the fame way in the 
 neighbourhood, fufpe^led that the fever arofe from 
 fome local caufe. He examined the yard belonging 
 to the houfe, where he found an offenfive duck 
 pond. This pond was filled up, and the family 
 remained afterwaids free from an annmal bilious 
 fever. 
 
 Sporadic cafes of fever^ I believe, are often created 
 by the noxious air of water courfes, cellars, and 
 fmks of houfes that are equally unfufpe^iied with 
 the filth of the duck pond. A citizen of Philadel- 
 phia who had a fink in his kitchen, lofl a number of 
 dogs and cats by convulfions. At length one of his 
 fervants was afFe(fi:ed with the fame diforder. This 
 led him to invefligate the caufe of it. He foon 
 traced it to his fink. By altering its conllru^ion^ 
 fo as to prevent the efcape of noxious air from it, 
 he defiroyed its unwholefome quality, fo that dogs 
 and cats lived in good health afterwards in his 
 kitchen ► 
 
 la 
 
BILIOUS YELLOW FEVER, IN I794. 6f 
 
 ' In my former publication upon the yellow fever, 
 I mentioned the effe^ls of heavy rains in checking 
 it. But feveral obfervations made in the Weft In> 
 dies prove that this efFe£i: of rain is not uniform. 
 The following fadl extracted from a fecond letter from 
 Dr. Davidion, dated the 12th of November 1794, 
 will explain the caufe of the occafional deviations 
 from the general remark upon this fubjefl. 
 
 " Being ordered (fays the Do£i:or) up to Bar- 
 badoes laft November upon fervice, I found that the . 
 troops there had fuitered confiderably by that for-* 
 midable fcourge the yellow fever. The feafon had 
 been remarkably dry. It was obferved that a rainy 
 feafon contributed to make the troops healthier^ 
 excepting at Conftitution hill, where the fixth regi-* 
 ment was ftationed, and where a heavy fliower of 
 rain never failed to bring back the fever after it 
 had ceafed for fome time. I found the barrack 
 where this regiment was, furrounded by a pond of 
 brackifli water, which being but imperfectly drained 
 by the continuance of the drought, the furface w^as 
 covered with a green fcum which prevented the ex- 
 halation of marfliy exhalation. After a heavy 
 fhower of rain this fcum was broken, and the miaf- 
 mata were evolved, and aCled with double force 
 in proportion to the time of their retention." 
 
 E 2 Th^-i 
 
6S AN ACCOUNT OF THI 
 
 The generation of the yellow fever in our city 
 
 was rendered more certain by the prevalence of 
 
 bilious difeafes in every part of the United States, 
 
 and in feveral of them, in the grade of yellow fever. 
 
 It was common in Charleflon in South Carolina, 
 
 where it carried off many people, and where no fuf- 
 
 picion was entertained of its being of Weft India 
 
 origin. It prevailed with great mortality at that 
 
 part of the city of Baltimore which is known by the 
 
 name of FelFs Point, where Dr. Dryfdale aifures 
 
 mc it was evidently generated. A few fporadic 
 
 cafes of it occurred in New York, which were pro^ 
 
 duced by the morbid exhalation from the docks of 
 
 that city. Sporadic cafes of it occurred likewife in 
 
 moft of the ftates, in which the proofs of its being 
 
 generated were obvious to common obfervationj 
 
 and where the fymptoms of deprelTed pulfe, yellow- 
 
 nefs of the fkin, and black difcharges from the bowels 
 
 and ftomach (fymptoms which mark the higheil 
 
 grade of bilious remitting fever) did not occur, the 
 
 fevers in all their forms of tertian, quotidian, colic, 
 
 and dyfentery, were uncommonly obftinate, or fatal 
 
 in every ftate in the Union. In New Haven only 
 
 where the yellow fever was epidemic, it was faid to 
 
 have been imported from Martinique. It is poiiiblc 
 
 this was the cafe, but I fufpe£l: that this fever has 
 
 often been afcribed to importation, from the circum- 
 
 ftance 
 
BILIOUS YELLOW FEVER, IN 1 794. 69 
 
 ftance of its appearing firll: on board of ihips, and 
 among failors who have juft arrived from Wefl India 
 voyages, into whom the feeds of the fever are often 
 conveyed by the proximity of the fliips to filthy 
 wharves and docks, and in whom they are after* 
 wards excited into adlion by hard labour or intem- 
 perance. But where this is not the cafe, I beheve 
 the difeafe is fometimes excited by the effluvia of 
 fuch parts of the cargoes of fliips as are capable of 
 putrefa£i:ion, and whidi a£l: witli morbid force as 
 ibon as they are brought into conta^ with the ain 
 A folitary inftance of a fever which terminated ftfe- 
 tally, occurred in this city a few years ago, froia 
 the fmell of wine, which had become putrid in the 
 hold of a fliip, but which was inoffeniive uBtil it was 
 removed. 
 
 For a while I believed that I w«ls the €rft perlbii 
 who had aiTerted that a yellow fever had been ge- 
 nerated in Philadelphia ; but my friend Mr. Samuel 
 Coates, lately put into my hands a clinical le£lure 
 delivered in the Pennfylvania Hofpital by the late 
 Dr. Thomas Bond, on the 3d of December 1766, 
 and which was preferved by order of the managers 
 in the third volume of their Minutes, in which the 
 Doctor fays that he had feen the yellow fever five 
 times^ in Philadelphia. The fecond time he faw 
 it, it was indlgenoMSy from evident caufes, and 
 
 E 3 was 
 
70 AN ACCOUNT OF THE 
 
 was confined to one fquare of the city. The loca- 
 lity of this fever defignates its putrid origin, and 
 bilious character. BiUous fevers of all degrees are 
 often limited in their progrefs by winds, trees, hills, 
 houfes, and other circumftances. Dr. Bond men- 
 Jtions in the fame ledure that an intermittent pre- 
 vailed in the year 1765 from the fouthern parts of 
 Philadelphia to Georgia, affefting two-thirds of all 
 the inhabitants in that extenfive tra6l of country ; 
 and yet at this time the city of Philadelphia, except 
 its fouthern fuburbs, was healthy. The break-bone, 
 or bilious fever of 1780, was confined chiefly to 
 the eallern and fouthern flreets of Philadelphia. 
 
 ; The year 1795 furnifhed fever al melancholy 
 proofs of the American origin of the yellow fever. 
 All the Phyficians and citizens of New- York and 
 Norfolk agree in its having been generated in their 
 refpe£live cities laft year. It prevailed with great 
 mortality at the fame time in the neighbourhood 
 of the Lakes, and on the waters of the Genefee 
 river in the flate of New- York, From its fituation 
 it obtained the name of the Lake and Genefee fever. 
 It was fo malignant in fome parts of that new coun- 
 try as to afte£l horfes, 
 
 I have been frequently rebuked by my friends for 
 my attempts to prove that the yellow fever is one 
 
 of 
 
BILIOUS TELLOW FEVER, IN 1794, Jl 
 
 t>f the indigenous difeafes of our country, inafmuch 
 as the opinion expofed me to much unnecefTary per- 
 fecution, and thereby created an oppofition to the 
 remedies I had ufed and recommended for the cure 
 of that diforder. I have conflantly anfwered thefe 
 rcmonllrances by declaring the eflabhfliment of my 
 opinion to be deeply interefling to mankind, and 
 particularly to the inhabitants of the United States, 
 where an idea that the yellow fever could exift 
 among us only by importation has, until lately, very 
 generally prevailed. 
 
 Climates and feafons are not necefTarily fickiy. 
 The fun would feldom fmite by day, nor the moon by 
 night, were pains taken to prevent the accumula- 
 tion and putrefaiftion of thofe matters which occa- 
 fion malignant bilious fevers. Thofe parts of the 
 Weft India iflands which are removed from the 
 neighbourhood of marfh exhalations, are uncom- 
 monly healthy. Of this Dr. Lind has given us 
 many flriking inflances. Dr. Chilliolm has lately 
 added his teftimony to the truth of the fame obfer- 
 vation. * It is further confirmed by the following 
 extract of a letter from Dr. Davidfon, dated No- 
 vember 1 2th, 1794. " I have mentioned an in- 
 ftance (fays the Doctor) of the remarkable good 
 
 * IntroJadicTi, p. 30. 
 
 E 4 ftate 
 
Jl^ i^N ACCOUNT OF THE 
 
 ftate of health which the 66th regiment enjoyed at 
 St. Vincents for feveral years, upon a high hill 
 above the town, removed from all exhalations, and 
 in a fituation kept at all times cool by the blowing 
 of a conflant trade wind. They did noi lofe du- 
 ring eighteen months above tw^o or three men (the 
 regiment was completed to the peace ellablifliment), 
 and during eight years, they loft only two officers, 
 one- of whom, the quarter mafter, refided conftantly 
 in town, and died from over fatigue ; the other ar- 
 rived very ill from Antigua, and died within a few 
 days afterwards." But this is not all. There are 
 many proofs that uncommon degrees of longevity 
 as- well as health, are to be met with in all the Weft 
 India Iflands. 
 
 Thefe fa^ts are important, inafmuch as they 
 mcMiifeft the goodnefs of Heaven in having furren* 
 dered every part of the globe to man in a ftate ca- 
 pable of being inhabited and enjoyed. They fliew 
 moreover the connexion between health and lono^e- 
 vity, and the-reafon and labour of man. 
 
 Under the impreiTion of this fentiment, it would 
 be criminal in me to ceafe to propagate the opinion 
 of the domeftic origin of the yellow fever. It leads 
 to the annihilation of more human mifery than is 
 produced by war or famine. From the fuccefs 
 
 which 
 
BILIOUtif YELLOW FEVER, IN 1 794. 73 
 
 which has attended perreycrance in inculcating opi- 
 nions equally odious and unpopular, I am fatisfied 
 that truth, upon this fubje6i:, mujl: prevail, and that 
 I fhall fooner or later be believed and forgiven. 
 
 To every natural evil Heaven has difcovered or 
 prepared an antidote. The yellow fever furniilies 
 no exception to this remark. The means of pre- 
 venting it are as much under the power of human 
 reafon and induflry, as the means of preventing the 
 evils of lightning and common fire. I am fo fatis- 
 fied of the truth of this opinion, that I look for a 
 time, when our courts of law fhall punifli cities and 
 villages for permitting a fingle cafe of bilious or yel- 
 low fever to exifl within their jurifdivHiion. 
 
 I ftiall conclude this account of the origin of the 
 yellow fever by relating a fa6t which ferious and 
 contemplating minds will apply to a more interefling 
 fubje^l. 
 
 Notwithfianding the numerous proofs of the pre- 
 valence of the yellow fever in Philadelphia in the 
 year 1794 which have been mentioned, there are 
 many thoufands of our citizens, and a majority of 
 our phyficians, who do not believe that a cafe of it 
 exifled at that time in the city ; nor is a fmgle re- 
 cord of it to be met with in any of the newfpapers, 
 
 or 
 
74 AN ACCOUNT OF THE 
 
 or Other public documents of that year. Let us 
 learn from this fa£^, that thq denial of events, or a 
 general filence upon the fubje£t of themj is no refu- 
 tation of their truth, where they oppofc the pride 
 or interefls of the learned or the great. 
 
 What the exa^fi: flate of the atmofpherc is, which 
 difpofes to malignant fevers, is difficult to determine. 
 Two things are obvious with refpe£i: to it. i. It 
 pervades at the fame time a great extent of coun- 
 try. This was evident in the years 1793 and 1794 
 in the United States, During the fame year the 
 yellow fever was epidemic in mofl of the Weil In- 
 dia iflands. Many of the epidemics mentioned by 
 Dr. Sims * aifedled in the fame years the moft re- 
 mote parts of the continent of Europe. Even the 
 ocean partakes of a morbid conflitution in its atmo- 
 fphere, and difeafes at fea, fympathife in violence 
 with thofe of the land, at an immenfe diflance from 
 each other. This appears in a letter from a furgeon 
 on board a Britifh lliip of war to Mr Gooch, pub- 
 liflied in the third volume of his medical and furgical 
 obfervations. 2. This predifpofmg flate of the at- 
 mofphere to induce malignant difeafes continues for 
 fevera.1 years, under ail the circumflances of wet 
 and dry, and of hot and cold weather. 
 
 * Medical Memoirs, Vol. I. 
 
 The 
 
BILIOUS YELLOW FEVER, IN 1794. "/S 
 
 The weather in 1794 diiFered materially from 
 the weather in 1793, in the United States, in each 
 of the above particulars ; and yet the atmofphere 
 continued to maintain that quality which predifpofes 
 to a malignant flate of bilious fever. 
 
 This morbid peculiarity in the air is taken notice 
 of by Dr. Sydenham, and acknowledged by him as 
 an obfcure circumflance in the hiflory of epidemics. 
 It refembles a folitary fever and a general epide- 
 mic, in beginning with violence, and gradually wail- 
 ing its inflammatory force by time. To what change 
 in the ftate of the air, or to what impregnation of 
 it, fliall we attribute its difpofition to impart a 
 greater degree of malignity or inflammatory diathefis 
 to difeafes at one time than at another ? Hippocrates, 
 who felt the influence of this diathefis in his prac- 
 tice, afcribes it to " a divine fomething" in the at- 
 mofphere. Dr. Sydenham attributes it to certain 
 mineral vapours exhaled from the bowels of the 
 earth. I have fufpe6led it to be the efre6i: of a pre- 
 ternatural quantity of oxygen in the atmofphere. I 
 know that the experiments of Mr. Sheele and Mr. 
 Cavendifh prove that the proportions of azote and 
 oxygen are the fame in different fituations and dif- 
 ferent kinds of weather ; but as their experiments 
 were not made at a time Vv'hen difeafes of a high 
 degree of inflamm.atory a<5i:ion were epidemic, 1 do 
 
 not 
 
"J^S AN ACCOUNT OF THE 
 
 not think they mihtate againfl: my hypothefis. I 
 lament that the want of eudiometrical inflruments 
 prevented my deciding this queilion by aftual expe- 
 riments, during the prevalence of our late inflamma- 
 tory epidemics ; but the following fa<^s will, I 
 hope, render the hypothecs probable, i. The dif- 
 eafe was moil violent in thofe perfons in whom there 
 is fuppofed to be the greateil quantity of oxygen, 
 viz. the young and the robuft, and more efpecially 
 thofe who live freely. 2. It alFefted thofe perfons 
 mod violently who had lately arrived from places 
 or fituations in which oxygen abounded. Country 
 people fulfered more, under equal circnmftanccs, 
 from the fever, than the citizens of Philadelphia ; 
 but it was mofl violent in perfons who, after fpend- 
 ing four or five w^eeks at the fea-fliore, returned to 
 the city in the months of September and October. 
 This was the cafe with Peter Brown and Henry 
 Clymer, who fickened foon after they inh"aled the 
 atmofphere of our city, and were both afFe^l-ed by 
 the fever in a very high degree. I fliould have 
 fufpedted that the uncommon malignity of the dif- 
 eafe in thofe two gentlemen arofe from the indo- 
 lence and plentiful diet which conftitute part of the 
 pleafure of an excurfion to the fea-ihore, hud I not 
 met with feveral cafes of equal violence in perfons 
 who had jufl arrived from fea voyages, under cir- 
 cumilances by no means apt to produce inflammable 
 
 diathefi5 
 
Bilious yellow fever, in 1794. 77 
 
 diathefis in the blood-vefTels. 3. The colour of the 
 blood in moll cafes of yellow fever, as I fliall lay 
 hereafter, was fuch as is imparted by oxygen. It is 
 pofTible the air may communicate as much oxygen 
 to the blood, as is fufEcient to produce a predifpo- 
 fition to inflammatory difeafes, and yet rcfufc to dif- 
 cover itfelf in an undue quantity to an eudiometri- 
 cal experiment ; for Dr. Beddoes, to whofe autho- 
 rity upon this fubjci^ I yield my judgment, fays, 
 and I believe very juftly, in a letter I received from 
 him, dated May 3d, 1795, that " he has no doubt, 
 but a fmall excefs of oxygen is equal to the produc- 
 tion of highly inflammatory action." 
 
 If it fliould be found hereafter, that no excefs 
 in the quantity of oxygen in the atmofphere takes 
 place during the prevalence of malignant fevers, I 
 fhall flill fufpedl it to be their predifpofmg caufe, 
 and that it may pofllbly be derived from the ali- 
 ments and fruits of the feafon ; for all writers take 
 notice of a conneflion between great and mortal 
 epidemics^ and a deviation in quality or quantity 
 from common years in the vegetable produfls of the 
 earth. 
 
 The exhalations or gafes, which by ailing upon 
 an inflammatory predifpofltion produce a yellow 
 fever^ have been called by different names, accord- 
 ing 
 
7$ AN ACCOUNT OF TH£ 
 
 ing as they a£l in a flmple or compound Hate. They 
 all a£l as ftimulants upon the whole fyftem, and in 
 a more efpecial manner upon the liver. This is evi- 
 dent, not only in the affections of that vifcus in 
 bilious fevers, but in the morbid appearances of the 
 liver in cattle that feed in marfliy paflure in the fall 
 of the year. Thefe appearances were fo univerfally 
 admitted to be the effect of an unwholefome atmo- 
 fphere among the ancients, that they infpe<fted the 
 livers of animals, in order to determine on the 
 healthy or unhealthy fituation of the fpots on which 
 they willied to live. 
 
 Dr. Cleghorn defcribes a morbid ftate of the 
 liver in cattle in an unhealthy part of the ifland of 
 Minorca. Dr. Grainger takes notice of the fame ap-^ 
 pearances in the livers of feveral domellic animals in 
 Holland, in the year 1743. * But our own country 
 has furniflied fafts to illuflrate the truth of this ob' 
 fervation. Mr. James Wardrobe, near Richmond 
 in Virginia, informed me, that in the month of Au- 
 guil 1794, at a time when bilious fevers were pre- 
 valent in the neighbourhood, his cattle were feized 
 with a difeafe which is known by the name of the 
 yellow water, and which appears to be a true yel- 
 low fever. They were attacked with a flaggering. 
 
 Cap. lU. 
 
 Their 
 
BILIOUS YELLOW FEVER, IM 1 794. 79 
 
 Their eyes were muddy or ferocious : a conivenefs 
 attended in all cafes. It killed in two days. Fifty- 
 two of his cattle perifhed by it. Upon opening fe- 
 veral of their dead bodies, he found the liver fwell- 
 ed and ulcerated. The blood was dilTolved in the 
 veins. In the bladder of one of them he found 
 thirteen pints of blood and water. Curiofity led 
 him to inoculate two of his calves from the blood 
 of a difeafed animaL They both fickened in eight 
 days, and after being lightly indifpofed, they both 
 recovered. 
 
 I have avoided deciding lipon the fpecific nature 
 of the exhalations which induce difeafes : This fub- 
 je6t has been purfued with great ardor by Profeflbr 
 Mitchell of New- York. His accurate knowledge of 
 the laws of the animal economy, added to the re- 
 cords of the late unfuccefsful application of the prin- 
 ciples of ele£lricity and fixed air to medicine, will, I 
 hope, defend him from an undue application of his 
 ingenious difeoveries to the theory and practice of 
 phyfic. 
 
 It is no obje£lion to the influence of thefe exhala- 
 tions in difordering the liver, that the cattle killed 
 and fold in the Philadelphia market in the autumns of 
 1793 and 1794 exhibited, in only one inilance that 
 has come to my knowledge^ the leaft mark of dif- 
 
 eafe ; 
 
Bo AN ACCOUNT OF THE 
 
 eafe ; for tliofe cattle fed in paflures previoully to 
 their being killed, in which no exhalation took 
 place. This was evident from the uncommon healthi- 
 nefs of the people in that part of the neighbour- 
 hood of the city, from whence the cattle were 
 brought a day or two before they were killed* . 
 
 Thus I have endeavoured to fix the predifpofnig 
 and remote caufes of the yellow fever in our coun- 
 try. The remote caufe is fometimes fo powerfuJ, 
 as to become an exciting caufe of the difeafe ; but 
 in general, both the predifpofmg and remote caufes 
 are harmlefs in the fyilem, until they are roiifed into 
 action by fome exciting caufe. 
 
 Before I proceed to mention the remedies which 
 were ufed in the cure of the fever which has been 
 defcribed, I fiiall fubjoin fcales of the relative conta- 
 gious nature, of the diflance of infefbion, and of the 
 mortality of the moH com.mon contagious fevers, 
 beginning with thofe which predominate under each 
 head. 
 
 L 
 
 A fcale of the extent or univerfality of contagious 
 fevers. 
 
 I. Small-pox* 
 2 Meafles. 
 
 4 3-^1^- 
 
BILIOUS YELLOW FEVER, IN I794. Si 
 
 3. Influenza. 
 
 4. Plague. 
 
 5. Bilious fever in the form of yellow fever 
 in certain feafons and places. 
 
 6. Cynanche fcarlatina. 
 
 7. Cynanche maligna. 
 
 8. The dyfentery. 
 
 9. The common bilious remitting fever. 
 1 o. The common intermitting fever. 
 
 The influence of climate^ weather and habit of 
 body, fometimes vary this fcale, but the relative 
 order in which the above fevers aife^l a greater or 
 lefs number of people, I believe in common years, 
 and in moll countries, accords with the obfervations 
 of moil phyficianS. 
 
 11, 
 
 Scale of the relative dijlance at which contagious^ 
 fevers propagate themfelves, : 
 
 I. Small-pox* 
 
 1, Meafles. 
 
 3» Influenza. 
 
 4. Yellow fever. 
 
 5. Plague. 
 
 6. Jail fever. 
 
 7. Cynanche maligna* 
 
 VOL. iv« F 8. Cynan- 
 
Si AN ACCOUNT OP TH'g ^ 
 
 8. Cynanche fcarlatina. 
 
 9. Dyfentery. 
 
 I o. The common intermitting fever. 
 
 ^ III. - 
 
 Scale of the relative mortality of contagious 
 difeafes. 
 
 1. The plague- . 
 
 2. The yellow fever. 
 
 3. The jail fever; 
 
 4. The cynanche maligna. 
 
 5. The dyfentery. 
 
 6. The natural fmajl-pox. 
 
 7. The cynanche fcarlatina. 
 
 8. The influenza and mealies. 
 
 9. The common bilious fever. 
 
 I o. The common intermitting fever. 
 
 The above fcale reprefents the relative order of 
 contagious fevers when left to themfelves. DiiFe- 
 rence of climate, feafon, habit of body, ?ind above 
 all, difference of treatment greatly vary their re- 
 lative mortality. For example, in Jamaica a fourth 
 and in St. Domingo one half fometimes die of the 
 yellow fever who take bark and wine, whereas in 
 Philadelphia the mortality, as will be fliewn here- 
 after does not exceed more than one in fifty, where 
 depleting remedies are ufed in their proper extent. 
 
 Methoe 
 
BiLIOtm YELLCrW FEVER, IN I794. 83 
 
 /:,?::.D::i:'i 
 
 Of the JMtethod of Cure. 
 
 A HE remedies employed for the cure 
 of this fever, were the fame that I employed the 
 year before. I fliall only relate itich effe(fts of them 
 as tend more fully to eftablifli the pfaftice adopted 
 in the year 1793, and fuch as efcaped my notice in 
 my former obfervatibns upon thofe remedies. My 
 method of cure cbnfifted '"^^ "^^: 
 
 I. In the abfl:ra£lion of the ftimulus of blood, and 
 heat from the whole body, and of bile, and othef 
 acrid humors from the bowels, by means of the fol- 
 lowing remedies ; 
 
 1. Bleedings 
 
 2. Purging.- _o* iu.a \ 
 
 3. Cool air, and cold drinks^ 
 
 4. Cold water applied to the external parts 
 of the body, and to the bowels by means of 
 
 < glyfters. ' -^ 
 
84 AN ACCOtJNT OF rat 
 
 II. In creating a diverfion of congellion, inflam- 
 mation, and ferous efFufion, from the brain and vif- 
 cera to the mouth, by means of a falivation, and 
 to the external parts of the body, by means of 
 bliflers. 
 
 in. In reflcHring the ftrength of the fyflem, by 
 tonic remedies. > 
 
 I proceed to make a few remarks upon the reme- 
 dies fet down under each of the above heads. 
 
 I. Q F B L E E D I N G, 
 
 X HAVE taken noti66 that this fever dif- 
 fered from the fever of 1793, incoming forward 
 in July ancf Auguft with a number of paroxyfms, 
 which reiufed to yield to purging alone. I there- 
 fore began the curt of every cafe I was called to by 
 bleeding. 
 
 I fliall mention the eife^s of this remedy, and the 
 circumflanccs, manner, and degrees in whith I ufed 
 it OGcafionally, in this fever, iamy defence of blood- 
 letting. Under the-prefent head I fliall only fur- 
 nifh the reader with a table of the quantity of blood 
 
 drawi^ 
 
BILIOUS ¥^LL@W PV^^, I^ 1794- ^5 
 
 drawn £r€?miL anmfe^r ©f pf patiefit^ in the cpurfe 
 of th|B difefife. From ffeyer^,! of them th^ quantity 
 fet dawn, wg8 ukm ia ttir^e, four, itjii ivf days. 
 I idiall afterw«^r4§ 4?i&ribe \k^ appigftrascf ^ f f tfe^ 
 blood. 
 
 Month. 
 
 Patients. 
 
 ^laritity ' 
 ounces. 
 
 50 
 
 Number of 
 times bled. 
 
 Augufl. 
 
 Peter Denhani. 
 
 5 
 
 
 Mrs. Bruce. 
 
 70 
 
 7 
 
 
 Andrew Gribble 
 
 
 
 
 aged 1 5 years. 
 John Madge. 
 Peter Brown. 
 
 50 
 
 150 
 
 80 
 
 5 
 
 12 
 
 8 
 
 September. 
 
 Mrs. Gardiner. 
 Mifs Sally gyre. 
 Mrs. Gafs. ^ 
 
 80 
 
 59 
 
 7 
 9 
 3 
 
 
 Richard W^ls's 
 
 
 
 
 maid. 
 
 i 00 
 
 10 
 
 
 Mr. Nerval. 
 
 ICO 
 
 9 
 
 
 Mr. Harrifon. 
 
 90 
 
 9 
 
 Ociober. 
 
 Henry Clymer. 
 Mrs. Mitchell. 
 
 80 
 120 
 
 8 
 ^3 
 
 - ■ 
 
 Mrs. Lenox. 
 
 80 
 
 7 
 
 
 Mrs. Kapper. 
 ReVcDr.Magaw^s 
 maid. 
 
 140 
 
 100 
 
 II 
 
 10 
 
 
 Mifs Hood. 
 
 100 
 
 10 
 
 
 Mrs. Vogles. 
 
 70 
 
 5 
 
 1795 
 January. 
 
 Guy Stone. 
 Benj. Hancock. 
 Mr. Benton. 
 
 100 
 100 
 
 9 
 10 
 
 13 
 
 
 Mrs. Fries. 
 
 150 
 
 15 
 
 
 Mrs. Garrigues, 
 
 80 
 
 7 
 
 F3 
 
 Three 
 
B6'' • . AN AeeouNT of the "^^ra 
 
 :/ Three of the women whofe names- 1 have men- 
 tioned, were in the advanced flage of pregnancy, 
 viz. Mrs. Gardiner, Mrs. Gafs, and Mrs. Garrigues. 
 They have all fmce borne healthy children. I have 
 omitted the names of above one hundred perfons 
 who had the fever, from whom I drew thirty or 
 forty ounces of blood by two or three bleedings^ 
 I did not cure a fingle perfon without at leafl one 
 bleeding. . 
 
 ■ - - - rf 
 
 It is only by contemplating the extent in which 
 it is neceiFary to ufe this remedy, in order to over* 
 come a yellow fever, that we can acquire jufl ideas 
 of its force. Hitherto this force has been eftimated 
 by no other meafure than the grave, :^nd this we 
 know puts the {Irength of all difeafes upon a leveL . 
 
 The blood drawn in this fever exhibited the toU 
 lowing appearances. 
 
 1. It was difTolved in a few inftances. 
 
 2. The craffamentum of the blood was fo partially 
 difTolved in the ferum as to produce an appearance 
 in the ferum refembling the walhings of jfjefh in 
 water. 
 
 3. The ferum was fo lightly tinged of a r^d 
 colour as to be perfectly tranfparent. '-^'^ 
 
 4. The 
 
BILIOUS YE-ULQW FEVER, IN . 1794, 8^ 
 
 4. Theferum was in many cafes of a deep yellow. 
 colour. 
 
 5. Thore was in every cafe in which the blaod 
 was not diifolved, or in which the fecond appearance 
 thatiias been mentioned did not take place, a beau-, 
 tiM fcarlet coloured fediment in the bottom of the 
 bowl, forming lines, or a large circle. It feemed to 
 be a tendency of the blood to diiTolution. This flate 
 of the blood occurred in almofl all the difeafes of the 
 lafl two years, and in fome in which there was not 
 the leafl fufpicion of the miafmata or contagion of 
 the yellow fqven 
 
 6. The craffamentum generally floated in the 
 ferum, but it fometimes funk to the bottom of the 
 bowl. In the latter cafCj the ferum had a muddy 
 appearance. 
 
 7. I faw but one cafe in which there was not a 
 feparation of the craflamentum and ferum of the 
 blood. Its colour in this cafe was of a deep fcarlet. 
 In the year 1793 this appearance was very common, 
 
 8. I fav/ one cafe in which the blood drawn, 
 amounting to 14 ounces, feparated partially, and was 
 of a deep black colour. This blood was taken from 
 Mr. Norval a citizen of North Carolina, who had 
 
 - , F 4 been 
 
B^ AN ACCOUNT OF THS 
 
 been infc6led with the fever by fleeping in the fame 
 Toom with Mr. Harrifon, a citizen of Virginia. 
 
 9. There was in feveral inftances a tranfparent 
 felly-like pellicle which covered the craffamentum 
 of the blood, and which was eafily feparated from 
 it, without altering its texture. It appeared to have 
 no connection with the blood. 
 
 10. The blood towards the crilis of the fever ia 
 many people exhibited the ufual forms of inflam- 
 matory cruft. It was cupped in many inftances. 
 
 11. After the lofs of 70 or 80 ounces of blood, 
 there was an evident difproportion of the quantity 
 of craiTamentum to the ferum. It was fometimes lefs 
 hy one half, than in the firll bleedings. 
 
 Under this head, it will be proper to mention 
 that the blood when it happened to flow along ths 
 external part of the arm in falling into the bowl, 
 was fo warm as to excite an unpleafant fenfation of 
 heat in feveral patients. 
 
 To the appearances exhibited by the blood to the 
 eye, I fhall add a fa6l communicated to me by a 
 German bleeder who followed his bufmefs in the 
 city during the prevalence of the fever in 1793. 
 
 He 
 
BILIOUS YELLOW FEVER, IN 1 794. 89 
 
 He informed me that he could diftinguifli a yellow 
 fever from all other flates of fever, by a peculiar 
 fmeli which the blood emitted while it was flowing 
 from a vein. From the certainty of his decifion in 
 one cafe which came under my notice, before a fuf- 
 picion had taken place of the fever being in the 
 city, I am difpofed to beHeve that there is a founda- 
 tion for his remark. 
 
 2. OF PURGING. 
 
 I 
 
 HAVE but little to add under this head 
 to the obfervations that I have made upon this re- 
 medy in the year 1793. I purged with jalap, calo- 
 mel, and gamboge until I obtained large and dark-cc- 
 loured flools ; after wlifch I kept the bowels gentlj 
 open every day with cailor oil, cremor tartar, or 
 Glauber falts. I gave calomel in much larger quan- 
 tities that I did the year before. John Madge took 
 nearly 150 grains of it in fix days. I iliould have 
 thought this a large quantity, had I not fnice read 
 that Dr. Chifliolm gave 400 grains of it to one 
 patient in the courfe of his fever, and 50 grains to 
 another at a fmgle dofe, three times a-day. I found 
 flrong mercurial purges to be extremely ufeful in 
 
 the 
 
90- an: account of tnz . 
 
 the winter months, when the fever put on fymp- 
 toms of pleurify. I am not fmgular in afcribing:i 
 much to the efEcacy of purges in the bilious pleu- 
 rify. Dr. Defportes tells us, that he found the: 
 pleurify of St. Domingo, which was of the bilious 
 kind, to end happily in proportion as the bowels 
 were kept conftantly open, * Nor am I fmgular in 
 keeping my eye upon the original type of a difeafe, 
 which only changes its fymptoms with the weather 
 or the feafon, and in treating it with the fame re- 
 nledies. Dr. Sydenham bled as freely in the diar- 
 rhoea of 1668, as he had done in the inflammatory 
 fever of the preceding year, f How long the pleu- 
 rifies of winter, in the city of Philadelphia, may con- 
 tinue to retain the bilious fym.ptoms of autumn, 
 which they have aflumed for three years pad, I 
 know not ; but the late Dr. Fayfleaux of South 
 Carolina informed me, that for many years he had 
 not feen a pleurify in Charlefton with the common 
 inflammatory fymptoms which chara<!lerized that dif- 
 order^ v/hen he v\^as a ftudent of medicine. They 
 all now put on bilious fymptoms, and require flrong 
 purges to cure them* The pleurifies which the late 
 Dr. Chalmers fuppofes he cured by purging, were 
 probably nothing but bilious fevers, in which the 
 ciool w:eather had excited fome pleuritic fymptoms. 
 
 * ?. 140. t Wallis*s. edition, p. 211. Vol. I. 
 
 3-1 
 
BILIOUS YELLOW FEVEJR, IN 1794. 51: 
 
 3. 1 have nothing to add to the obfervatlons I^ 
 have elfewhere piibhflied upon the efficacy of cool 
 air and cold drinks in this fever. They were both 
 equally pleafant and ufeful^ and contributed, with, 
 
 cleanlinefs, very much to the fuccefs of my pra£iice. 
 
 - . - ■ , - I- 
 
 4. Cold water applied to the external parts of the 
 body, and inje^ed into the bowels by way of gly« 
 fter, did great fervice in many cafes. John Madge 
 found great relief from cloths dipped in cold wa- 
 ter and applied to the lower part of his belly. They 
 eafed a pain in his bowels, and procured a dif- 
 charge of urine. A throbbing and moft diftreffing 
 pain in the head, was relieved by the fame remedy 
 inMrs. Vogles and Mrs. Lenox. The cloths were 
 applied for three fucceffive days and nights to Mrs* 
 Lenox's head, during an inflammation of her brain,, 
 which fucceeded her fever, and were changed 
 during the greater part of the time, every ten or 
 fifteen minutes. In 1795 I increafed the coldnefs 
 of pump water when ufed in this way, by diffolving, 
 ice in it, and in fome cafes I applied powdered ice 
 in a bladder to the head, with great advantage. 
 
 The following fafts will fliew the good elFects of 
 cold water in this, as well as other fevers of too 
 much action. In the afternoon of one of thofe days 
 m wliich my fyitem was impregnated with the conta* 
 
 gion 
 
92 AN ACCOUNT OF TK5 
 
 gion of the yellow fever, I felt fo much indifpofed 
 that I deliberated whether I fliould go to bed, or 
 viiit a patient about a mile in the country. The 
 afternoon was cool and rainy. I recolle6led at this 
 time- a cafe related by Dr. Daignan, a French phy* 
 fician, of a man who was cured of the plague by 
 being forced to lie all night in an open field in a 
 ihower of rain. I got into my chair, and expofed' 
 myfelf to the rain. It v/as extremely grateful to 
 my feelings. In two hours I returned, v/hen to 
 my great fatisfa^iiion I found all my feverifli fymp- 
 toms had left me, nor had I the leafl return of 
 them afterwards. Dr. Caldwell, who a^ed as a 
 furgeon of a regiment in the expedition againfl the 
 infurgents in the weilern counties of Pennfylvania, 
 furnillied me, in a letter dated from Bedford, Octo- 
 ber 20th, 1794, with an account of his having been 
 cured of a fever by a more copious ufe of the fame 
 remxdy. *^ I w^as (fays the Do^lor) to ufe a vulgar 
 exprelFion, zvei to the Jkin^ and had no opportunity 
 of fliifting my clothes for feveral hours. In confe- 
 quence of this thorough bathing, and my fubfequent 
 expofure to a cool air,, I was relieved from every 
 fymptom of indifpofition in a few hours, and have en- 
 joyed more than m^y ufual flock of health ever fmce.** 
 
 The efficacy of cold water in preventing and 
 cunng infiammation, may be conceived from its ef- 
 fects 
 
BILIOUS YELLOW FEVER, IN 1/94. 93 
 
 £e£ts when ufed with mud or clay, for obviating the 
 pain and inflammation which arife from the fling of 
 venomous infers. The fame remedy applied for 
 half an hour has lately, it is faid, been equally ef- 
 feflual in preventing the deleterious effects of the 
 bite of a rattle-fnake, 
 
 II. The good eiFefts I had obferved from a sa- 
 livation in the yellow fever of 1793, induced me 
 to excite it as early as poiTibk in all thofe cafes 
 which did not yield immediately to bleeding and 
 purging. I was delighted with its eire<^s in every 
 cafe in which I ufed it. Thefe effciSls were as fol- 
 low : 
 
 1. It immediately attra6led and concentrated in 
 the mouth, all the fcattered pains of every part of 
 the body. 
 
 2. It checked a naufea and vomiting. 
 
 3. It gradually, when it was copious, reduced the 
 pulfe, and thereby prevented the neceiTity of further 
 bleeding fer piirging, 
 
 I wifb it were poiTible to render the ufe of this 
 remedy univerfal in the treatment of malignant fe- 
 vers. Dr. Chifholm, in his Account of the Boul- 
 
 lam 
 
54 AN ACCi^tJNT OP VhE 
 
 lam. fever, has done much to eflablifli its fafety aiid 
 efficacy. It is a rare occurrence for a patient that 
 has been fufficiently bled and purged, to die after a 
 falivation takes place. The artificial difeafe excited 
 by the mercury, fufpends or deftroys difeafe in every 
 part of the body. The occafional inconveniences 
 which attend it, are not to be named with its cer^ 
 tain and univerfal advantages. During the whole 
 of the late feafon in which the yellow fever pre* 
 vailed, I faw but two inflances in which it probably 
 loofened or dellroyed the teeth. I am not fatisfied 
 that the mercury was the caufe of the injury or lofs 
 of thofe teeth ; for who has not feen malignant fe- 
 vers terminate in ulcers, which have ended in the 
 crofions of bony parts of the body ? '^ 
 
 It has been juftly remarked, that there can be 
 but one a6i:ion at a time in the blood-veflels. This 
 was frequently illuflrated by the manner in which 
 mercury aded upon the fyflem in this fever. ' It fel- 
 dom falivated until the fever intermitted or declined. 
 I faw feveral cafes in which the falivation came on 
 during the intermiffion, and went off during its ex- 
 acerbation ; and many, in which there was no fa- 
 livation until the morbid aftion had ceafed altoge- 
 ^er in the blood- veffels, by the folution of tbefc- 
 yer. It is becaufe the aftion of the veffels in epi- 
 l(epf^ and pulmonary confumption furpaifes the, fli- 
 
 mulus 
 
BILIOUS YELLOW FEVER, IN 1794. 95 
 
 mulus of the mercury, that it is fo difficult to excite 
 a falivation in both thofe diforders. 
 
 Let not the advocates for the healing powers of 
 nature complain of a falivation as an unnatural re- 
 medy in fevers. Dr. Sydenham fpeaks in high 
 terms of it in the fever of 1670, 1671, and 1672, 
 and fays that it cured it when it was fo malig- 
 jaant, as to be accompanied by purple fpots on the 
 body.* 
 
 Blisters, when applied at ^ proper t\mc<i did great 
 fervice in this fever. This time was, when the fe- 
 ver was fo much weakened by evacuations, that the 
 artificial pain excited by the flimulus of the blifters 
 deflroyed, and, like a conductor, conveyed off, all 
 the natural pain of the body. It is from ignorance, 
 or inattention to the proper flage of fevers in which 
 bliflers have been applied, that there have been fo 
 many difputes among phyficians refpeiSling their effi- 
 cacy. When applied in a flate of great arterial 
 adion, they do harm : When applied after that ac- 
 tion has nearly ceafed, they do little or no fervice. 
 I have caHed the period in which blifters are ufefuJa 
 the blijiering point. In bilious fevers this point is 
 generally circumfcribed within eight-and-forty hours. 
 
 * Vol. II, p. 212, 
 
 The 
 
g6 AN ACCOUNT OF THE 
 
 The effe£^s of bliflers were as follow : 
 
 1. They concentrated, like a falivatlon, all the 
 fcattered pains of the body, and thereby 
 
 2. Reduced the pulfe in force and frequency. 
 
 3. They inflantly checked a ilcknefs at the fto- 
 mach and vomiting. 
 
 4. They often induced a gentle moiHurc upon the 
 ikin. 
 
 I found it of little confequence to what part of 
 the body the bliflers were applied ; for I obferved 
 a pain in the head, and even delirium, to be as 
 fpeedily and certainly cured by bliflers upon the 
 Tviifls, as they were by a large blifler to the neck. 
 
 III. After the redu£lion of the morbid a6lion of 
 the blood- vefTels, by means of the remedies which 
 have been mentioned, I feldom made ufe of any 
 other tonic than a nourifhing and gently flimulating 
 diet. This confifled of fummer fruits, bread and 
 milk, chicken broth, the white meats, eggs, oyflers, 
 and malt liquors, more efpecially porter. I made 
 many attempts to cure this fever when it appeared 
 in the form of a fimple intermittent, by means of 
 
 4 BARK> 
 
IJ1LI0*JS YELLOW FEVER, IN 1794. 97 
 
 feARK, without malignant fymptoms, but always, 
 except in two inllances, without fuccefs ; and in them 
 it did not ta^^e effeft until after bleedingo In feve- 
 ral cafes it evidently did harm* I fhould have fuf- 
 pe£led my judgment in thefe obfervations refpefting 
 this medicine, had I not been aiTured by Dr. Grif- 
 fltts, Dr. Phyfick, and Dr. Woodhoufe, that it was 
 equally ineife£lual in their pra£lice, in nearly all 
 the cafes in which they gave it, and even where 
 blood-letting had been premifed. Dr. Woodhoufe 
 faw a cafe in which near a pound of bark had 
 been taken without effe61: ; and another, in which 
 a fatal dropfy fucceeded its ufe» Dr. Griffitts ex- 
 cepted from his teflim.ony againfl the bark, the cafes 
 of feven perfons from the country, who brought 
 the feeds of the intermitting fever with them to 
 the city. In them, the bark fucceeded without 
 previous bleeding. The facility v/ith which thefe 
 feven cafes of intermitting fever were cured by the 
 bark, clearly proves that fevers of the fame feafon 
 differ very much, according to the nature of the 
 exhalations which excite them. The intermittents in 
 thefe flrangers were excited by miafma of lefs 
 force than that which was generated in our city, 
 in which, from the greater heat of the atmofphere, 
 and the more heterogeneous nature of the putrid 
 matters which llagnate in our ponds and gutters, 
 the exhalation probably poiTeffes a more a£live and 
 VOL. IV. G Simulating 
 
98 AN ACCOUNT OF THE 
 
 {limulatiiig quality. Thus the mild remittents la 
 June and in the beginning of July, which were 
 produced by the ufual filth of the flreets of Phila- 
 delphia, in the year 1793, differed very much from 
 the malignant remitting yellow fever which was pro- 
 duced by the ftench of the putrid coffee a few weeks 
 afterv/ards. 
 
 Sir John Pringle long ago taught the inefEcacy 
 of bark in certain bilious fevers. But Dr Chilliolm 
 has done great fervice to medicine by recording its 
 ill effe£ts in the Boullam fever. " Head ach, (fays 
 the Do£lor) a heavy dull eye, with a confiderable 
 protrufion from its orbits, low fpirits, thirff, and a 
 total want of appetite, were the general confequen- 
 ces of the treatment with bark without the previous 
 antiphlogiflic." 
 
 I have mentioned a cafe of internal dropfy of the 
 brain having been produced by the improper ufe of 
 the bark in a fon of Mr. Coates. I have no doubt 
 but this diforder, as alfo palfy, and confumption, 
 obflruftions of the liver and bowels, and dropfies 
 of the belly and limbs, are often induced by the ufe 
 of the bark during an inflammatory flate of the 
 blood- veffels. It is to be lamented that the affoci- 
 ation of certain difeafes and remedies in the minds 
 of phyficians, becomes fo fixed, as to refufe to yield 
 
 to 
 
BILIOUS YELLOW FEVER, IN 1 794. OO 
 
 to the influence of reafon. Thus pain and orium-, 
 dropfy and foxglove, low fpirits and aflafoet da, 
 and above all, an intermitting fever and bark, are 
 all conne6J:ed together in common pra6lice as mecha- 
 nically, as the candle and the fnufFers are in the 
 mind of an old and fleady houfe fervant. To abo- 
 hili the mifchief of thefe mechanical alTociations in 
 medicine, it will be necelTary for phyficians to pre- 
 fcribe only for the different flates of the fyflem. 
 
 Finding the bark to be fo univerfally ineffe^ual 
 or hurtful, I fubftituted Columbo root, the Carri- 
 bean bark and feveral other bitters in its place, but 
 without fuccefs. They did lefs harm than the 
 Jefuit's bark, but they did not check the return of 
 a fmgle paroxyfm of fever. 
 
 I know that bark was given in this fever in fome 
 inllances in which the patients recovered ; but they 
 were fubje£l during the winter, and in the following 
 fpring, to frequent relapfes, and in fome inllances to 
 affe^cions of the brain and lungs. In the highefl 
 grade of the fever it certainly accelerated a fuppofed 
 putrefaction of the blood, and precipitated death- 
 The praflice of phyficians who create this gangre- 
 nous ilate of fever by means of the bark, refembles 
 the ccndu<5l of a horfe, who attempts by pawing to 
 
 G 2 remove 
 
lOO AN ACCOUNT OF THE 
 
 remove his fliadow in a ftream of water, and thereby 
 renders it (o turbid that he is unable to drink it. 
 
 Should the immediate fuccefs of tonic, and de- 
 pleting remedies in dedroying the fever be equal, 
 the effe^ls of the former upon the conflitution can- 
 not fail of being lefs fafe than the latter remedies. 
 They cure by overflraining the powers of life. There 
 is the fame difFerence therefore between the two 
 modes of pra£tice5 that there is between gently lift- 
 ing the latch of a door, and breaking it open in 
 order to go into a houfe. 
 
 Wine was hurtful in every cafe of yellow fever 
 in which it was given while there v/ere any remains 
 of inflammatory aftion in the fyflem. I recolle£^ 
 that a few fpoonsful of it, which Mr. Harrifon of 
 Virginia took in the deprefled flate of his pulfe, 
 excited a fenfation in his llomach which he com- 
 pared to a fire. Even wine-whey, in the excitable 
 flate of the fyflem induced by this fever, was fome- 
 times hurtful. In a patient of Dr. Phyfick who 
 was on the recovery, it produced a relapfe that had 
 nearly proved fatal in the year 1795. Dr. Defper- 
 rieres afcribcs the death of a patient to a fmall 
 quantity of wine given to him by a black nurfe.* 
 
 * Vol. II. p. 108. 
 
 Thefc 
 
BILIOUS YELLOW FEVER, IN 1 794, lOI 
 
 Thefe h^ts are important, inafmuch as wine is a 
 medicine which patients are mofl ap|: to ufe in ajl 
 cafes, without the advice of a phyfician. 
 
 I obferved opium to be lefs hurtful in this fever 
 than it was in the fever of 1793. I adminiftered a 
 few drops of laudanum, in one cafe in the form of a 
 glyfter in a violent pain of the bowels, with evident 
 advantage, before the inflammatory a^lion of the 
 blood velTels was fubdued. In this way I have often 
 obtained the compofing eifefts of laudanum where 
 it has been reje£led by the flomach. But I gave it 
 fparingly, and in fmall dofes only, in the early flage 
 of the fever. John Madge, whofe pains in his 
 bowels were often as exquifite as they are in the 
 mofl acute colic, did not take a fmgle drop of it, 
 I ufed no anodyne in his cafe but bleeding, and ap- 
 plications of cold water to the infide and outfide of 
 his bowels. After the fever had palled the feventh 
 day, and had been fo far fubdued by copious eva- 
 cuations as to put on the form of a common inflam- 
 matory intermittent, I gave laudanum during the 
 intermiflipns of the fever with great advantage. In 
 fom,e cafes, it fuddenly checked the paroxyfms of 
 the fever, while in many more it only moderated 
 them, but in fuch a manner, that they wore them- 
 felves away in eight or ten days. One of my female 
 patients who had taken bitters of every kind, with- 
 
 G 3 out 
 
I02 AN ACCOUNT OF THE 
 
 out effect to cure a tertian which fucceeded a yel- 
 low fever, took a large dofe of laudanum in the in- 
 terval of her paroxyfms to cure a tooth ach. To 
 her great furprife it removed her tertian. The 
 elfedls of laudanum in this fever were very different 
 from thofe of bark; Where it did no fcrvice, it did 
 not, like the bark do any harm. 
 
 Perhaps this dilFerence In the operation of thofe 
 two medicines depended upon the bark acling with 
 an allringent, as well as ftimulating power chiefly 
 upon the blood vefTels, while the atlion of the 
 opium was more fmiply flimulating, and diffufed at 
 the fame time over all the fyilems of the body. 
 
 I fliall fay in another place that I fornetimes direft- 
 ed a few drops of laudanum to be given in that flate 
 of extreme debility which fucceeds a paroxyfm of 
 fever^ v/ith evident advantage. 
 
 Nitre, fo ufeful In common inflammatory fevers, 
 was in moll cafes fo offenfive to the flomach in this 
 fever, that I was feldom able to give it. Where 
 the flomach retained it, I did not perceive it to do 
 any fervice. 
 
 Antimonials were as inefre£]:ual as nitre In 
 abating the aflion of the fanguiferous fyflem, and in 
 
 producing 
 
BILIOUS YELLOW FEVER, IN 1 794. I03 
 
 producing a fweat. I fhould as foon expert to com- 
 pofe a ftorm by mufic, as to cure a yellow fever 
 by fuch feeble remedies. 
 
 Thus have I finiflied the hiftory of the fymptoms, 
 origin, and cure of the yellow fever as it appeared in 
 Philadelphia in 1794 and in the winter of 1795. 
 The eiSicacy of the remedies which have been men- 
 tioned, was eftabliflied by almofl univerfal fuccefs. 
 Out of upwards of 200 patients to whom I was call- 
 ed in the firll ftage of the fever between the 1 2 th 
 of June 1794 and the firft of April i795) I loll: but 
 four perfons in whom the unequivocal fymptoms had. 
 occurred, w^hich chara^Slerife^ the firfl grade of the 
 difeafe. • 
 
 It will be ufeful, I hope, to relate the cafes of the 
 patients whom I loft, and to mention the caufes of 
 their deaths. The iirft of them was Mrs. Gavin. 
 She objefted to a fifth bleeding in the beginning of 
 a paroxyfm of her fever, and died from the want 
 of it. Her death was afcribed to the frequency of 
 her bleedings by the enemies of the depleting fyftem. 
 It was faid that flie had been bled ten times, o wing- 
 to ten marks of a lancet having been difcovered on 
 her arms after death, five of which were occafioned 
 by unfuccefsful attempts to bleed her. She died 
 with the ufual fymptoms of congeftion in her brain. 
 
 G 4 Mr, 
 
J 04 AN ACCOUNT OP THE 
 
 Mr. Marrj to whom I v/as called on the firft dav 
 of his diibrder, died in a paroxyfm of his fever which 
 came on in the middle of the 7th nightj after fix 
 >)leedings. I had left him the night before nearly- 
 free of fever^ and in good fpirits. He might pro- 
 Ibably have been faved, (humanly fpeaking) by one 
 more bleeding in the exacerbation of what appeared 
 to be the critical paroxyfm of his fever* 
 
 Mr. Montford of the State of Georgia died under 
 the joint care pf Dr. Phyfick and myfelf. He had 
 been cured by plentiful bleeding, and purging, 
 but had reiapfed. He appeared to expire in a fainty 
 fit in the firfl ftagp of a paroxyfm pf the fever. 
 Death from this caufe (which occurs moil: frequently 
 where bloodletting is not ufed) is common in the 
 yellow fever of the Weil Indies. Dr. Biffet in de- 
 fcribing the different ways in which the difeafe ter- 
 minates fatally fays. " In a few cafes, the patient 
 is carried off by an u?iexpe6led fyncopeJ^' * 
 
 A fervant of Mr, Henry Mitchell, to whom I 
 was called in the early ffage of his diforder, died 
 in confequence of a fudden effufion in his lungs 
 which had been weakened by a previous pulmonary 
 complaint. 
 
 * Medical EiTays and Obfervations, p. 28. 
 
 I wlili 
 
 ^ 'j. 
 
BILIOUS YELLOW FEVER, IK 1 794. IC5 
 
 I wiih the friends of bark and wine in tlie yel- 
 low fever, or of moderate bleeding with antimonial 
 medicines, would publifii an account of the number 
 of their deaths by the fever, within the period I 
 have mentioned, and with the fame fidelity I have 
 done. The contrafl w^ould for ever decide the con- 
 troverfy in favour of copious depletion. The mor- 
 tality under the tonic mode of practice may eafiiy 
 be conceived from the acknowled element of one of 
 the gentlemen who ufed it, but who premifed it, 
 in many cafes^ by two and three bleedings. He 
 informed Dr. Woodhoufe that out of twenty-feven 
 patients whom he had attended in the yellow fever, 
 he had faved but nine. Other pra£litioners w^re, 
 I believe, equally unfuccefsful in proportion to the 
 number of patients whom they attended. The 
 reader will not admit of many deaths having occur- 
 red uoxa the difeafes (formerly enumerated) X.o 
 which they were afcribed, when he recoilefts that 
 even a fmgle death from moil of them, in common 
 feafons, is a rare occurrence in the practice of re- 
 gular bred phyficians. 
 
 In anfwer to the account I have given of the mor- 
 tality of the fever in 1794, it will be faid, that 30 
 perfons died lefs In that year, than in the healthy 
 year of 1792. To account for this, it will be ne- 
 f elTary to recollecl: that the inhabitants of Philadel- 
 phia 
 
Io6 AN ACCOUNT OF THE 
 
 phia were reduced in number upwards of 4000, 
 in the year 1793 and of courfe that the proportion 
 of deaths was greater in 1794 than it was in 1792 
 although the number was lefs. It is remarkable 
 that the burials in the Grangers' grave yard amount- 
 ed in the year 1792 to but 201, whereas in 1794 
 they were 676. From this it appears, that the deaths 
 muil have been very numerous among new comers 
 (as they are fometimes called) in the year 1794 
 com-pared with common years. Now this will eafily 
 be accounted for when we recolle£l5 that thefe 
 people who were chiefly labourers, were expofed to 
 the conllantly exciting caufes of the difeafe, and 
 that in all countries they are the principal fuiFerers 
 by it. 
 
 But in order to do juflice to this comparative 
 view of the mortality induced by the yellow fever 
 in the year 1 794, it will be neceffary to examine the 
 bill of mortality of the fucceeding year. By this it 
 appears that 2274 perfons died in 1795, making 
 1139 more than died in 1.794. The greatnefs 
 of this mortality, I well recolleft, furprized many of 
 the citizens of Philadelphia who had juft pafTed an 
 autumn which was not unufually fickly, and who 
 had forgotten the uncommon mortality of the months 
 of January, February and March, which fucceeded 
 the autumn of 1 794. 
 
 It 
 
BILIOUS YELLOW FEVER, IN 1 794. I07 
 
 It will probiibly be afked, how it came to pafs, 
 that I attended (o many more patients in this fever 
 than any of my brethren. To this I anfwer, that 
 fmce the year 1793 a great proportion of my patients 
 have confiftcd of Grangers, and of the poor ; and 
 as they are more expofed to the difeafe than other 
 people, it follows, that of the perfona affected by 
 the fever, a greater proportion mufl: have fiillen to 
 my (liare as patients, than to other phyficians. My 
 ability to attend a greater number of patients than 
 moil of my brethren, was facilitated by my having 
 at the time of the fever, feveral ingenious and aflive 
 pupils, who aiTiiled me in vifiting and prefcribing 
 for the fick. Thefe pupils were, Ailiton Alexander 
 (now phyfician at Baltimore), John Otto, Nathaniel 
 Potter (nov/ phyficians in Philadelphiaj, and Gilbert 
 Watfon. 
 
 The antiphiogillic remedies were not faccefsful in 
 Philadelphia, in the yellow fever, in my hands 
 alone. They were equally, and perhaps more fo, 
 in the hands of my friends Dr. Gritlitts, Dr. Ph}^- 
 fick. Dr. Dewees, and Dr. Woodhoufe. 
 
 They were moreover fuccefsful at the fame time 
 in New Haven, Baltimore, and in Charlefton in 
 South Carolina. Eighteen out of twenty died of 
 all who took bark and wine in New Haven, but 
 
 only 
 
I08 AN ACCOUNT OF THE 
 
 only one in ten, of thofe who ufed the depleting 
 medicines. In a letter from Dr. Brown, a phy- 
 fician of eminence in Baltimore, dated November 
 27th, 17945 he fays, " of the many cafes which fell 
 to my care, two only proved mortal where I was 
 called on the firfl day of the difeafe, and had an un- 
 controuled opportunity to follow my judgment. 
 Where falivation took place, I had no cafe of mor- 
 tality ; and in two of thofe cafes a black vomiting 
 occurred." Dr. Ramfay of Charleilon, in a letter 
 to one of his friends in this city, dated 061:ober 
 14th, 1794, fubfcribes to the efEcacy of the fam.e 
 pra&ce in a fever which prevailed at that time in 
 Charleflon, and which, he fays, refembled the yeli 
 low fever of Philadelphia in the year 1793. 
 
 But the fuccefs of the depleting fyftem was not 
 confined to the United States. In a letter before 
 quoted, which I received from Dr. Davidfon of St. 
 Vincents, dated July 22d, 1794, there is the fol- 
 lowing teflimony in favour of evacuations from the 
 blood-veiTels, bowels, and falivary glands. 
 
 " Where the fever comes on with great deter- 
 mination to the head, and an afFe£lion of the fto- 
 mach, in confequence of that determination, vio- 
 lent head ach, rednefs of the eyes, turgefcence of 
 the face, impatience of light, &c. attended with 
 
 a full 
 
BILIOUS YELLOW FEVER, IN 1794. I09 
 
 a full and hard pulfe, blood-Iettmg ihould be em- 
 ployedyr^Wj and repeatedly^ cold applications ihould 
 be applied to the head, and purging medicines 
 ihould be employed. As a purge, calomel has been 
 ufed with the greatefl advantage, fometimes by it- 
 felf, but moil frequently combined with fome aftive 
 purgative medicine, fuch as jalap. From fome 
 peculiarity in the difeafe, an uncommon quantity 
 of the calomel is neceiTary to aifeiSi: the bowels and 
 falivary glands. As I found a fmall quantity of 
 it did not produce the efFe£l I wiihed for promptly, 
 I have gradually increafed the quantity, until I 
 now venture to give ten grains of it, combined 
 with five of jalap, every two hours until flools are 
 procured. The calomel is then given by itfelf. 
 
 " The patients have generally an averiion to 
 wine. The bark is feldom found of much advan- 
 tage in this ilate of the fever, and frequently 
 brought on a return of the vomiting. I preferred 
 to it, in a remiiTion of the fymptoms, a vinous 
 infufion of the quaiTia, which fat better upon the 
 ftomach." 
 
 In the ifland of Jamaica, the depleting fyftem 
 has been divided. It appears from feveral publica- 
 tions in the Kingfton papers, that Dr. Grant had 
 ad(^ted blood-letting, while moil of the phyficians 
 
 of 
 
no AN ACCOUNT OF THJi 
 
 of the ifland reft the cure of the yellow fever 
 upon ftrong mercurial purges. The ill effects of 
 moderate bleeding appear to have thrown the lan- 
 cet into difrepute ; and the balance of fuccefs, from 
 thofe publications, is evidently in favour of fimple 
 purging. I have no doubt of the truth of the 
 above ftatement of the controverfy between the 
 exclufive advocates for bleeding and purging ; and 
 I think the fuperior efficacy of the latter remedy 
 may be explained in the following manner. 
 
 In warm climates the yellow fever is generally, 
 as it v/as in Philadelphia in the month of Auguil 
 and in the beginning of September 1793, a dif- 
 eafe of but tv^o or three paroxyims. It is fome- 
 times, I believe, only a fimple ephemera. In thefe 
 cafes, purging alone is fufficient to reduce the fyf- 
 tem, without the a.id of bleeding. It was found 
 to be fo, until the beginning of September in 1793, 
 in moft cafes in Philadelphia. The extreme de- 
 prellion of the fyftem in the yellow fever in warm 
 weather and in hot climates, renders the reftora- 
 tion of it to a healthy ftate of a6lion more gradual, 
 and of courfe more fafe, by means of purging, than 
 bleeding. The latter remedy does harm, only by 
 reftoring the blood-veflels too fuddenly to preterna» 
 tural aftion, without reducing them afterwards. 
 Had bleeding been pra6tifed agreeably to the me- 
 thod 
 
BILIOUS YELLOW FEVER, IN 1 794. Ill 
 
 thod defcribed by RIverius, (mentioned in a former 
 publication *), or had the fever in Jamaica run on 
 to more than four or five paroxyfms, I am fure the 
 lofs of blood would have been not only fafe, but 
 generally beneficial. I have, in another place, f 
 given my reafons why moderate bleeding in this, as 
 well as many other difeafes, does harm. In thofe 
 cafes where it has occurred in large quantities from 
 natural haemorrhages, it has always done fervice in 
 the Weft Indies. The inefficacy, and in fome cafes, 
 the evils, of moderate blood-letting are not confined 
 to the yellow fever. It is equally inefieflual, and 
 in fome inftances equally hurtful, in apoplexy, in- 
 ternal dropfy of the brain, pleurify, and pulmonary 
 confumption. Where all the different ftates of the 
 pulfe which indicate the lofs of blood are perfe£lly. 
 underftood, and blood-letting conformed in time and 
 in quantity to them, it never can do harm in any 
 difeafe. It is only when it is prefcribed empirically, 
 without the dire^ion of juft principles, that it has 
 ever proved hurtful. Thus the fertilizing vapors 
 of heaven, when they fall only in dew, or in profufe 
 lliowers of rain, are either infufficient to promote 
 vegetation, or altogether defti*u£live to it. 
 
 There may be habits in which great and long 
 protraifbed debility, whether direcl or indiredi:, may 
 
 * Account of the Yellow Fever in 1793. t Il^itiem. 
 
 have 
 
112 AN ACCOUNT OF tHE 
 
 have fo far exliaufled the aci:ive powers of the fyf- 
 tem, as to render bleeding altogether improper in 
 this difeafe, in a Weft India climate. Such habits 
 are fometimes produced in foldiers and failors by 
 the hardiliips of a military and naval life. Bleeds 
 ing in fuch cafes. Dr. Davidfon alTures me in a let- 
 ter dated from Martinique, February 29th , 1796, 
 did no good. The cure was effedled under thefe 
 circumflances by purges, and large dofes of calomel. 
 But where this chronic debility does not occur, 
 bleeding, when properly ufed, can never be inju- 
 rious, even in a tropical climate, in the yellow feven 
 Of this there are many proofs in the writings of 
 the mod: refpe£l:able Englifli and French phyficians. 
 In fpite of the fears and clamors v/hich have been 
 lately excited againil it in Jamaica, my late friend 
 and cotemporary at the college of Edinburgh, Dr. 
 Broadbelt, in a letter from Spanifli Town, dated 
 January 6th, 1795, and my former pupil Dr. Wef- 
 ton, in a letter from St. Ann's Bay, dated June 
 17th, 1795, both affure me that they have ufed it 
 in this fever with great fuccefs. Dr. Wefton fays 
 that he bled " copioujiy three times in 24 hours, and 
 thereby faved his patient.'* 
 
 Dr. Chilliolm has lately endeavoured to reft the 
 cure of malignant fevers wholly upon the evacua- 
 tion obtained from the falivary glands, by means of 
 
 I mercury. 
 
fitLlOUS YELLOW FEVER, IN 1794. II3 
 
 tntrcuiy. I have no doubt of the efficacy of the 
 Doctor's praiflice, but from his own account it was 
 much lefs fuccefsful than the practice in the United 
 States has been, from the combined operation of 
 bleeding, purging, and a faHvation. From the de- 
 fcription which the Doiflor has given of the (late 
 of the pulfe, of the frequent haemorrhages which 
 occurred in the Boullam fever, and of the ftate of 
 the brain after death, I am fatisfied that bleeding 
 and purging would have rendered his pra6i:ice much 
 more fuccefsful. Notwithflanding the Boullam fever 
 was highly inflammatory, it was materially different 
 from the yellow fever of the Wefl Indies and of 
 the American States. This appears i. From its 
 origin, it having been produced by human miaf- 
 mata in an African veffel which arrived at Gre- 
 nada, and not by marfh exhalation. 2. From its 
 being contagious in the Well Indies, which Dr. 
 Chifliolm fays is never the cafe with the yellow 
 fever *. 3. From its infedling at the dillance of but 
 6, 8, or 10 feet; whereas the yellow fever infers 
 at the dillance of 20 and 30 feet. 4. From the 
 yellow fever, and a fever compofed of the com- 
 bined contagions of the Boullam a.nd yellow fevers, 
 prevailing at the fame time in Grenada. 
 
 ; ^ P. 147, 
 
 II I fay 
 
114 -AN ACCOUNT OF THE 
 
 I fay nothing of the difference of the fymptoms 
 in the two fevers, for this depends upon circum- 
 flances purely accidental. In both, the contagion 
 a£ls like other violent and general flimuli, which all 
 produce nearly the fame effects upon the fyflem. 
 
 From Dr. Chifliolm being unacquainted at the 
 time he compofed his book, with the hiflory of the 
 yellow fever of Philadelphia in the year 1793, he 
 has afferted that it was the fame difeafe that pre- 
 vailed at Grenada, and ^hat it had been conveyed 
 from that ifland to Philadelphia. The affertion fur- 
 liiflied a fliort lived triumph to fome of the phyfi- 
 cians of Philadelphia ; but the facls which I have 
 mentioned from the Dolor's book, foon fliev/ed it 
 to be without the lead foundation. 
 
 The fuperior advantages of the North American 
 mode of treating the yellow fever by means of all 
 the common antiphlogiflic remxedies, will appear 
 from comparing its fuccefs, with that of the Wefl 
 India phyficians, under all the modes of practice 
 w^hich have been adopted in the iflands. Dr. Def- 
 portes lofl one half of all the patients he attended 
 in the yellow fever in one feafon in St. Domingo. * 
 His remedies vv^ere moderate bleeding, and purging, 
 and the copious ufe of diluting drinks. Dr Biffet 
 
 * Vol. I. p. $^. 
 I fays, 
 
BILIOUS YELLOW FEVER, IN 1794. II5 
 
 fays, " the yellow fever is often under particular 
 circumflances very fiital, carrying off four or five in 
 feven whom it attacks, and fometimes, but feldom, 
 it is fo favourable, as to carry off only one patient 
 in five or fix." * The Doctor does not defcribe the 
 practice under which this mortality takes place. 
 
 Dr. Home, I have elfewhere remarked,! lofi: "one 
 out of four of his patients in Jamaica. His remedies 
 were moderate bleeding, and purging, and after- 
 wards bark, wine, and external applications of blan- 
 kets dipped in hot vinegar. 
 
 Dr. Blane pronounces the yellow fever to be ^^ one 
 of the mofi: fatal difeafes to which the human body 
 is fubjecl, and in v/hich human art is the moil unavail- 
 ing." His remedies were bleedingj bark, bliflers, 
 acid drinks, faline draughts, and camomile tea. 
 
 Dr. Chifliolm acknowledges that he lofi: one in 
 twelve of all the patients he attended in the jail 
 fever. His principal remedy was a falivation. I 
 iliall hereafter fliew the inferiority of this fingle 
 mode of depleting, to a combination of it with bleed- 
 ing and purging. In Philadelphia, and Baltimore 
 where bleeding, purging, and falivation were ufed 
 
 * Medical E flays and Obfervations, p. 29, 
 f Account of die yellow fever in 1793. 
 
 n 2 in 
 
Il6 AN ACCOUNT OF THE 
 
 In due time, and after the manner that has been 
 defcribcd, not more than one in fifty died of the yel- 
 low fever. It is probable that greater certainty and 
 fuccefs in the treatment of this difeafe, will not eafily 
 be attained, for idiofyncracy, and habits of intem- 
 perance which refill or divert the operation of the 
 mofh proper remedies, a dread of the lancet, or the 
 delay of an hour in the ufe of it, the partial appli- 
 cation of that or any other remedy, the unexpe^led 
 recurrence of a paroxyfm of fever in the middle of 
 the night, or the clandeftine exhibition of wine or 
 laudanum by friends, or neighbours, often defeat the 
 befh concerted plans of cure by a phyfician. Heaven 
 in this, as in other inftances, kindly limits human 
 power, and benevolence, that in all fituations man 
 may remember his dependence upon the power and 
 goodnefs of his Creator.* 
 
 * An innate dread of the lancet, deprived the world pre- 
 maturely, of the talents and virtues of William Bradford 
 Efq. Attorney General of the United States, on the 23d of 
 Augufl; 1795. ^^ refufed to fubmit to bleeding in a malig- 
 nant bilious fever for five days, during which time fuch ef- 
 fufions took place, as rendered that, and other remedies in- 
 effedual in his cafe. I ftiall long, very long, mourn the 
 death of this excellent man. He was to me a friend and a 
 brother. The delay of bleeding for one night only, during 
 a fevere paroxyfm of the fame (late of fever, deprived me cf 
 a beloved pupil Mr. Gilbert Watfon on the 25th of Septem- 
 ber of the fame year. He caught it by the moft extraordinary 
 
 exertions 
 
BILIOUS YELLOW FEVER, IN 1 794. llj 
 
 This victory Incomplete as it is, over a difeafe, 
 once the terror and fcourge of mankind, has not 
 been a cheap one. It has been purchafed at the 
 expenfe of much hibour and obloquy. The num- 
 ber of the perfons who have died under my care, 
 has been much exaggerated, and the mofl affefting 
 llories have been circulated of their dying under the 
 immediate ufe of my remedies. A fmgle death 
 where bleeding had been ufed without fuccefs, has 
 injured my reputation more than twenty deaths 
 created by the negle^l of it, or by the improper 
 ufe of tonic remedies, have injured other phy- 
 ficians. Nay, further, the palenefs which is induced 
 by bleeding, has in a fmgle inflance, been urged 
 with more fuccefs to difcredit my pra61:ice, than a 
 dozen deaths would have been, had I confined myfelf 
 to the ufual remedies for fever. The reader will 
 conceive of the horror with which my prafiice of 
 bleeding in this fever is viewed, when I add, that 
 a lady who vifited one of my female patients whom 
 I had bled feveral times, implored her upon her knees 
 not to permit me to bleed her any more. Her 
 prayer had no eftcifr. I bled her frequently after- 
 wards, but that ilie might not be diflurbed by a 
 repetition of the entreaties of her friend, I concealed 
 
 exertions of fk'll and humanity in attending and nurfing \ 
 Tick family, on the Delaware, about 20 nules from Phila- 
 delphia. 
 
 H 3 the 
 
Il8 AN ACCOUNT ScC, 
 
 the blood, at her requeft, each thne after drawhig it 
 in a clofet, nor was it known that I did fo, until 
 fome time after her recovery. 
 
 I commit the calumnies which have followed my 
 opinions and praci:ice in this fever, to the dufl. If 
 the foil, I have endeavoured to cultivate, fliould 
 afford a plentiful harvefl to my pupils, I fliall not 
 repine, although I have reaped nothing from it, but 
 briars and thorns. And if my labours upon this 
 fubjecl fliould be bleffed to the conviction and benefit 
 of the citizens of Philadelphia, I fliall rejoice in my 
 pcrfecutions. 
 
 To that Being who often makes ufe of weak and 
 unworthy inftruments to accomplifli the purpofes 
 of his benevolence, in order thereby to fix the gra- 
 titude of his creatures upon his own almighty power 
 and goodnefs, I defire thus publicly to record my 
 acknowledgments for having made me in the fmallefl 
 degree ufeful to my fellow m.en in any part of the 
 world, by the revival and application of remedies 
 which have fubdued, in a great meafure, the force of 
 a once formidable and mortal diforder. To his great 
 and holy name be afcribed honor, and power, and 
 glory, by all his intelligent creatures, for ever, and 
 ever. 
 
AN 
 
 INQUIRY 
 
 INTO THE 
 
 PROXIMATE CAUSE 
 
 OF 
 
 FEVER. 
 
AN 
 
 INQJJIRY, &c. 
 
 m A V I N G yielded to the follcitations of 
 my pupils to piiblifli a defence of blood-letting in 
 certain difeafes, I found that I could not do juflice 
 to the fubjeft, as it relates to the cure of fevers, 
 without firfl delivering a few obfervations upon that 
 ftate of the blood-veiTels, which conftitutes the 
 proximate caufe of fever. I fliall therefore proceed 
 briefly to deliver the fubflance of what I have taught 
 for feveral years upon this fubje^t in the Univerfity 
 of Pennfylvania, and what has, for many years, re- 
 gulated my pradice in the treatment of fevers. 
 
 Previouily to my entering upon this fubjeci:, I 
 Ihall give a fliort account of the changes which I 
 have made in my opinions upon It. My firil prin- 
 ciples in medicine were derived from Dr. Boer- 
 Jiaave, and from his aphorifms as explained by 
 y.anf\yiete^.i5 I adopted my firfl ideas of fever. 
 
 The 
 
122 ON THE PROXIMATE 
 
 The reader may eafily conceive of the pains I took 
 to become mailer of this fubje£^, when I add, that 
 before I was twenty years of age, I abridged all 
 thofe vohmies of Vanfwieten's Commentaries on 
 Dr. Boerhaave's aphorifms which treat of fever. 
 I need hardly add, that Dr. Boerhaave placed its 
 proximate caufe wholly in a lentor of the blood, 
 and in morbific matter. 
 
 When I w^ent to Edinburgh in the year 1766, 1 
 relinquiilied this theory of fever, and embraced a 
 m.ore rational one, firfl propofed by Dr. Hoffman, 
 and afterwards revived with many advantages by 
 Dr. Cullen, I mean the theory of a fpafm upon the 
 extremities of the capillary veiTels in every part of 
 the furface of the body. Soon after my fettlement 
 in Philadelphia in the year 1769 I found that this 
 theory did not accord with many of the phenomena 
 of fever. I was therefore forced to defert it ; and 
 for many years I fioundered upon an ocean of 
 doubt and uncertainty with refpe<5l to the proximate 
 caufe of fever. Many painful hours have I fpent 
 in contemplating this fubjefi:. At length light broke 
 in upon my mind. The phenomena of fever fuddenly 
 appeared to me in a new order. I inflantly combined 
 them into a new theory. Whether this theory be 
 juft, or not, time muft difcover. Since I have 
 adopted it, my practice in fevers has been more Am- 
 ple, 
 
CAUSE OF FEVER. 1 23 
 
 pIc, and far more fuccefsful than formerly. It has 
 moreover thrown a light upon the proximate caufc 
 of feveral other difeafes, and led to a practice equally 
 fimple and fuccefsful in them.. I feel no fliaine in 
 thus publicly acknowledging that I have more than 
 once changed my opinions in medicine. To be un- 
 changeable, belongs only to that being who fees 
 things in their order and relation to each other by 
 a fnigle act of intuition. A change in opinions is 
 the necelTary eifeft of fuccefTion in the acquifition of 
 knowledge, and I believe a new truth is feldom ac- 
 quired by men of common education, but at the ex- 
 pence of an old error. 
 
 I fliall not attempt to give a definition of fever. 
 It appears in fo many different form?, that a jufl 
 view of it can only be given in a minute detail of all 
 its fymptoms and dates. 
 
 In order to render the theory of fever, which I 
 am about to deliver, more fimple and intelligible, 
 it will be neceflary to premife a few general pro- 
 pofitions. 
 
 I. Fevers of all kinds are preceded by general 
 -debility. This debility is of two kinds, viz. direfl: 
 and indire^l:. The former depends upon an ab- 
 Itraclion of ufual and natural fi:imuh ; the latter 
 
 upon 
 
124 t)N THE PROXIMATE 
 
 upon an increafe of natural, or upon the a£tion of 
 preternatural flimuli upon the body. However op- 
 pofite thefe caufes of debility may be, they unite 
 in their efFedls, and that in fuch a manner, that dire(51: 
 and indirect debility are frequently to be diftinguilli- 
 ed, only by a knowledge of the caufes which in- 
 duce them. 
 
 That fevers are preceded by general debility, I 
 infer from their caufes. Thefe aft direftly or in- 
 direftly on the fyflem. I fliall firfl mention thofe 
 caufes of fever which aft by inducing dired^ and 
 afterwards thofe which aft by inducing indired de- 
 bility. 
 
 The former are, 
 
 I . Cold. This is univerfally acknowledged to be 
 a predifpofmg caufe of fever. That it debilitates, I 
 infer, i. From the languor which is obferved in the 
 inhabitants of cold countries ; and from the weaknefs 
 which is felt in labour or exercife in cold weather. 
 2. From the effefts of experiments, which prove, 
 that cold air and cold water leiTen the force and 
 frequency of the pulfe. 
 
 The other caufes of direft debility which predif- 
 pofe to fever are, 
 
 2. The 
 
CAUSE OF FEVER. I25 
 
 1. The debilitating paffions of fear, grief, and 
 defpair. 
 
 3. All excelTive evacuations, whether by the 
 bowels, blood-veffels, pores, or urinary palTages. 
 
 4. Famine, or the abflraflion of the ufual quan- 
 tity of nourifhing food. 
 
 The caufes which predifpofe to fever by inducing 
 indired debility are, 
 
 1 . Heat. Hence the greater frequency of fevers 
 in warm climates and in warm weather. 
 
 2. Intemperance in eating and drinking, 
 
 3. Fatigue. 
 
 4. Certain caufes which a61: by over-fb-etching a 
 part or the whole of the body, fuch as lifting heavy 
 weights, external violence acting mechanically in 
 wounding, bruifmg, or compreflmg particular parts, 
 extraneous fubftances afting by their bulk or gra- 
 vity, burning, and the like. * Some of thefe caufes 
 a6l locally, but they aife^l the fyflem fecondarily by 
 
 * Cullen's Firll lines. 
 
 inducing 
 
126 ON THE PROXIMATE 
 
 inducing" in it indirect debility. I infer further, that 
 fevers depend upon predifpofmg debihty from the 
 time in vi^hich they moft commonly attack, viz. in 
 the night, when the fyflem is in a ftate of debility ; 
 and from the fyraptoms which accompany the at- 
 tack of a fever, fuch as weaknefs in the limbs, in- 
 ability to ftand or walk, coldnefs or chills, fleepinefs, 
 a fiirinki.ng of the hands and face, and a weak or 
 quick puh'e. 
 
 In anf iver to this general propofition it may be 
 faid, that contagions, whether of the fmall-pox or 
 meailes, a<51 without the predifpofition of debility ; 
 and that this predifpofition is not neceffary to pro- 
 duce a fever from the contagions of the plague or 
 yellow fever. To this I reply, that none of thofe 
 contagioQs a«5t fo as to produce fever, until they 
 have firli^. induced indirect debility ; and that their 
 action is more fpeecly, certain, and violent in pro- 
 portion to the degrees of direct or indirect debility 
 which hare preceded them. This is fo well known, 
 that the f afety or fatal iffue of fevers from conta- 
 gion is generally expefted, from their having been 
 preceded by more or lefs of the enumerated caufes 
 of direct oj: indirect debility. 
 
 II. Deb.^Oity is always fucceeded by increafed ex- 
 citability, or a greater aptitude to be acted upon 
 
 by 
 
CAUSE OF FEVER. 1 27 
 
 by flimuli. This Increafe of excitability is faid by 
 Dr. Brown to be confined only to a ftate of direci 
 debility, but it takes place in all cafes of indire£l: 
 debility ; where it isfuddoih induced upon the fyf- 
 tern. IndirecH: and dire<Si: debility are upon a foot- 
 ing, where they are of a chronic nature. They 
 both equally expend the excitability of the fyfteiii, 
 and leave it in a flate in which llimuli generally 
 adt with too little force upon it to excite in it tlie 
 commotions of fever. 
 
 III. The diminution or abflra61;ion of one fLimulus 
 IS always followed by the increafed a6lion of others. 
 
 Let us apply thefe principles, before w^e lofe fight 
 of them, to the produ6lion of fever. 
 
 Has the body been debilitated by long expofure 
 to the cold air ? — its excitability is thereby in- 
 creafed, and heat acts upon it with an accumulated 
 force ; hence the frequency of catarrhs, pleurifies, 
 and other inflammatory fevers in the fpring, after 
 a cold winter ; and of bilious remittents in the au- 
 tumn, when Vv^arm days fucceed to cold and damp 
 nights. Thefe difeafes are feldom felt for the firfh 
 time in the open air, but generally after the body 
 has been expofed to cold, and afterwards to the heat 
 of a warm room or a warm. bed. Mild intermit- 
 
 tents 
 
128 ON THE PROXIMATE 
 
 tents have frequently been obferved to acquire ztt 
 inflammatory type in the Pennfylvania hofpital, \u 
 the months of November and December, from the 
 heat of the flove rooms acling upon bodies prevr- 
 oufly debilitated by cold and difeafe. 
 
 Has there been an abflra^lion of heat by a fud- 
 den fliifting of the wind from the fouth-wefl to the 
 north-weil or north-eaft points of the compafs, or 
 by a cold night fucceeding to a warm day ? — a fever 
 is thereby frequently excited. Thefe fources of fever 
 occur every autumn in Philadelphia. The rniaf- 
 mata or contagion which exifl in the body at that 
 time in a harmlefs ftate, are excited into a61ion by 
 the debility from cold, aided in the latter cafe by 
 the inaction of fleep fuddenly induced upon the fyflem. 
 
 Again : Has the body been fuddenly debilitated 
 by fatigue ? — its excitement is thereby diminiflied, 
 but its excitability is increafed in fuch a manner that 
 the ftimulus of a full meal, or an intemperate glafs 
 of wine, if taken immediately after the fatigue is 
 induced upon the body, excites a fever ; hence the 
 frequency of fevers in perfons upon their return 
 from hunting, furveying, long rides, or from a camp 
 life. A fever from the laft caufe, was very com- 
 mon during the late war in America. A hot fup- 
 per, and afterwards the heat of a warm bed, fome- 
 
 times 
 
CAUSE OF FEVER, 12^ 
 
 times induced not only fever, but a convulfion in 
 the nervous fyftem in many perfons the night after 
 they returned from the coarfe diet of the camp^ 
 and from lleeping upon an earthen or wooden fioon 
 Many other inflances might be mentioned of fever 
 being brought on by ordinary fliimuli, ailing upon 
 increafed or accumulated excitability. 
 
 This conne6lion of excitability with debility, has 
 lately been pointed out by the French phyficians by 
 the terms " laxite vibratile,*' by which they mean 
 a liablenefs in the fyilem to be thrown into vibra*' 
 tions or motions by the predifpolition of debility. 
 
 That this vibratility, or difpofition to preterna* 
 tural motion in animal matter, is the predifpoling 
 caufe of fevers, is evident from their occurring in 
 thofe flages of life in which it is mofh common, as 
 in infancy, childhood, youth, and middle life. Fe- 
 vers are lefs common in old age, for the vibra- 
 tility of the fanguiferous fyilem, in which I fhall 
 prefently fay the proximate caufe of ordinary fevef 
 is feated, generally declines in old people. It even 
 leiTens in the ikin, as appears by contrading it for 
 half a minute between the fingers. 
 
 IV. The flimuli which are the remote or exciting 
 caufes of fever, a6t in a manner wholly different 
 
 I froni 
 
1^6 ON THE PROXIMATE 
 
 from what they do, upon a body in which there is 
 tio predifpofition to fever. In health there is a con- 
 flant and jufl proportion between the degrees of 
 excitement and excitability, and the force of flimuli. 
 But this is not the cafe in a predifpofition to a fe- 
 ver. The ratio between the action of flimuli and 
 excitement, and excitability is^ deftroyed ; and hence 
 the former act upon the latter with a force which 
 produces irregulaf action, or a convulfion in the ar- 
 terial fyilem. When the body is debilitated, and 
 its excitability increafed, either by fear, darknefs, 
 or filence, a fudden noife occafions a fhort convul- 
 fion. We awake in like manner in a light convul- 
 fion, from the fudden opening of a door, or from 
 the fprinklrng of a few drops of water in the face, 
 after the excitability of the fyilem has been accu* 
 mulated by a night^s fleep. In a word, it feems to 
 be a law of the fyilem that ilimulus, in an over-pro- 
 portion to excitability, either produces convulfion, 
 or goes fo far beyond it, as to deflroy motion alto- 
 gether in death. 
 
 V. The flimuli which induce the irregular a^lion 
 ©r convulfion of fever, a£l, for the mofl part, pri- 
 marily upon the fanguiferous, and particularly upon 
 the arterial fyflem. The arteries pervade every 
 part of the body. They terminate on every part 
 ef its furface, in which I include the lungs and ali- 
 mentary 
 
CAUSE OF FEVER. 1^| 
 
 mentary canal, as well as the ikin. It is from this 
 circumflance that they are fo eafily afFe^led by cold^ 
 heat, and all the other remote and exciting caufes 
 of fever* I need not paufe to prove that the blood- 
 velTels poiTefs mufcular fibres, and that their irrita- 
 bility, or difpofition to motion, depends upon them. 
 This has been demonflrated by Dr. Vaffchuer and 
 Mr. John Hunter by many experiments. Dr. Boer- 
 haave admits it in the hiflory he has given in his In- 
 ftitutes, of an ox that was killed immediately after 
 it had been violently heated by running away. The 
 coats of its arteries were fuffufed with blood, in 
 confequence of inflammation. Even Dr. Haller, 
 who denies the mufcularity and irritabihty of the 
 blood- veflels, implies an aflent to them in the fol- 
 lowing words : " There are nerves which defcend 
 for a long way together through the furface of the 
 artery, and at lafl vanifh in the cellular fubflance of 
 the veflel, of which we have a fpecimen in the ex- 
 ternal and internal carotids, and in the arch of the 
 aorta ; and from thefe do not the arteries feem to 
 derive a mufcular and convulfive force very different 
 from that of their fimple elaflicity ? Does not this 
 ftiew itfelf plainly in fevers^ faintings, pallies, coni- 
 fumption, and palfions of the mind ?'' * 
 
 * FIrfl Lines, f 32. of the chapter on the Arteries. 
 
 I 2 The 
 
f^i ON THE PROXIMATE 
 
 The morbid a£lion of the blood-veffels difcovers 
 jtfelf in preternatural force or frequency in the pul- 
 fations of the arteries. In this flate of the arteries, 
 the flomach, bowels, and mufcles exhibit marks of 
 preternatural weaknefs, for natural excitement is 
 abflracled from them, and concentrated in the fan* 
 guiferous fyftem. 
 
 VI. There is bat one remote caufe of fever, and 
 that is flimulus. Heat, alternating with cold, * 
 marili and human miafmata, contagions and poifons 
 of all kinds, intemperance, paJfTions of the mind^ 
 bruifes, burns, and the like, all a£l by a flimulating 
 power only, in producing fever. This proportion 
 is of great application, inafmuch as it cuts the fmews 
 of the divillon of difeafes from their remote caufes. 
 Thus it eftabliflies the famenefs of a pleurify, whe- 
 ther it be excited by heat fucceeding cold, or by the 
 contagion of the fmall-pox, meafles, or yellow fever. 
 
 VII. There is but one fever. Hovv^ever diiFerent 
 the predifpofmg, remote, or exciting caufes of fever 
 
 * Dr. Sydenham afcrlbes nearly all fevers to this caufe, 
 particularly to leaving off winter clothes too foon, and to ex- 
 pofing the body to cold after it has been heated. Thefe two 
 fources of fever, he adds, deftroy more than the plague, fword, 
 jOT faroinc. 
 
 Wallis's Edition, Vol. I. p. 357. 
 
 jnay 
 
CAUSE OF FEVER. i:*-; 
 
 may be, whether dire<^ or indire^l debility, whe^ 
 ther heat or cold fucceeding to each other, whether 
 marlli or human miafmata, whether intemperance, 
 a fright, or a fall, (till I repeat, there can be but 
 one fever. I found this proportion upon all the 
 fuppofed variety of fevers having but one proxi- 
 mate caufe. Thus fire is an unit, whether it be 
 produced by fri^lion, percullion, elecl:ricity, fermen- 
 tation, or by a piece of wood or coal in a flate of 
 ■inflammation. 
 
 VIII. All ordinary fever being feated in the 
 blood-vefleis, it follows of courfe, that all thofe 
 local alfedions we call pleurify, angina, phrenitis, 
 internal dropfy of the brain, pulmonary confump- 
 tion, and inflammation of the liver, flomach, bowels, 
 and limbs, are fyraptoms only of an original and 
 primary difeafe in the fanguiferous fyftem. The 
 truth of this propofition is obvious, from the above 
 local aifeclions fucceeding primary fever, and from 
 their alternating fo frequently with each other. I 
 except from this remark thofe cafes of primary af- 
 fections of the vifcera which are produced by local 
 injuries, and which, after a while, bring the whole 
 fanguiferous fyflem into fympathy. Thefe cafes are 
 uncommon, amounting probably to not more than 
 one in a hundred of all the cafes of local affc<flion 
 which occur in general fever. 
 
 I 3 Having 
 
134 ON THE PROXIMATE 
 
 Having premifed thefe general propofitions, I 
 go on to remark, that a fever (when not mifplaced") 
 confills in a morbid excitement and irregular action 
 in the blood- vefTels, more efpecially in the arteries. 
 This morbid excitement, or irregular aftion, mani- 
 fells itfelf to the fingers, v^hen prelTed upon the 
 radial artery, by preternatural fulnefs, force, and 
 frequency, or by preternatural flownefs, intermif- 
 iions and depreffion in what are called inflammatory 
 fevers, and by preternatural frequency without ful- 
 nefs or force, in what are called typhus fevers, 
 
 I have called the aclion of the arteries irregular 
 in fever, to diftinguiih it from that excefs of action 
 which takes place after violent exercife, and from 
 that quicknefs which accompanies fear or any other 
 diredly debilitating caufe. The adiion of the arteries 
 here is regular^ and when felt in the pulfe, affords a 
 very different perception to the mind from that 
 which we feel in the pulfe of a patient labouring 
 under a fever. 
 
 This irregular a^lion is in other words, a con- 
 vulsion in the fanguiferous, but more obvioufly, in 
 the arterial fyilem. 
 
 That this is the cafe I infer from the flri^l analogy 
 between fymptoms of fever, and convulfions in the 
 
 nervous 
 
CAUSE OF FEVER.. . Ij^j;. 
 
 nervous fyftem. I lliall briefly mention the partlcu-. 
 lars in which this analogy takes place. 
 
 1. Are convulfions in the nervous fyflem pre- 
 ceded by debility ? So is the convuliion of the blood- 
 vcffels in fever. 
 
 2. Does debility induced on the whole, or on a 
 part only, of the nervous fyflem, predifpofe to 
 general convulfions, as in tetanus ? So we obferve 
 debility, whether it be induced on the whole or on 
 a part of the arterial fyflem, predifpofes to general 
 fever. This is obvious in the fever which enfues 
 alike from cold applied to every part of the body, 
 or irom a flream of cold air falling upon the neck, 
 or from the wetting of the feet. 
 
 5. Do tremors precede convulfions in the nervous 
 fyflem ? So they do the convulfion of the blood- 
 vefTels in fever. 
 
 4. Is a coldnefs in the extremities a precurfor 
 of convulfions in the nervous fyflem ? So it is of 
 fever. 
 
 5. Do convulfions in the nervous fyflem impart 
 .a jerking fenfation to the fingers ? So does the con- 
 
 I 4 vulfion 
 
13^ ON THE PROXIMATE 
 
 vulfion of fever in the arteries, when felt at the 
 wriib. 
 
 6. Arc conYulfions in the nervous fyftem attended 
 with alternate a£tion and remiffion ? So is the con- 
 vulfion of fever. 
 
 7. Do convulfions in the nervous fyflem return 
 at regular and irregular periods ? So does fever. 
 
 8. Do convulfions in the nervous fyftem, under 
 certain circumftances, affeft the functions of the 
 brainf So do certain flates of fever. 
 
 9. Are there certain convulfions in the nervous 
 fyllem which affe£l the limbs, without aifefting the 
 fun£Hons of the brain, fuch as tetanus, and chorea 
 fanfli Viti ? So there are certain fevers, particularly 
 the common he<^ic, which feidom produces delirium 
 or even head ach, and frequently does not confine 
 a patient to his bed, 
 
 10. Are there local convulfions in the nervous 
 fyflem, as in the hands, feet, neck, and eye-lids ? 
 So there are local fevers. Intermittents often appear 
 in the autumn with periodical heat and pains in the 
 eyes, ears, jaws, and back, 
 
 II, Are 
 
CAUSE OF FEVER, *" I37 
 
 11. Are there certain grades in the convulfions of 
 the nervous fyftem, as appears in the hydrophobia, 
 tetanus, epilcpfy, hyfteria and, hypochondriacs ? So 
 there are grades in fevers, as in the plague, yellow 
 fever, fmall-pox, rheumatifm, and common remitting 
 and intermitting fevers. 
 
 12. Are nervous convulfions moll apt to occur ii! 
 infancy ? So are fevers. 
 
 13. Are perfons once afFefted with nervous con- 
 vulfions, frequently fubje£l to them through lifer 
 So are perfons once aiFefted with fever. The inter- 
 mitting fever often returns with fuccelTive fprings or 
 autumns, and in fpite of the bark, fometimes con- 
 tinues for many years in all climates and feafons* 
 
 1 4. Is the ftrength of the nei'vous fyilem increafed 
 by convulfions ? This is fo evident, that it often re- 
 quires four or Rye perfons to confine a delicate 
 woman to her bed in a convulfive fit. In like man- 
 ner the flrength of the arterial fyflem is increafed in 
 a fever. This ftrength is great in proportion to the 
 weaknefs of every other part of the body. 
 
 15. Do we obferve certain nervous convulfions 
 to aife^l fome parts of the nervous fyftem more 
 than others, or in other words, do we obferve pre- 
 ternatural 
 
138 ON THE PROXIMATE 
 
 ternatural flrength or excitement, to exifl in one 
 pai't of the nervous fyllem, while other parts of 
 tlie fame fyflem exhibit marks of preternatural 
 weaknefs, or defe^l of excitement ? We obferve 
 the fame thing in the blood- veiTels in a fever. The 
 pulfe at the wrifl is often tenfe^ while the force 
 of the heart is very much diminillied. A delirium 
 often occurs in a fever from excefs of excitement in 
 the blood-velTels of the brain, while the pulfe at the 
 wrifl exhibits every mark of preternatural weak- 
 nefs, 
 
 16. Is there a rigidity of the mufcles in certain 
 nervous difeafes, as in catalepfy ? Something like 
 this folftice in convulfion occurs in that flate of fever 
 in which the pulfe beats but 60, or fewer ftrokes in 
 a minute. 
 
 17. Do convullions go off gradually from the 
 nervous fyftem, as in tetanus, and chorea fan£i:i Viti ? 
 So they do from the arterial blood-velTeis in certain 
 Hates of fever. 
 
 18. Do convulfions go o^ fuddenly in any cafes 
 from the nervous fyftem ? The convulfion in the 
 "blood- veffels, goes off in the fame manner by a 
 fweat, or by an hjemorrhage, frequently in the 
 foiirfe of a night, and fometimes in a fmgle hour. 
 
 19. Does 
 
CAUSE OF FEVER. 1 39 
 
 19. Does palfy in fome inflances fucceed to con- 
 vulfions in the nervous fyftem ? Something like a 
 palfy occurs in the blood-veffels in fevers of great 
 inflammatory aftion. I fliall hereafter afcribe the 
 diflblved appearance of the blood in malignant fevers 
 to this tendency of the blood-veflTels to a paralytic 
 ftate. It begins in the veins in which mufcular aftion 
 is more feeble than in the arteries. This has been 
 proved by Dr. Mitchell in his account of the yellow 
 fever in Virginia in the year 1741. He found the 
 blood to be diflblved when drawn from the veins ^ 
 "Vi^hich when drawn from the arteries of the fame 
 perfons, exhibited no marks of difTolution. This faft 
 is of great importance in medicine, as I hope to 
 fliew when I come to treat of blood-letting. 
 
 From the fa£i:s and analogies which have been 
 mentioned, I have been led to believe that irregular 
 a£l:ion or a convulfion in the blood-veffels, is the 
 proximate caufe of fever. 
 
 There is a wonderful frugality in the operations 
 of nature. Two inilruments are never employed 
 by her to accomplifli that which can be effeded by 
 one. As the predifpofmg and remote caufes of all 
 general difeafes are fimple, fo is the proximate. My 
 theory of fever then refolves itfelf into a chain, con- 
 filling of four links, i . Predifpofmg debility, or 
 
 weakened 
 
i40 ON THE PROXIMATE 
 
 weakened excitement of the blood-velTels. 2. An 
 increafe of their excitability. 3. Stimulating powers 
 applied to them. And, 4. Irregular a^lion or con- 
 vuliion. 
 
 I might digrefs here, and fliew that all difeafes, 
 whether they be feated in the arteries, mufcles, 
 nerves, brain, or alimentary canal, are all preceded 
 by debility ; and that their efience confifts in irre- 
 gular aftion, or in the abfence of the natural order 
 of motion, produced or invited by prcdifpofmg de- 
 bility. Hence they have very properly been called 
 DISORDERS. I might further fliew, that all the 
 moral as well as phyfical evil of the world confifls 
 in predifpofmg v/eaknefs, and in fubfequent de- 
 rangement of action or motion ; but thefe collateral 
 fubjecls are foreign to our prefent inquiry. 
 
 Let us now proceed to examine how far the 
 theory, which ha^ been delivered, accords with the 
 phenomena of fever. 
 
 I fliall divide thefe phenomena into two kinds. 
 
 I. Such as are tranfient, and more or lefs com- 
 mon to all fevers. Thefe I fliall call fymptoms of 
 
 fever. 
 
 II. Such 
 
CAUSE OF FEVER. I4I 
 
 IL Such as, being more permanent and fixed, 
 have given rife to certain fpecific names. Thefe I 
 ihall czWjlaUs of fever. 
 
 I fliall endeavour to explain and defcribe each of 
 them in the order in which they have been men- 
 tioned. 
 
 I. Laffitude is the natural efFe6l of the predif- 
 pofmg debility which precedes fever. 
 
 Coidnefs and chills are the efFecls of the abflrac- 
 tion of excitement, or natural motion from the fur- 
 face of the body. The abfencc of chills indicates 
 the fenfibility of the external parts of the body to 
 be fufpended or deilroyed, as well as their irrita- 
 bility ; hence where death occurs in the fit of an 
 intermittent, there is no chill. A chilly fit, for the 
 fame reafon, feldom occurs in the moil malignant 
 cafes of fever. It has been remarked, that the 
 chilly fit, in common fevers, feldom appears in its 
 full force until the patient approaches a fire, or lies 
 down in a warm bed ; for in thefe fituations the fen- 
 fibility of the fyfi:em is refi:ored by the fi:imulus of 
 the heat ailing upon the extremities of the blood- 
 vefifels. It is produced in a mechanical manner, and 
 is by no means the effe^i: of an effort of the healing- 
 powers of nature to fave the fyflem from defi;ru(^ion. 
 
 Tremors 
 
142 ON THE PROXIMATE 
 
 Tremors are the natural confequence of the ab- 
 flra^lion of that fupport which the mufcles receive 
 from the fulnefs and tenfion of the blood- veiTels. 
 It is from this retreat of the blood towards the vif- 
 cera, that the capillary arteries lofe their fulnefs and 
 tenfion ; hence they contraft like other foft tubes 
 that are emptied of their contents. This contraction 
 has been called a fpafm, and has improperly been 
 fuppofed to be the proximate caufe of fever. From 
 the explanation that has been given of its caufe, it 
 appears like the coldnefs and chills, to be nothing 
 but an accidental concomitant or effed of a pa- 
 roxyfm of fever. 
 
 The local pains in the head, breafl, and bones in 
 fever, appear to be the eifects of the irregular de- 
 termination of the blood to thofe parts, and to mor- 
 bid aflion being thereby induced in them. 
 
 The vomiting and diarrhoea are produced by mor- 
 bid excitem.ent in the veflels of the ftomach and 
 bov/els- 
 
 The want of appetite and coflivenefs are the con- 
 fequences of a defect of excitement or natural ac- 
 tion in the fame parts of the body. 
 
 The 
 
CAUSE OF FEVER. 14^ 
 
 The dry fkin or partial fweats appear to depend 
 Hpon dimlniflied or partial action in the velTelg 
 which terminate on the furface of the body. 
 
 The high coloured and pale urine, are occafioned 
 by an excefs or a deficiency of excitement in the 
 fecretory vefTels of the kidneys. 
 
 The fuppreflion of the urine feems to arife from 
 what Dr. Clark calls an engorgement, or choaking 
 of the velTels of the kidneys. It occurs moil fre- 
 quently in malignant fevers. 
 
 Thirfl is probably the efFe^l: of a preternatural 
 excitement of the veiTels of the fauces. It is by 
 no means an uniform fymptom of fever. We fome- 
 times obferve it in the highefl degree, in the iaft 
 flage of difeafes, induced by the retreat of the lafl 
 remains of excitement from every part of the body^ 
 to the throat. 
 
 The white tongue is produced by a change in 
 the fecretion which takes place in that organ. Its 
 yellow colour is the effect of bile j its drynefs, is 
 occafioned by an obflru^tion of fecretion ; and its 
 dark and black colour, by a tendency to mortifica- 
 tion. 
 
 It 
 
144 ON THE PROXIMATE 
 
 It will be difficult to account for the variety In 
 the degrees and locality of heat in the body in a 
 fever, until we know more of the caufe of animal 
 heat. From whatever caufe it be derived, its excefs 
 and deficiency, as well as all its intermediate de- 
 grees, are intimately conne£led with more or lefs 
 excitement in the arterial fyilem. It is not neceffary 
 that this excitement fliould exifl only in the large 
 blood-veifels. It will be fufficient for the purpofc 
 of creating great heat, if it occur only in the cuta- 
 neous velTels ; hence we find a hot ikin in fome 
 cafes of malignant fever in which there is an ab- 
 fence of pulfe, A defecl of excitement produced 
 by great excefs of flimulus, as in the firfl flage of 
 violent malignant fevers, is often accompanied by a 
 deficiency of heat, and in fome inftances by a cold- 
 nefs on the furface of the body. In thefe cafes 
 there is a defe61: of excitement in the vefiels of the 
 Jlcin as well as in the larger blood-vefi!els. Local 
 heat, whether in the head, breaft, hands, or feet, 
 I fuppofe to be the ^ffeci: of local excitement. 
 
 Eruptions feem to depend upon efiufions of fe* 
 rum, lymph, or red blood upon the ilcin, with or 
 without inilammaticn, in the cutaneous veifels. 
 
 I decline taking notice in this place of the fame* 
 D.efs of the fymptoms which are produced by in- 
 
 4 direct 
 
CAUSE OF FEVER. I45 
 
 dire£i: and dlre<ft debility in the fyftem. They ap- 
 pear not only in the temperature of the body, but 
 in all the different fymptoms of fever. It is of im- 
 portance to know when they originate from the 
 former, and when from the latter dates of debility, 
 as they require very different and oppofite remedies 
 to remove them. 
 
 It remains only to explain the caufe, w^hy excefs 
 in the, force or frequency of the a£i:ion of the 
 blood-veffels fliould fucceed debiHty in a part, or 
 in the whole of the body, and be connected for days 
 ^nd weeks with preternatural debility in the muf- 
 cles, nerves, brain, and alimentary canal. I fhall 
 attempt the explanation of this phenomenon by 
 diredling the attention of the reader to the opera- 
 tions of nature in other parts of her works. 
 
 1. A calm may be confidered as a flate of de- 
 bility in the atmofphere. It predifpofes to a cur- 
 rent of air. But is this current proportioned to 
 the lofs of the equilibrium of the air ? By no means : 
 It is exceffive in its force, and tends thereby to de-^ 
 flroy the works both of nature and art. 
 
 2. The paffions are given to man on purpofe to 
 aid the flow and uncertain operations of reafon* 
 But is their action always proportioned to the caufes 
 which excite them? An acute pneumony brought 
 
 K on 
 
146 ON THE PROXIMATE 
 
 on by the trifling injury done to the fyflem by the 
 fatigue and heat of an evening fpent in a dancing 
 aflembly, is but a faint reprefentation of the im- 
 menfe difproportion between a trifling affront, and 
 that excefs of paflion which feeks for gratification in 
 poifon, aflafllnation, or a duel. The fame difpropor- 
 tion appears between caufe and effbft in pubHc bo- 
 dies. A hafty word of no mifchievous influence, 
 has often produced convulfions, and even revolu- 
 tions, in ftates and empires. 
 
 If we return to the human body, we fhall find in 
 it many other inflances of the difproportion between 
 ftimulus and aftion, befides that which takes place 
 in the exciting and proximate caufe pf fever, 
 
 3. A fingle caftor oil nut, although rejected by 
 the ilomach upon its firfl eflbrt in vomiting, has, in 
 one inflance that came within my knowledge, pro- 
 duced a vomiting that continued nearly twenty-four 
 hours. Here the duration of a^lion was far beyond 
 
 all kind of proportion to the caufe which excited it, 
 
 » 
 
 4. A grain of fand, after being wafhed from 
 the eye, is often followed by fuch an iliflammation, 
 or excefs in the a^lion of the veflfels of the eye, as 
 to require bleeding, purging, and bliftering to re- 
 move it. 
 
 Could 
 
CAUSE OF FEVER, I47 
 
 Could we comprehend every part of the fublime 
 and ineffable fyflem of the natural, moral, and po- 
 litical government of the world, I am fure we ftiould 
 dilcover nothing in it, but what tended ultimately 
 to order and happinefs. But there is evil in the 
 world, and the operations of nature, which were 
 originally the minifters of goodnefs only to man, 
 are in many inilances the vehicles of this evil. In 
 religion and morals, as well as in medicine, nature 
 leads to error and deflruftion. When we worlliip 
 the fun, a cat, a crocodile, or the devil, we follow 
 nature. When we lie, fleal, and commit murder 
 and adultery, we follow nature. In like manner, 
 when we indulge every appetite and paiTion of our 
 patients in ficknefs, and create hcemorrhages, ob- 
 llru£iions, dropfies, pallies, apoplexies*, and death, 
 by neglecting bleeding and purging in fevers, we 
 follow nature. But while I maintain this unufual 
 language in medicine, let it be remembered, that 
 the operations of nature were not originally the 
 means of feducing or injuring man ; and Revelation 
 affures us, that a time will come, when the dominion, 
 of order ihall be reftored over every action of his 
 body and mind, and health and happincfs again be 
 the refult of every movement of nature. 
 
 From the view I have given of the ftate of the 
 blood-veffels in fever, the reader will perceive the 
 
 K 2 difference 
 
148 ON THE PROXIMATE 
 
 diiFerence between my opinions and Dr. Brown^s 
 upon this fubjeft. The Do£kor fuppofes a fever to 
 conlift in debility. I do not admit debility to be a 
 difeafe, but place it wholly in morbid excitement, 
 invited and fixed by previous debility. He makes 
 a fever to confift in a change only of a natural 
 action of the blood-veflels. I maintain that it con- 
 fifts in a preternatural and convulfive aftion of the 
 blood-veffels. Laflly, Dr. Brown fuppofes excite- 
 ment and excitability to be equal in fever. My 
 theory fuppofes a fever to be the reverfe of this. 
 It confifts in unequal or divided excitement and ex- 
 citability. Health confifts in the equality and uni* 
 formity of them both ; and the bufmefs of medi- 
 cine, as I fliall fay hereafter, is to equalize them in 
 the cure of fever ; that is, to abilra<^ their excefs 
 from the blood-veffels, and to reft ore them to the 
 other parts of the body. 
 
 It belongs to this part of our view of fever to 
 repeat from Dr. Boerhaave, that its termination is 
 always in health, in another difeafe, or in death. 
 A flight fever only can terminate in health. All 
 fevers of violent action, when left to themfelves, or 
 when partially cured, terminate in other difeafes, 
 or in death* The laft is the effect of the fmgle or 
 combined operation of the following caufes : i. Ef- 
 fufions in parts effential to life. 2. Such a change 
 
 being 
 
CAUSE OF FEVER, j^c) 
 
 being induced in the excretions, by the violent 
 action of the veiTels upon the blood, as to render 
 them deftruiflive to the organs of the body. 3. The 
 inability of the fyllem, from univerfal direct debi- 
 lity, to receive imprelTions, or to fupport the mo- 
 tions of life. Or lailly, death from fever is the 
 -efFefi: of the combined operation of all the three 
 caufes that have been mentioned. I cannot difmifs 
 the blood-veflels, as the feat of a general and fre- 
 quent difeafe, without lamenting that their phyfio- 
 logy and pathology have been fo little fludied by 
 phyficians. They are the firft born parts of the hu- 
 man body ; they fupport, in a great meafure, the 
 fecfibility and irritability of the nervous fyflem ; 
 they are the centinels of the whole fyflem in ileep ; 
 and, they are the lafl retreat of departing life. 
 
 11. I come now to apply the theory which I have 
 delivered, to the explanation and defcription of the 
 different phenomena or flates of fever. 
 
 I have faid that there is but one fever. Of courfe 
 I do not admit of its artificial divifion into genera 
 and fpecies. A difeafe which fo frequently changes 
 its form and place, fhould never have been delig- 
 nated, like plants and animals, by unchangeable cha- 
 r adders. The oak tree and the lion polTefs exadlly the 
 fame properties which they did near 6000 years ago. 
 
 K 3 But 
 
150 ON THE PROXIMATE 
 
 But who can fay the fame thing of any one difeafe ? 
 The pulmonary confumption is fometimes transform- 
 ed into head ach, rheumatifm, diarrhoea, cind mania, 
 in the courfe of two or three months, or the fame 
 number of weeks. The biHous fever often appears 
 in the fame perfon in the form of colic, dyfentery, 
 inflammation of the liver, lungs, and brain, in the 
 courfe of {ivQ or fix days. The hypochondriafis and 
 the hyfteria feldom fail to exchange their fymptoms 
 twice in the four-and-twenty hours. Again : The 
 oak tree has not united with any of the trees of the 
 foreft, nor has the lion imparted his fpecific qua- 
 lities to any other anim.aL But who can apply fimi- 
 lar remarks to any one difeafe ? Phrenitis, gaflritis, 
 enteritis, nephritis, and rheumatifm, all appear at 
 the fame time in the gout and yellow fever. Many 
 obfervations of the fame kind might be made upon 
 all other difeafes. To defer ibe them therefore by 
 any fixed or fpecific charaders, is as impradlicable as 
 to meafure the dimenfions of a cloud on a windy 
 day, or to {ix the component parts of water by 
 weighing it in a hydroftatic balance. Much mifchief 
 has been doneby nofological arrangements of difeafes. 
 
 They ere£l: imaginary boundaries between things 
 which are of a homogeneous nature. They de- 
 grade the human underflanding, by fubflituting 
 fimple perceptions, to its more dignified operations 
 
 of 
 
CAUSE OF FEVER. . 155: 
 
 of judgment and reafoning. They gratify Indolence 
 In a phylician, by fixing his attention upon the 
 name of a difeafe, and thereby leading him to ne- 
 gleft the varying ftate of the fyftem. They more- 
 over lay a foundation for difputes among phyficians, 
 by diverting their attention from the fimple predif- 
 pofing and proximate, to the numerous, remote, 
 and exciting caufes of difeafes, or to their more nu- 
 merous and complicated effe(5i:s. The whole materia 
 medica is infected with the baneful confequences of 
 the nomenclature of difeafes ; for every article in 
 it is pointed only againfl their names, and hence 
 the origin of the numerous contradiftions among 
 authors who defcribe the virtues and dofes of the 
 fame medicines. By the rejedlion of the artificial 
 arrangement of difeafes, a revolution mufl follow 
 in medicine. Obfervation and judgment will take 
 the place of reading and memory, and prefcriptions 
 will be conformed to exifling circumftances. The road 
 to knowledge in medicine by this means will likewife 
 be fhortened ; fo that a young man will be able to 
 qualify himfelf to practice phy fie at as much lefs ex- 
 penfe of time and labour than formerly, as a child 
 would learn to read and write by the help of the 
 Roman alphabet, inflead of Chinefe charadlers. 
 
 In thus reje£l:ing the nofologies of the fchools, 
 1 do not wifli to fee them banifhed from the libra- 
 
 K4 ries 
 
1^2 ON THE PROXIMATE 
 
 ries of phyficians. When confulted as hiftories of 
 the effects of difeafes only, they may ilill be ufefuL 
 I ufe the term difeafes, in conformity to cuflom, for 
 properly fpeaking, difeafe is as much a unit as fever. 
 It Gonfifls fmiply of morbid action or excitement in 
 fome part of the body. Its different feats and de- 
 grees, fliould no more be multiplied into different 
 difeafes, than the numerous and different effedts of 
 heat, and light upon our globe fhould be multiplied 
 into a plurality of funs. 
 
 The advocates for Dr. Cullen's fyflem of medi- 
 dicine, will not, I hope, be offended by thefe obfer- 
 vations. His immenfe flock of reputation, will 
 enable him to fuflain the lofs of his nofology, without 
 being impoveriflied by it. In my attempts to in* 
 troduce a new arrangement of difeafes, I fliall only 
 give a new diredlion to his efforts to improve the 
 healing art. 
 
 1 have confidered morbid adlion in the blood- 
 veffels, whether it confifl in preternatural force and 
 frequency, or preternatural force without frequency, 
 or frequency without force, to conflitute the proxi- 
 mate caufe of fever. Excefs in the force and fre- 
 quency of the blood- veffels, has been confidered as 
 the charafteriflic mark of what is called inflam- 
 matory fever. But there are marks which indicate 
 a much greater excefs of flimulus upon the blood- 
 
 veffels* 
 
CAUSE OF FEVER. l^j 
 
 veffels. Thefe are preternatural flownefs, inter- 
 miflions and depreffion in the pulfe, fuch as occur 
 in certain malignant fevers. In applying my theory 
 of fever to the explanation of all its different flates, 
 I am leu by this view of its inflammatory flate, to 
 confider them in the order of their inflammatory 
 chara^iicr, or according to the force of flimulus 
 which a^ls upon the blood- veflTels. The following 
 appears to be the ufual order of inflammatory 
 diathefis, prefented to us by nature, in the diiFerent 
 fevers which are defcribed by authors ; 
 
 1. The plague. 
 
 2. The yellow fever. 
 
 3. The natural fmail-pox. 
 
 4. The malignant fore throat. 
 
 5. The fever from the alternate aftion of cold 
 and heat on the body, appearing with the fymp- 
 toms of pleurify, rhumatifrn, tonic gout, internal 
 dropfy of the brain, and pulmonary confumption. 
 
 6. The meafles. 
 
 7. Catarrh from cold, and influenza from con- 
 tagion. 
 
 8. The common remitting fever, appearing oc- 
 caflonally with the fymptoms of colic, dyfentery, 
 inflammation of the liver, and internal dropfy of 
 
 (he brain. 
 
 9. The fcarlatina, puerperilc and hedlic fevers. 
 
 I o. The 
 
154 ON THE PROXIMATE 
 
 I c. The jail fever. 
 
 1 1 . The common mild intermittent. 
 
 This fcale of the degrees of morbid a£lion in 
 fevers is taken from their ufual fymptoms. They 
 vary with climate, feafon, and habit. There are in- 
 termittents, jail, and puerperile fevers, fo inflam- 
 matory as to require frequent bleedings to cure 
 them ; and there are cafes of plague, yellow fever, 
 and pleurify, which yield to a fmgle dofe of purging 
 phyfic. It is upon the account of this want of 
 uniformity in the charafter of fevers, and the in- 
 fluence of climate, feafon, and habit upon them, that 
 I fliall follow Dr. Clark, by fubflituting in the place 
 of their ufual names, certain definite ftates which 
 may be applied, with varying circumflances, to them 
 all. 
 
 1 . I fliall divide them into fuch as aife£l: the whole 
 arterial fyfliem, with no, or but little local afle£l:ion. 
 
 2. Into fuch as aiteft the whole arterial fyfliem, 
 and are accompanied at the fame time with evident 
 local affections. And, 
 
 3. Into fuch as appear to pafs by the arterial 
 fyftem, and to fix themfelves upon other parts of 
 
 the 
 
CAUSE OF FEVER. i^^ 
 
 the body. Thefe ftates of fever I Ihall call 
 mi/placed. 
 
 I. I fliall begin under the firil head, with the 
 MALIGNANT Hate of fcver. It confhitutes the 
 highefl grade of inflammatory diatheiis. It is known 
 by attacking frequently without a chilly fit, by 
 coma, a deprefled, flow, or intermitting pulfe, and 
 fometimes by a natural temperature or coldnefs of 
 the flcin. It occurs in the plague, in the yellow 
 fever, in the gout, and in the fmall-pox. Dr. Quier 
 has defcribed a pleurify in Jamaica, in which fome of 
 thofe malignant fymptoms took place. They are 
 the efFe£l: of fuch a degree of fliimuius as to profl:rate 
 the arterial fyfl:em, and to produce a defeat of adtion 
 from an excefs of force. Such is this excefs of force 
 in fome infl:ances in this fl:ate of fever, that it induces 
 general convulflons, tetanus, and palfy, and fome- 
 times extinguiflies life in a few hours by means of 
 apoplexy or fyncope. The lefs violent degrees of 
 flimulus in this fl:ate of fever produce palfy in the 
 blood-veflTels. It probably begins in the veins, and 
 extends gradually to the arteries. It feems further 
 to begin in the extremities of the arteries, and to 
 extend by degrees to their origin in the heart. This 
 is evident in the total abfence of pulfe which fome- 
 times takes place in malignant fevers four-and- 
 twenty, and even eight and forty hours before 
 
 death. 
 
15^ ON THE PROXIMATE 
 
 death. But there are cafes in which this paify 
 affects both the veins and arteries at the fame time. 
 It is probably from this fimultaneous affection of the 
 blood- veffels, that the arteries are found to be nearly 
 full of blood after death from malignant fevers* 
 The depreffed, and intermitting pulfe which occurs 
 in the beginning of thefe fevers perhaps depends 
 upon a tendency to palfy in the arteries indepen- 
 dently of an affection of the heart or brain. 
 
 This deprejfed ffate of fever more frequently when 
 left to itfelf terminates in petechise, buboes, car- 
 buncles, abfceffes and mortifications, according as 
 ferum., lymph, or red blood is effufed in the vifcera 
 or external parts of the body. Thefe morbid ap- 
 pearances have been afcribed to putrefa^ion, and 
 the fever has received, from its fuppofed prefence, 
 the name of putrid. The exiftence of putrefaiStion 
 in the blood in a fever is rendered improbable, 
 
 I . By Dr. Seybert's experiments '^ which prove 
 that it does not take place in the blood in a living 
 ilate. It occurs in the excretions of bile, fceces, 
 and urine, but in this cafe it does not -aB. as a fer- 
 ment, but a flimulus only upon the living body. 
 
 * Inaugural diiTertation entitled, << An Attempt to dtfprove 
 the putrefa^f^ionofthe blood In living animals.'* 
 
 2. B7 
 
CAUSE OF FEVER. l^y 
 
 2. By Cmilar appearances, with thofe which have 
 been afcribed to putrefaction, having been produced 
 by hghtning, by violent emotions of the mind, by 
 extreme pain, and by every thing eU'e which Induces 
 fudden and univerfal diforganifation in the fluids and 
 foiids of the body. To the faCts mentioned in a 
 former work,* with a view of refuting the opinion 
 of putrefaction taking place in the blood, I fliall add 
 fome others, which clearly prove that the fymxptoms 
 which have been fuppofed to defignate a putrid 
 fever, are wholly the effecl of mechanical aftion in 
 the blood-veflels, and are unconne6led with the in- 
 trodudlion of a putrid ferment into the blood. 
 
 Hippocrates relates the cafe of a certain Antiphil- 
 lus, in whom a putrid bilious fever (as he calls it) 
 was brought on by the application of a cauftic to a 
 wound.f 
 
 An acute pain in the eye, Dr. Phyfick inform- 
 ed me, produced what are called the fymptoms of 
 a putrid fever, which terminated in death in five 
 days, in St. George's hofpitalin the year 1789. 
 
 Dr. Defportes takes notice that a fifli which he 
 calls a fucker, aifec^ed the fyftem nearly in the fame 
 
 * Account of the yellow fever, in 1793. 
 f Epidemics, book Iv, 
 
 manner 
 
158 ON THE PROXIMATE 
 
 manner as the contagion of the yellow fever. A 
 diilrelTnig vomiting, a coldnefs of the extremities, 
 and an abfence of pulfe, were fome of the fyraptoms 
 produced by it, and an inflammation and mortifi- 
 cation of the flomach and bowels, were difcovered 
 after death to be the effe6i:s of its violent operation. 
 
 Even opium in large dofes, fometimes produces 
 by its powerful flimulus the fame fymptoms which 
 are produced by the flimulus of what are called 
 putrid contagions. Thefe fymptom^s are, a How 
 pulfe, coma, a vomiting, cold fweats, a fallow colour 
 of the face, and a fupprelFion of the difcharges by 
 the urinary pafTages and bowels. 
 
 Error is often perpetuated by words. A belief 
 in the putrefa£i:ion of the blood has done great mif- 
 chief in medicine. The evil is kept up, under the in- 
 fluence of new theories, by the epithet putrid, which 
 is flill applied to fever in all our medical books. 
 For which reafon I fhall rejeft it altogether hereafter, 
 and fubilitute in its room 
 
 2. The GANGRENOUS ftate of fever, for what 
 appear to fome phyficians to be figns of putrefadlion, 
 are nothing but the ifTue of a violent inflammation 
 left in the hands of nature, or accelerated by flimu- 
 lating medicines. Thus the fun, when viewed at 
 
 mid-day 
 
CAUSE OF FEVERr I59 
 
 mid-day/ appears to the naked eye, from the excefs 
 of its fplendor, to be a mafs of darknefs, inftead of 
 an orb of hght. 
 
 The fame explanation of what are called putrid 
 fymptoms in fever, is very happily delivered by Mr. 
 Hunter in the follov^ing words : " It is to be ob- 
 ferved (fays this acute phyfiologift) that when the 
 attack upon thefe organs, which are principally 
 connected with life, proves fatal, that the eiTe(fi:s of 
 the inflammation upon the conflitution, run through 
 all the flages with more rapidity than when it hap- 
 pens in other parts ; fo that at its very beginning, 
 it has the fame effedl: upon the conflitution, which 
 is only produced by the fecond itage of inflamma- 
 tion in other parts." * 
 
 3. The SYNOCHA, or the common inflammatory 
 flate of fever, attacks fuddenly with chills, and is 
 fucceeded by a quick, frequent, and tenfe pulfe, 
 great heat, thirft, and pains in the bones, joints, 
 breail, or fides. Thefe fymptoms fometimes occur 
 in the plague, the jail and yellow fever, and the 
 fmall-pox ; but they are the more common charac- 
 teriflics of pleurify, gout, and rheumatifm. They 
 now and then occur in the influenza, the meafles, 
 and the puerperile fever. 
 
 * Treatife on Inflammation, chap. I. 8, 
 
 A, The 
 
l6o ON THE PROXIMATE 
 
 4. The BILIOUS ftate of fever is produced by 
 marfli miafmata or contagion, ailing fpecifically 
 upon the biliary du6ts, or it may be induced by the 
 ufual remote caufes of the gout. It is known by 
 a full, quick, and tenfe pulfe, or by a quick, full, 
 and round pulfe, without tenfion, and by a dif- 
 
 [ charge of green, dark coloured, or black bile from 
 the flomach and bowels. 
 
 Befides thefe occafional forms of bilious fever, it 
 fometimes puts on the fymptoms of a heflic. I 
 have feen many inftances of it in the autumn. The 
 patient feels no pain in his head, has a tolerable 
 appetite, and is able to fit up, and even to do bu- 
 fmefs. My late invaluable friend Dr. Clarkfon, 
 died of this flate of bilious fever. 
 
 5. The TYPHUS flate of fever is generally pre-r 
 ceded by all thofe circumjflances which induce direct 
 debility. It is known by a weak and frequent 
 pulfe, a difpofition to fleep, a torpor of the alimen- 
 tary canal, tremors of the hands, a dry tongue, and, 
 in fome inftances, by a diarrhcea. Thefe fymp- 
 toms occur moft frequently in the mild grades of 
 the jail fever, and in the clofe of all the inflamma- 
 tory ftates of fevers in which depleting remedies 
 have not been ufed in their iirft ftage. I heard 
 of it in a few cafes in the yellow fever o( 17939 
 
 4 and 
 
CAUSE Ol? ^EVER* l^^f 
 
 arid all writers take notice of cafes of the plague, 
 which run on into a flow fever that continues 10 
 and 40 days. 1 have feen it fucceed the common 
 bilious fever, pleurify, atld influenza. It has been 
 confounded with the malignant ftate of fever, undei- 
 the name of typhus gravior ; but it diiFers widely 
 from it in being accompanied by a feeble excitement 
 in the blood-veffels, from a feeble ftimulus, and by 
 the ufual figns of dire6l debility in every other part 
 of the body. 
 
 From the acceflion of new flimuli, or an increafe 
 in the force of former ones, this typhus ftate of 
 fever fometimes affumes, on the nth, 14th, and 
 even 20th days, the fymptoms of the fynocha ftate 
 of fever. It will be ufeful to remember this ob- 
 fervation, not only becaufe it eftablifties the unity 
 of fever, but becaufe it will juftify the ufe of a 
 remedy, feldom prefcribed after the difeafe haa 
 acquired that name which aftbciates it with ftimu- 
 lating medicines. 
 
 The common name of this ftate of fever is, the 
 nervous fever. This name is improper ; for it in- 
 vades the nervous fyftem by pain, delirium, and 
 convuliions much lefs than feveral other ftates of 
 fever. To prevent the abfurd, and often fatal aiTo- 
 f iation of ideas upon the treatment of this ftate of 
 
 L fever. 
 
tS2 ON THE PROXIMATE, 
 
 fever, I fliall hereafter call it, from its duration, the 
 low chronic ftate of fever. I have adopted the term 
 l6w^ from Dr. Butter's account of the remitting 
 fever of children, in order to diflinguilh it from 
 flates of fever to be mentioned hereafter, in vrhich 
 the patient is not confined to his bed. This new 
 name of the typhus or nervous fever, eftablillies its 
 analogy with feveral other difeafes. We have the 
 acute and the chronic rheum.atifm ; the acute and 
 chronic pneumony, commonly called the pleurify 
 and pulmonary confumption ; the acute and chronic 
 inflammation of the brain, known unfortunately by 
 the unrelated names of phrenitis, madnefs, and in- 
 ternal dropfy of the brain. Why ihould we hefi- 
 tate, in like manner, in admitting acute and chro» 
 nic fever in all thofe cafes where no local inflamma- 
 tion attends. 
 
 6. The typhoid ftate of fever is compofed of the 
 fynocha and low chronic ftates of fever. It is the 
 JIow nervous fever of Dr. Butter. The excitement 
 of the blood-veflfels is fomewhat greater than in the 
 low chronic ftate of fever. Perhaps the mufcular 
 fibres of the blood-veflels, in this ftate of fever, are 
 affected by different degrees of ftimulus and excite- 
 ment. Suppofmg a pulfe to confift of eight cords, 
 I think I have frequently felt more or lefs of them 
 tenfe or relaxed, according as the fever partook 
 
 more 
 
CAUSE OF FEVER* fC^ 
 
 more or lefs of the fynocha, or low chronic flates 
 of fever. This flate of fever occurs moft frequently 
 in what are called the hectic and puerperal fevers, 
 and in the fcarlatina* 
 
 Both the low chronic, and the typhoid ftates of 
 fever (the fever generated in jails, Ihips, and hofpi- 
 tals excepted) are mod frequently artificial difeafes. 
 They are created by the negligence of patients, in 
 not fending for early medical aid, or by the ignorance 
 of phyficians in not ufing fufficient evacuations. 
 
 7. There is a ftate of fever inclining more to the 
 fy nocha than what is called the typhus, or low 
 chronic flate of fever. I have called it the fjriQ^ 
 choid flate of fever. 
 
 8. There is a flate of fever in which the pulfe is 
 fmall, but tenfe and quick* The patient, in this 
 flate of fever, is feldom confined to his bed. We 
 obferve it fometimes in the chronic rheumatifm, and 
 in pulmonary confumption. The inflammatory flate 
 of this grade of fever is proved from the inefficacy 
 of the volatile tin6lure of guaiacum and other flimu- 
 lants to remove it, and from its yielding fo fuddenly 
 to blood-letting. I have called it x\i^ fynochula ilate 
 of fever. 
 
 L 2 Q. The 
 
i64 ON THE TROXIMATE 
 
 9. The HECTIC ftate of fever differs from all the 
 other flates of fever, by the vi^ant of regularity in 
 its paroxyfms, in vi^hich chills, fever, and fweats are 
 included ; and by the brain, nerves, mufcles, and 
 alimentary canal, being but little impaired in their 
 fundions by it. It appears to' be an excluiive dif- 
 eafe of the blood-veffels. It occurs in the pulmo-^ 
 riary confumption, in fome cafes of lues, of fcro- 
 |)hula, and of the gout, and after moil of the flates 
 t>f fever v^hich have been defcribed. The force of 
 the pulfe is various, being occafionally fynochoid^ 
 typhoid, and typhus. 
 
 10. There is a ftate of fever in which the mor- 
 bid action of the blood-veffels is fo feeble, as fcarcely 
 to be perceptible. Like the he£lic ftate of fever, it 
 feldom affe^ls the brain, nerves, mufcles, or alimen- 
 tary canal. It is knov^^n in the fouthern ftates of 
 America, by the name of inward fevers. The 
 Englifli phyficians formerly defcribed it by the name 
 of febricula. 
 
 11. Intermiffions, or the n^TERMiTTiNG and re- 
 mitting ftates of fever, are common to all the ftates 
 of fever which have been mentioned. But they oc- 
 cur moft diftinclly and univerfally in thofe which 
 partake of the bilious diathefis. They have been 
 afcribed to the reproduclion of tlie ftimulus of bile. 
 
CAUSE OF FEVER, 1 65 
 
 to the recurrence of debility, and to the iniluence 
 of the heavenly bodies upon the fyflem. None of 
 thefe hypothefes has explained the recurrence of 
 fever, where the bile has not been in fault, where 
 (Jebility is uniform, and where the paroxyfms of 
 fever do not accord with the revolutions of any 
 part of the folar fyftem. I have endeavoured to 
 account for the recurrence of the paroxyfm of fe- 
 ver, in common with all other periodical difeafes, 
 by means of a natural or adventitious ajTociation 
 of motions. Dr. Percival has glanced at this law 
 of animal matter ; and Dr. Darwin has explained 
 by it, in the rnoft ingenious manner, many natural 
 and morbid a6lions in the human body. 
 
 12. The SWEATING ftate of fever occurs in the 
 plague, in the yellow fever, in the fmall-pox, the 
 pleurify, the rheumatifm, and in the hectic and in- 
 termitting ftates of fever. Profufe fweats appeared 
 every other day in the autumnal fever of 1795 in 
 Philadelphia, without any other fymptom of an in- 
 intermittent. The Englifli fweating ficknefs was 
 nothing but a fymptom of the plague. The fweats 
 in all thefe cafes are the effects of morbid and ex- 
 ceiTive action, concentrated in the capillary veiTels. 
 
 13. The FAINTING ftate of fever accompanies 
 the plague, the yellow fever, the fmall-pox, and 
 
 L 3 fome 
 
1 66 ON THE PROXIMATE 
 
 fome dates of pleiirify. It is the efte£l of great 
 indirefl debility ; hence it occurs mod frequently 
 in the beginning of thofe dates of fever. 
 
 14. The BURNING date of fever has given rife to 
 what has been called a fpecies of fever. It is the 
 caufus of authors. Dr. Mofely, who rejects the 
 epithet of yellow, when applied to the bilious 
 fever, becaufe it is only one of its accidental 
 fymptoms, very improperly didinguidies the fame 
 fever by another fymptorn, viz. the burning heat 
 of the iliin, and which is not more univerfal than 
 the yelipwnefs v/hicji attends it, 
 
 15. The COLD and chilly date of fever differs 
 from a common chilly fit, by continuing four or 
 five days, and to fuch a degree, that the patient 
 frequently cannot bear his arms out of the bed. 
 The coldnefs is mod obdinate in the hands and feet. 
 A COOLNESS only of the ddn attends in fome cafes, 
 which is frequently midaken for an abfence of fe- 
 ver. 
 
 Having mentioned thofe dates of fever which 
 affect the arterial fydem, without any, or with 
 but little topical afrecl:ion, I proceed next to enu- 
 merate thofe dates of fever in which there are 
 local affections combined more or lefs with general 
 
 , fever, 
 
• CAUSE OF FEVER. ^ 157 
 
 fever. They depend, i. Upon local debility in 
 the part afFe6i:ed. 2. Upon increafed excitability in 
 the part, in conlequence of this debility. And, 3. 
 Upon the morbid excitement induced in the part, 
 by the flimulus of diftention from the blood, and 
 by the efFulion of ferum, lymph, or red globules in. 
 the weakened, and afterwards inflamed part. The 
 reader will perceive here that I adopt the error loci 
 of Dr. Boerhaave, as a link in the chain of caufes 
 which produce local inflammation. The ftates of 
 fever which belong to this fecond head are as follow. 
 
 16. The INTESTINAL ftatc of fever. I have 
 been anticipated in giving this epithet to fever, by 
 Dr. Balfour. * It includes the colera morbus, diar-* 
 rhoea, dyfentery, and colic. The remitting bilious 
 fever appears, in all the above forms, in the fummer 
 months. They all belong to the febris introverfa 
 of Dr. Sydenham. The jail fever appears likewife 
 frequently in the form of diarrhoea and dyfentery. 
 The dyfentery is the olTspring of miafmata and con- 
 tagion, but it is often induced in a weak flate of 
 the bowels, by other exciting caufes. The colic 
 occafionally occurs with itates of fever to be men- 
 tioned hereafter. 
 
 * Account of the Inteftinal Remitting Fever of Bengal. 
 V L4 17. The 
 
l6S ON TH^ PROXIMATE 
 
 17, The PULMONARY flate of fcver includes the 
 tvic and bailard pneumony in their acute forms ; 
 gjfo catarrh from cold and contagion, and the chro^ 
 jiic form of pneumony in what is called pulnionary 
 eonfumption* 
 
 T 
 
 18, The ANGIN031E: ftat^ of f&ver includes all 
 thofe affedions of the throat which are known by the 
 names of cynanche, inflammatoria, tonfiUaris, paro- 
 tidea, maligna, fcarlatina, and trachealis. The cy- 
 nanche trachealis is a febrile difeafe. The mem« 
 brane which produces fufFocation and death in the 
 wind-pipe, is the efFe£i: of inflammation. It is pro- 
 bably formed, like other niembranes which fuc« 
 ceed inflammation, from the coagulable lymph of 
 the bloodo 
 
 19, The RHEUMATIC Hate of fever is confined 
 chiefly to the labouring part of mankind. The 
 topical afle£i:ion is feated moll commonly in the 
 joints and mufcles, which from being exercifed 
 more than other parts of the body, become mor§ 
 debilitated, and are, in confequence thereof, ex* 
 cited into morbid or inflammatory a^ion. 
 
 20, The ARTHRITIC or GOUTY flate of fever, 
 differs from the rheumatic, in aifefting, with the 
 joints and mufcies, all the nervous and lymphatic 
 
 fyflierasj 
 
CAUSE OF FEVER. 169 
 
 fyftems, the vlfcera, and the ilvin ; alfo In having 
 a fpeclfic remote caufe, viz. intemperance. Its 
 predifpofmg, exciting, and proximate caufes are the 
 fame as the rheumatic and other dates of fever. 
 It bears the fame ratio to rheumatifm, which the 
 yellow fever iDears to the common bilious fever. 
 It is a fever of mgre force than rheumatifmo 
 
 21. The MANIACAL {late of fever. I prov£ 
 mania to be a fever^ i. From its caufes, which 
 are the fame as thofe which induce all the other 
 dates of fever. 2. From its fymptoms, particu- 
 larly 21 full, tenfe, quick, and fometimes a flov/ 
 pulfe. 3. From the inflammatory appearances of 
 the blood which has been drawn to relieve it. 
 And, 4. From the phenomena exhibited by diffec- 
 tion in the brains of maniacs, being the fame as are 
 exhibited by other inflamed vifcera after death. 
 Thefe are, effulions of water or blood, abfceffeSj 
 and fchirrus. The hardnefs in the brains of ma- 
 niacs, taken notice of by feveral authors, is no- 
 thing but a fchirrus (fui generis) induced by the 
 negle£l of fufHcient evacuations in this flate of fever. 
 The reader will perceive by thefe obfervations, 
 that I reje^l: madnefs from its fuppofed primary 
 feat in the mind or nerves. It is as much an ori*. 
 ginal difeafe of the blood-veflels, as any other flate 
 ©f fever. It is t^) phrenitis, what pulmonary con- 
 
 fumption 
 
170 ON THE PROXIMATE 
 
 fumption is to pneumony. The derangement' iii 
 the operations of the mind is the c&£i only of 
 a chronic inflammation of the brain, exilline with^ 
 out an abflradlion of mufcular excitement. 
 
 22. The APOPLECTIC, 23. the phrenitic, 
 24. the paralytic, 25. the lethargic, and 26. 
 the VERTIGINOUS flatcs of fever, often accom- 
 pany the malignant fliate of fever. They are com- 
 monly the eiFe(5i:s of flrong flimuli afting fuddenly 
 upon the brain in the beginning of fever ; but they 
 fometimes occur in the clofe of the comm.on ftates 
 of fever, m.ore efpecially where blood-letting has 
 not been ufed in a fiifficient quantity. 
 
 27. The HYDROCEPHALIC flate of fever occurs 
 chiefly in children. The water which is found in 
 the brain, is the effect of inflammation. To the 
 proofs from dilTedions which I publifhed formerly,* 
 of the inflammatory nature of this flate of fever, I 
 fliall add one more, communicated to m^e by my for- 
 mer pupil Dr. Coxe, in a letter from London, dated 
 July 17th, 1795. " It fo happened (fays my inge- 
 nious correfpondent) that at the time of my receiv- 
 ing your letter. Dr. Clark was at the hofpital. I 
 read to him that part of it which relates to your 
 fuccefs in the treatment of hydrocephalus internus. 
 
 * Medical Inquiries and Obfervations, Vol. II. 
 
 He 
 
CAUSE OF FEVER. I7I 
 
 He was mncli pleafed with It, and mentioned to me 
 a fci£t, which flrongly corroborates your idea of its 
 being a primary inflammation of the brain. This 
 fa£l was, that upon opening, not long fmce, the head 
 of a child who had died of this difeafe, he found 
 between three and four ounces of water in the ven- 
 tricles of the brain ; alfo an inflammatory crufl on 
 the optic nerves, as thick as he had ever obferved it 
 on the intefl:ines in a ilate of inflammation. The 
 child lofl: its fight before it died. The crufl: account- 
 ed, in a fatisfadlory manner, for its biindncfs. Per- 
 haps fomething flmilar may be always noticed in the 
 diile^lions of fuch as die of this difeafe, in whom 
 the eyes are much affciSLed." 
 
 30. The NEPHRITIC ftate of fever is often In- 
 duced by calculi, but it frequently occurs in the 
 gout, fmall-pox, and malignant ftates of fever. There 
 is fuch an engorgement, or choaking of the veflTels 
 of the kidneys, that the fecretion of the urine is 
 fometiraes totally obflrufed, fo that the bladder 
 yields no water to the catheter. It is generally ac- 
 companied with a full or tenfe pulfe, great pain, 
 ficknefs, or vomiting, high coloured urine, and a 
 pain along the thigh and leg, v/ith occafionally a 
 retra6bion of one of the teftlcles. It exifl:s fome- 
 times without any pain. Of this I met with feveral 
 iuftances in the yellow fever of 1 793. 
 
 -^i. The 
 
172 ON THE PROXIMATE 
 
 3 1. The DROPSY, whether local or general is a 
 fiaic of fever. There are feveral flates of fever 
 which are more frequently accompanied by ferous 
 eftufions than others. Thefe are the fcarlet, the 
 puerperal, and the rheumatic dates of fever. They 
 all difpofe to effufions in the limbs, Intermittents 
 tend to produce thofe conjeflions in the abdominal 
 vifcera which terminate in effufions in the belly, A 
 negle^ied catarrh, and a half cured pneumony, tend 
 to produce effufions in the thorax^ while a chronic 
 phrenitis relieves itfelf by an effulion of water in the 
 brain. Nineteen dropiies, out of twenty appear to 
 be original arterial difeafes ; and the water, which 
 has been fuppcfed to be the caufe of the dropfy, is as 
 much the effeel of preternatural and morbid a6i:ion 
 in the blood-velTels, as pus, gangrene, and fchirrus 
 are of previous inflammation. The common febrile 
 fymptoms which accompany dropfy, render this 
 highly probable ; but it has lately been demon- 
 ftrated by diffe^tion, by Mr. Samuel Cooper, the 
 apothecary of the Pennfylvania hofpital, in a man 
 who died of an afcites. Pus and blood, as well as 
 water, were found in the cavity of the abdomen.* 
 
 * The origin of dropfy, in the negle^fl of blood-letting in 
 fevers, has been afcertalncd by many obfervations j hence 
 that difeafe occurs rnoft frequently where bleeding is feldom 
 ufed. Dr. Wilkes mentions a fa(5l which is diredly to cur 
 purpofe. << After the laft epidemical fever (fays the Do<5lor), 
 
 It 
 
CAUSE OF FEVER. I7J 
 
 It is no obje(^ion to this theory of dropfy, that 
 we fometimes find water in the cavities of the body 
 after death, without any marks of inflammation on 
 the contiguous blood- velTels. We often find pus 
 both in the living and dead body under the fame 
 circumflances, wdiere wie are fure it was preceded 
 by inflammation. 
 
 33. The ERUPTIVE ftate of fever includes the 
 fmall-pox, meafles, and all the other exanthemata of 
 Dr. Cullen. 
 
 33. The HEMORRHAGIC ftatc of fever Is always 
 the effect: of preternatural excitement in the blood- 
 veffels. Hcemorrhages have been divided into a£live 
 and paffive. It would be more proper to divide 
 them, like other ftates of general fever, into haemor- 
 rhages of flrong and feeble morbid aflion. There 
 is feldom an ilTue of blood from a veffel in which 
 there does not exifl preternatural or accumulated 
 excitement. We obferve this haemorrhagic flate of 
 fever moil frequently in malignant fevers, in pul- 
 monary confumption, in pregnancy, and in that 
 period of life in which the menfes ceafe to be regular, 
 
 which began at Kldderminfter in 1728, and foon after fpread, 
 not only over Great Britain, but all Europe, more people 
 died dropfical in three years, than did perhaps in 20, or 30 
 years before,'* 
 
 Hiftorical EiTay on the dropfy, p. 326. 
 
 33. The 
 
174 Oyi THE PROXIMATE 
 
 34. The AMENORRHAGic flatc of fever occurs 
 more frequently than is fufpefled by phyficians, 
 A full and quick pulfe, thirft, and preternatural 
 heat, often accompany a chronic obflru61:ion of the 
 menfes. The inefficacy and even hurtful effedls, 
 of what are called emenagogue medicines, in this 
 ilateofthe fyflem, without previous depletion, fhew 
 the propriety of introducing it among the different 
 ffiates of fever. 
 
 35. The haemorrhoids are frequently a local 
 difeafe, but they are fometimes accompanied with 
 pain, giddinefs, chills and an aclive pulfe. When 
 iliis is the cafe, I have given them the name of the 
 ji^MORRHoiDAL ftatc of fcver. 
 
 36. The opthalmia when it occurs with the fymp- 
 toms of general fever, may properly be confidered 
 as an opti-ialmic itate of fever. 
 
 We cam.e now in the third and lall place to mention 
 the mifplaced ilates of fever. The term is not a 
 new one in medicine. We read of mifplaced gout. 
 Morbid excitement, in feveral other ftates of 
 fever, is equally liable to be tranflated from the 
 blood-velTels to other parts of the fyflem. The 
 periodical pains in the head, eyes, ears, jaws, hips 
 s.]id back, which occur in the fckly autumnal 
 
 months. 
 
CAUSE OF FEVER, I^J 
 
 months, and which impart no fulnefs, force, or fre- 
 quency to the pulfe, are all mifplaced fevers. But 
 there are other morbid affections which are lefs 
 fufpe6led of belonging to febrile diforders. Thefe 
 are, 
 
 37. The HEPATIC ftate of fever. The caufes, 
 fymptoms, and remedies of the liver diforder of the 
 Eaft Indies, as mentioned by Dr. Gravenftine, all 
 prove that it is nothing but a bilious fever tranllated 
 from the blood- veiTels, and abforbed, or fuffocated 
 as it were in the liver. This view of the chronic 
 hepatitis is important, inafmuch as it leads to the 
 liberal ufe of all the remedies which cure bilious 
 fever. Gall ftones and contulions, now and then 
 produce a hepatitis, but under no other circum- 
 ftances do I believe it ever exifts, but as a fymptom 
 of general, or latent fever. 
 
 38. The CONVULSIVE or fpafniodlc ftate of fever, 
 Convulfions it is well known often uflier in fevers, 
 more efpecially in children. But the conne£l:ion 
 between fpafmodic affections, and fever in adults 
 has been lefs attended to by phyficians. The fame 
 caufes which produced general fever q.nd hepatitis 
 in the Eaft Indies, in fome foldiers, produced locked 
 jaw in others. Several of the fymptoms of this difor- 
 der as defcribed by Dr. Girdleftone, fuch as coldnefs 
 
 oa 
 
17^ ON THE PROXIMATE 
 
 on the furface of the body, cold fweats on the iiands 
 and feet, intenfe third, a white tongue, inceffant 
 vomitings, and carbuncles, all belong to the malig- 
 nant Hate of fever,* By means of blood-letting, 
 and the other remedies for the violent flate of bilious 
 fever, I have feen the convulfions in this diforder, 
 tranilated from the mufcles to the blood-velfelsj 
 where they immediately produced all the common 
 fymptoms of fever. 
 
 39^ TheiiYSTERICAL and KYPOCHONiDRlACAL 
 
 itates of fever. The former is known by a rifmg 
 in the throat, which is for the mofl part erroneoufly 
 afcribed to worms, by pale urine, and by a difpofi- 
 tion to flied tears, or to laugh upon trifling oc- 
 cafions. The latter difcovers itfelf by falfe opinions 
 of the nature and danger of the difeafe under which 
 the patient labours. Both thefe llates of the ner- 
 vous fyftem occur frequently in the gout and in the 
 malignant ftate of fever. It is common to fay. 
 In fuch cafes, that patients have a complication of 
 clifeafes; but this is not true, for the hyfterical and 
 hypochondrical fymptoms are nothing but the effe^ls 
 of one remote caufe, concentrating its force chiefly 
 upon the nenres, and mufcle?. It was in this ftate 
 of fever that patients fat up, walked about their 
 
 * Elfay on the Spafmodlc AfFedlons in India, p. $1- 54- SS- 
 
 I rooms, 
 
CAU^E OF FEVER. I77 
 
 i'Ooms, and even went out into the ftrcets a few 
 hours before they died, in the epidemic of 1793 in 
 Philadelphia. 
 
 40. The CUTANEOUS ftate of fever. Dr. Sy* 
 denham calls a dyfentery a " febris introverfa." 
 Eruptions of the ikin are often nothing but the 
 reverfe of this introverted fever. They are a fever 
 tranflated to the ikin ; hence we find them mofl com^- 
 mon in thofe countries and feafons in which fevers 
 are epidemic. The prickly heat, the rafli, and the 
 effere of authors, are all Hates of mifplaced fever> 
 " Agues, fevers, and even pkurifia (fays Mr. 
 Townfend in his journey through Spain *) are faid 
 often to terminate in fcabies, and this frequently 
 gives place to them, returning however when the 
 fever ceafes. In adults it takes poil'elTion of the 
 hands and arms, with the legs and thighs, covering 
 them with a filthy crufl." Small boils are common 
 among the children in Philadelphia, at the time 
 the colera infantum makes its appearance. Thefe 
 children always efcape the fummer epidemic. The 
 elephantiafis defcribed by Dr. Hillary in his account 
 of the difeafes of Barbadoes, is evidently a tranfla- 
 tion of an intermittent to one of the limbs. It is 
 remarkable that the leprofy and malignant fevers of 
 
 * Vol. IL Dublin edition, p 262, 
 
 M all 
 
lyS ON THE PROXIMATE 
 
 all kinds have appeared and declined togetlier in 
 the fame ages and countries. But further, petechias 
 fometimes appear on the ikin without fever. Cafes 
 of this kind with, and without haemorrhages, are 
 taken notice of by Riverius,* Dr. Duncan, and 
 many other practical writers. They are cotempo- 
 rary, or fubfequent to fevers of a malignant com- 
 plexion. They occur likewife in the fcurvy. From 
 fome of the predifpofmg, remote and exciting caufes 
 of this difeafe, and from its fymptoms and remedies, 
 I have fufpefled it, like the petechice mentioned by 
 Riverius, to be originally a fever generated . by 
 human miafmata, in a mifplaced ftate. The haemor- 
 rhages which fometimes accompany the fcurvy, cer- 
 tainly arife from a morbid flate of the blood-veifels. 
 The heat, and quick pulfe of fever, are probably 
 abfent, only becaufe the preternatural excitement 
 of the whole fanguiferous fyflem is confined to thofe 
 extreme or cutaneous vefTels which pour forth 
 blood. In like manner the fever of the fmall-pox 
 deferts the blood-vefTels, as foon as a new a6lion 
 begins on the fkin. Or perhaps the excitability of 
 the larger blood-vefTels may be fo far exhaufted by 
 the long, or forcible imprefiion of the remote and 
 predifpofing caufes of the fcurvy, as to be incapable 
 of undergoing the convulfive aflion of general fever, 
 
 "^ Praxis Medica, lib. xviii. cap. i. 
 
 With 
 
Cause of fever^ 175 
 
 With this, I clofe my inquiry into the proximate 
 caufe of fever. It is imperfeft from its brevity, as 
 well as from other caufes. I commit it to my pupils 
 to be corrected and improved. 
 
 " We think our fathers fools, fo wife we grow. 
 " Our wifer fons I hope will thiak us fo/* 
 
 u u 
 
DEFENCE 
 
 OF \^ 
 
 BLOOD-LETTING 
 
 AS A 
 
 REMEDY 
 
 FOK 
 
 CERTAIN DISEASES. 
 
DEFENCE, &c. 
 
 XjEFORE I proceed to the Defence of 
 Blood-letting as a remedy for certain difeafes, par- 
 ticularly for fevers, it will be neceflary to introduce 
 a fyllabus of all the ufual remedies for fever, in its 
 ordinary ftate. They conUll, 
 
 I. Of fuch things as leflen, by the abflra^lion of 
 ftimulus, the morbid and exceffive a6lion of the 
 blood-veflels. 
 
 II. Of fuch, as by exciting a6lion in the flomach, 
 bowels, brain, nerves, mufcles, and ikin, equalize 
 the excitement of the whole fyllem, and thereby in- 
 directly deftroy a weak but morbid action in the 
 blood-veflels, by imparting to them a more vigo- 
 rous and healthy a6lion. 
 
 I. The remedies which belong to the first ge- 
 neral head are, 
 
 M 4 I. Eva- 
 
184 A DEFENCE OF BLOOD-LETTING, 
 
 I. Evacuant;. Thefe are, 
 
 1. B'ood-letting. 
 
 2. Vomits. 
 
 3. Purges. 
 
 4. Sweating medicines^ 
 
 5. A falivation. 
 
 6. Blifters. 
 
 II. Remedies which abftraiTt the iTimulus 
 *-- of heat by i. cold air, 
 
 3. cold water, and, 
 : 3. ice. 
 
 •«- of food by 4. abflinence. 
 
 — of found and light by 5. iilence and darknefs* 
 
 — ofinvigoratingpalTionsby 6. moderate fear. 
 i^w of motion by 7. reft. 
 
 W49- of acrimony by 8. diluting drinks, and, 
 
 9. cleanlinefs. 
 
 m. Remedies which divert local congeftion, in- 
 flammation, and ferous efFufion from vital parts, to 
 fuch as are lefs effential to life. Thefe are all fuch 
 as are mentioned under the head of evacuants, par. 
 ttcularly a falivation and blifters. 
 
 IV. Medicines faid to poffefs fedative powers, 
 fuch as 
 
 I . Nitre, and other neutral falts. 
 
 2. Certain 
 
A DEFENCE OF BLOOB-I^ETTIKG. 1 85 
 
 2- Certain preparations of antimony. 
 
 3. Sugar of lead* 
 
 4. Fox-glove. 
 
 5. Applications of fwcet oil to the CKtemal 
 furface of the body. 
 
 II. The remedies which belong to the sEt:oND 
 general head, are ftimulants. Thefe divide them- 
 felves naturally into fuch as are internal, and fuch 
 as are external. 
 
 I. The internal Itimulants may further be divided 
 into medicines and aliments. The medicines are 
 
 1. All fermented and diililled liquors. 
 
 2. Volatile alkali. 
 
 3. Empyreumatic and aromatit: oils. 
 
 4. Opium. 
 
 5. ^ther. 
 
 ' 6. Bark, and bitters of all kinds. 
 
 7. Mercury. 
 
 8. Pure air. 
 
 9. The invigoration of the paflions and un- 
 ftanding. 
 
 The aliments include fuch vegetable and animal 
 matters, as are commonly ufed in diet, together 
 with fago, faloop, tapioca, and the like. 
 
 II. The 
 
l86 A DEFENCE OF BLOOD-LETTING. 
 
 II. The external ilimulants are 
 
 1. Several of the internal flimulants fo pre- 
 pared, as to be applied to different parts of the 
 body, as the nofe, the temples, the external re- 
 gions of the ftomach and bowels, the limbs, and 
 the lower inteflines, by way of glylfer. 
 
 2. The cold and warm baths. 
 
 3. Bliflers. 
 
 4. Cataplafms of onions, garlic, and muflard, 
 to the feet. 
 
 5. Canities. 
 
 6. Boiling water* 
 
 I return now, agreeably to the title of this effay, 
 to confider blood-letting as a remxdy for fevers, 
 and certain other difeafes. In treating of the 
 comparative advantages of blood-letting, I fhall 
 be under the neceflity of making a few remarks 
 upon each of the remedies fet down in the fyllabus, 
 under the head of evacuants. 
 
 I fhall begin this fubjeft by remarking, that 
 blood-letting is indicated in the inflammatory flate 
 of fever, 
 
 I. By the fudden fuppreflion or diminution of 
 the natural difcharges by the pores, bowels, and kid- 
 neys, whereby a plethora is induced in the fyftem. 
 
 2. By 
 
A DEFENCE Of BLOOD-LETTING. 187 
 
 2. By the robuft habits of the perfons who are 
 moil fubje(Si: to the inflammatory ftate of fever. 
 
 3. By the proximate caufe of fever. I have at- 
 tempted to prove that the inflammatory flate of 
 fever depends upon morbid and exceiTive aci:ion in 
 the blood-vefTels. It is connected, of courfe, with 
 preternatural fenfibility in their mufcular fibres. 
 The blood is one of the moil powerful flimuli which 
 a6i: upon them. By abllra^iing a part of it, we 
 leiTen the principal caufe of the fever. The effe^ 
 of blood-letting is as immediate and natural in re- 
 moving fever, as the abftra^lion of a particle of fand 
 is to cure an inflammatiou of the eye, w^hen it arifes 
 from that caufe. 
 
 4. By the fymptoms of the firil flage of this ilatc 
 of fever, fuch as a ileepinefs and an opprefTed pulfe^ 
 cr by delirium, with a throbbing pulfe and great 
 pains, in every part of the body. 
 
 5. By the rupture of tlie blood-vefTcls, w^hich 
 takes place from the quantity or impetus of the 
 blood in inflammatory fever. Let no one call bleed- 
 ing a cruel or unnatural remedy. It is one of the 
 fpecifics of nature ; but in the ufc of it fhe feldom 
 affords much relief. Siie frequently pours the flimu- 
 Jating and oppreiTmg mafs of blood into the lungs 
 
 and 
 
J 88 A DEFENCE OF BLOOD-LETTING. 
 
 and brain; and when flie finds an outlet for it 
 through the nofe, it is difcharged either in fuch a 
 deficient or exceiTive quantity, as to be ufelefs or 
 hurtful. By artificial blood-letting, we can choofe 
 the time and place of drawing blood, and we may 
 regulate its quantity by the degrees of zQion in the 
 blood-vefiels. The difpofition of nature to cure 
 the inflammatory ilate of fever by depletion, is fur- 
 ther manifefled by her fubflituting, in the room of 
 blood-letting, large, but lefs fafe and lefs beneficial, 
 evacuations from the flomach and bowels. 
 
 6. By the relief which is obtained in fevers of 
 violent a£lion by remedies of lefs efiicacy (to be 
 mentioned hereafter) which aft indireftly in re- 
 ducing the force of the fanguiferous fyftem. 
 
 7. By the immenfe advantages which have at- 
 tended the ufe of blood-letting in the inflammatory 
 ilate of fever, when ufed at a proper time, and in a 
 quantity fuited to the force of the difeafe. I fliall 
 briefly enumerate thefe advantages. 
 
 3. It frequently flirangles a fever when ufed in 
 its forming flate, and thereby faves much pain, time, 
 and expenfe to a patient. 
 
 2. It imparts flrength to the body, by removing 
 the preflure of indireft debility. It moreover ob- 
 viates 
 
A DEFENCE OF BLOOD-LETTING. iS^ 
 
 viates a difpofitiou to faint, which arifes from this 
 ftate of the fyflem. 
 
 3, It reduces the uncommon frequency of the 
 pulfe. The lofs of ten ounces of blood reduced 
 Mifs Sally Eyre's pulfe from 176 ftrokes to 140 
 in a few minutes, in the fever of the year 1 794* 
 
 4, It renders the pulfe more frequent when it 
 is preternaturally flow. 
 
 5, It checks the naufea and vomiting which at- 
 tend the malignant flate of fever. Of this I faw 
 many inflances in the year 1794. Dr. Poiffonnier 
 Defperrieres confirms this remark in his Account of 
 the Fevers of St. Domingo ; and adds further, that 
 it prevents, when fufficiently copious, the trouble- 
 fome vomiting which often occurs on the fifth daj 
 of the yellow fever. * 
 
 6, It renders the bowels, when coflive, more 
 eafily moved by purging phyfic. 
 
 7, It renders the a61:ion of mercury more fpeedy 
 and more certain in exciting a falivation* 
 
 * Traite des fi^vres de Vide de St. Domingue. Vol. II. 
 p. 76. 
 
 8. It 
 
19^ A D^FE^CE OF ELOOr)-LETTlNd* 
 
 8. It difpofes the body to fweat fpontaneoull}% 
 or renders diluting and diaphoretic medicines more 
 effedlual for that purpofe. 
 
 9- It fuddenly removes a drynefs, and gradually 
 a blacknefs, from the tongue. Of the former ef- 
 fect of bleeding, I faw two inflances, and of the lat- 
 ter, one, during the autumn of 1794* 
 
 10. It removes or leiTens pain in every part of 
 the body, and more efpecially in the head, 
 
 1 1. It removes or leffens the burning heat of the 
 fkin, and the burning heat in the flomach, fo com- 
 mon and fo diilreffing in the yellow fever. 
 
 12. It removes a conflant chillinefs which fome« 
 times continues for feveral days, and which will 
 neither yield to cordial drinks, nor warm bed-cloaths. 
 
 13. It checks fuch fweats as are profufe \Vith- 
 out affording relief, and renders fuch as are partial 
 and moderate, univerfal and falutary. 
 
 14. It fometimes checks a diarrhoea and tenefmus, 
 after aflringent medicines have been given to no 
 purpofe. This has often been obferved in the 
 meafles, 
 
 15. It 
 
A DEFENCE OF BLOOD-LETTING. tgt 
 
 15. It fuddenly cures the intolerance of light 
 which accompanies many of the inflammatory ilates 
 of fever, 
 
 16. It removes coma. Mr. Henry Clymer was 
 fuddenly relieved of this alarming fymptom in the 
 fever of 1794, by the lofs of twelve ounces of 
 blood. 
 
 17. It induces fleep. This effe£l: of bleeding is 
 fo uniform, that it obtained, in the year 1794, the 
 name of an anodyne in feveral families. Sleep 
 fometimes ftole upon the patient while the blood 
 was flowing. 
 
 18. It prevents elFufions of ferum and blood. 
 Haemorrhages feldom occur where bleeding has been 
 fuflEciently copious. 
 
 19. It belongs to this remedy to prevent the 
 chronic difeafes of cough, confumption, jaundice, 
 abfcefs in the liver, and all the different ftates of 
 dropfy which fo often follow autumnal fevers. 
 
 My amiable friend Mrs Lenox, furniflied an ex- 
 ception to this remark in the year 1794. After 
 having been cured of the yellow fever by feven 
 bleedings, (he was affe(51:ed, in confequence of taking 
 
 a ride. 
 
Xg2 A DEFENCE OF Bl^OOB-LETTING. 
 
 a ride, with a flight return of fever, accompanied 
 by an acute pain in the head, which I was afraid 
 would end in a dropfy of the brain. As her pulfe 
 was tenfe and quick, I advifed repeated bleedings to 
 remove it. This prefcription, for reafons which it 
 is. unneceiTary to relate, was not followed at the 
 time, or in the manner, in which it was recom- 
 mended. The pain, in the mean time, became 
 more alarming. In this fituation, two phyficians 
 were propofed by her friends to confult with me. 
 I obje6led to them both, becaufe I knew their prin- 
 ciples and modes of pra^ice to be contrary to mine, 
 and that they %vcre propofed only with a view of 
 WTefting the lancet from my hand. From this dellre 
 of avoiding a controverfy with my brethren, where 
 conviclion was impoffible on either fide, as well as 
 to obviate all caufe of complaint by my patient's 
 friends, I olFered to take my leave of her, and to 
 refign her wholly to the care of the two gentlemen 
 who were propofed to attend her with me. To this 
 Ihc objected in a decided m.anner. But that I might 
 not be fufpe£ted of an undue reliance upon my own 
 judgment, I propofed to call upon Dr. Griflitts or 
 Dr. Phyfick to aiTiil me in my attendance upon her. 
 Both thefe phyficians had renounced the prejudices 
 of the fchools in which they had been educated, 
 and had conformed their principles and practice to 
 the prefent improving flate of medical fcience. l^vly 
 I patient 
 
A DEFENCE OF BLOOD-LETTING. 193 
 
 patient preferred Dr. Griffitts, who in his firjfl vifit to 
 her, as foon as he felt her pulfe, propofed more bleed- 
 ing. The operation was performed by the Doctor 
 himfelf, and repeated daily for five days afterwards. 
 From an apprehenfion that the diforder was fo fixed 
 as to require fome aid to blood-letting, we gave her 
 calomel in fuch large dofes as to excite a falivation. 
 By the ufe of thefe remedies Ihe recovered flowly, 
 but fo perfe6lly as to enjoy her ufual health. 
 
 20. Bleeding prevents the termination of the in* 
 flammatory, in the gangrenous and chronic flates of 
 fever. This etFe£i: of blood-letting will enable us to 
 underfland fome thmgs in the writings of Dr. Mor^ 
 ton, and Dr. Sydenham which at firfl fight appear to 
 be unintelligible. Dr. Morton defcribes what he 
 calls a putrid fever, which was epidemic, and fatal 
 in the year 1678. Dr. Sydenham, who pra6tifed 
 in London at the fame time, takes no notice of this 
 fever. The reafon of his filence is obvious. By 
 copious bleeding he prevented the fever of that year 
 from running on to the gangrenous ilate, while Dr. 
 Morton by neglefting to bleed, created the fuppofcd 
 putrid fevers which he has defcribed* 
 
 It has been common to charcre the friends of 
 
 o 
 
 blood-letting with temerity in their pra^liee. From 
 this view which has been given of it, it appears that 
 
 K it 
 
194 -^ DEFENCE OF BLOOD-LETTING* 
 
 it would be more proper to afcribe iiinidity to them, 
 for they bleed to prevent the offenfive and diftrefT- 
 ing confequences of neglecting it, which have been 
 mentioned. 
 
 ^i. It cures without permitting a fever to put 
 on thofe alarming fymptoms, which excite conflant 
 apprehenfions of danger and death in the minds of 
 patients and their friends. It is becaufe thefe 
 alarming fymptoms are prevented, by bleeding, 
 that patients are fometimes unwilling to believe 
 they have been cured by it, of a malignant fever. 
 Thus the Syrian Leper of old, viewed the water of 
 Jordan as too fimple, and too cdmmon to cure a for- 
 midable difeafe, without recollefting that the reme- 
 dies for the greatefl evils of life are all fimple, and 
 within the power of the grcateil part of mankind. 
 
 22. It prepares the way for the fuceefsful ufe of 
 the bark and other tonic remedies, by deflroying, 
 or fo far weakning, a morbid aflion in the blood- 
 velTels, that a medicine of a moderate flimulus after- 
 wards exceeds it in force, and thereby reflorea 
 equable and healthy a£lion to the fyftem. 
 
 23. Bleeding prevents relapfes. It moreover 
 prevents that predifpofition to the intermitting, and 
 pleuritic flates of fever whioh fo frequently attack 
 
 perfons 
 
A DEFENCE OF BLOOD-LETTING. 195 
 
 perfons in the fpring, who have had the bilious re- 
 mitting fever in the preceding autumn. 
 
 But great and numerous as the advantages of 
 blood-letting are in fevers, there have been many- 
 objections to it. I fhall briefly enumerate, and en- 
 deavour to refute the errors upon this fubjeCt. 
 
 Blood-letting has been forbidden by phyficians, 
 by the follov^ing circumilances, and ftates of the 
 fyilem. 
 
 I. By warm weather. Galen bled in a plague, 
 and Ar^teus in a bilious fever, in a warm cli- 
 mate. Dr. Sydenham and Dr. Hillary, inform us 
 that the moil: inflammatory fevers occur in, and fuc- 
 ceed hot weather. Dr. C leghorn prefcribed it 
 copioufly in the warm months, in Minorca. Dr. 
 Mofely cured the yellow fever by this remedy in 
 Jamaica. Dr. Broadbelt and Dr. Wefl:on in the 
 fame Ifland have lately adopted his fuccefsful prac- 
 tice. Dr. Defportes fpeaks in the highefl terms 
 of it in all the inflammatory difeafes of St. Domingo. 
 He complains of the negle£l of it in the rheumatifm, 
 in confequence of which he fays, the difeafe pro- 
 duces abfceffes in the lungs.* I have never in any 
 
 * P. 35. 
 N 2 vear 
 
ig6 A DEFENCE OF BLOOD-LETTING* 
 
 year of my praftice, been retrained by the heat of 
 fummer in the ufe of the lancet, where the pulfe has 
 hidicated it to be neceffary, and have always found 
 the fame advantages from it, as when I have pre- 
 fcribcd it in the winter or fpring months* 
 
 The relaxation and debility of the body in warm 
 weather, and in hot climates, has not been underflood 
 until lately, to be of the indiredl kind. Of courfe, 
 inilead of forbidding, it requires depletion to remove 
 it. It is leiTencd at all times by abflemious living, 
 and by gentle dofes of phyfic, but when the flimulus 
 of a fever is added to that of the heat of the fun,, 
 blood-letting is often more neceffary to remove it, 
 than it is in cool weather, or in temperate climates* 
 
 2. Being born, and having lived in a warm cli- 
 mate. This is fo far from being an obje£i:ion to 
 blood-letting in an inflammatory difeafe, that it ren- 
 ders it more neceffary. I think I have lofl feveral 
 Wefl India patients from the influence of this 
 error. 
 
 3. Great apparent weaknefs. This, in acute and 
 violent fevers is always of the indiredl: kind. It is 
 induced by prefTure upon the fources of ftrength in 
 the mufcles. It refembles in fo many particulars 
 that weaknefs, which is the cSc£t of the abflra^ion 
 
 of 
 
A DEFENCE OF BLOOD-LETTtNG. I97 
 
 of ftlmulus, that it is no wonder they have been 
 confounded by phyficians. This famenefs of fymp- 
 toms from oppolite flates of the fyflem is taken 
 notice of by Hippocrates. He defcribes convulfions, 
 and particularly a hiccup as occurring equally from 
 repletion and inanition which anfwer to the modern 
 terms of indire^l, and dire(5l debility. The natural 
 remedy for the former is depletion, and no mode 
 of depleting is fo efFe(^ual or fafe as blood-letting. 
 But, the great objeftion to this remedy is when the 
 inflammatory (late of fever, affe^ls perfons of delicate 
 conflitutions, and fuch as have long been fubje<fi: to 
 direfl debility of the chronic kind. In this flate of 
 the fyllcm, there is the fame morbid and preter- 
 natural a(5lion in the blood- veiTeis, that there is in 
 perfons of robufl: habits, and the fame remedy is 
 neceiTary to fubdue it in both cafes. It is fometimes 
 indicated in a larger quantity in weakly, than in 
 robufl people, by the plethora which is more eafily 
 induced in their relaxed, and yielding blood- veiiels, 
 and by the greater facility with which ruptures and 
 cffufions take place in their vifcera. Thus it is more 
 nccelTary to throw overboard, a large part of the 
 cargo of an old and leaky velTcl in a ftorm, than of 
 a new andftrong one. I know that vomits, purges, 
 fweats, and other evacuating remedies, are preferred 
 to bleeding in weakly conflitutions, but I hope to 
 flicw hereafter, that bleeding is not only more ef- 
 
 N 3 fcflual, 
 
198 A DEFENCE OF BLOOD-LETTIN(^. 
 
 fe6!:ual, but more fafe in fuch habits, than any other 
 depleting remedy. 
 
 4. Infancy and childhood. This is fo far from 
 being an objection to bleeding, that the excitable 
 ftate of the blood-veiTels in thofe periods of life, 
 renders it peculiarly neceflary in their inflammatory 
 difeafes. Dr. Sydenham bled children in the hoop- 
 ing cough, and in dentition. I have followed his 
 practice, and bled as freely in the inflammatory flate 
 of fever in infancy as in middle life. I bled my 
 eldeft daughter vi^hen fhe was but fix weeks old, 
 for convulfions brought on by an excefTive dofe of 
 laudanum given to her by her nurfe ; and I bled my 
 youngeft fon twice before he was two months old, 
 for an inflammatory fever which fell upon his lungs 
 and bowels. In both cafes, life appeared to be faved 
 by this remedy. 
 
 5. Old age. The increafe of appetite in old 
 people, their inability to ufe fufiicient exercife, 
 whereby their blood- vefl^els become relaxed, ple- 
 thoric and excitable, and above all, the tranflation 
 of the flrength of the mufcles to the arteries, and of 
 plethora to the veins, all indicate bleeding to be 
 more neceflfary (in equal circumftances) in old than 
 in middle aged people. I am not the author of this 
 opinion, Botallus left a teflimony in favor of it 
 
 nearly 
 
A DEFEKCE OF BLOOD-LETTING. I99 
 
 nearly 200 years ago,* and it has fmce been con- 
 firmed by the experience of Hoffman, and many other 
 phyficians. An ignorance of, or inattention to this 
 change in the ftate of the blood-veffels, in perfons 
 in the decHne of life, and the negle6l of the only 
 remedy indicated by it, is probably the reafon why 
 difeafes often prove fatal to them, which in early, 
 or middle life cured themfelves, or yielded to a fmgle 
 dofe of phyfic, or a few ounces of bark. 
 
 6. The time of menftruation. The fyilem during 
 this period is plethoric and excitable, and of courfe 
 difpofcd to a violent degree of inflammatory fever, 
 from all the caufes which excite it. Bleeding therefore 
 is more indicated in an inflammatory flate of fever, 
 at this time, than at any other. Formerly the na- 
 tural difcharge from the uterus was trufl:ed to, to 
 remove a fever contradled during the time of men- 
 ftruation. But v/hat relief can the difcharge of 
 four or ^YC ounces of blood from the uterus afford, 
 in a fever which requires the iois of 50, or perhaps 
 of an 100 ounces to cure it? 
 
 7. Pregnancy. The difl:ention induced upon 
 the uterus dire(^tly, and indirectly upon the whole 
 
 "^ Magis effe adjuvandos fenes, miffione fangulnis dum 
 morbus poftulat, aut corpus eorum habitus malus eft, quara 
 ubi hac (quod abfonum videbltuv) juvenlhus conlingunt. 
 
 Dc Cur. per Sang, miffionem, cap. 11. § n. 
 N 4 fyfl:em 
 
200 A DEFENCE OF BLOOD-LETTING. 
 
 fyflem by the foetus, renders bleeding in the inflam- 
 matory itate of fever, more neceflary than at other 
 tirnes. I have elfewhere mentioned the advantages 
 pf bleeding pregnant women, in the yellow fever. 
 I did not learn the advantages of the pra<?i:ice in that 
 difeafe. I bled Mrs. Philler 1 1 times in feven days, 
 in a pleurify during her pregnancy, in the month of 
 March 1783. M^s. Fifs, wa.s bled 13 times in 
 the fpring of 1783 ; and Mrs. Kirby 16 times in the 
 fame condition by my orders in the winter of 1786, 
 m a fiinllar difeafe. All thefe women recovered, 
 and the children they carried during their ilinefs, 
 are at this time alive, and in good health. 
 
 8. Fainting after bleeding. This fymptom is 
 accidental in many people. No inference can be 
 drawn from it againil blood-letting. It often occurs 
 after the iirfl and fecond bleedings in a fever, but 
 in no fubfequent bleeding, though it be repeated 
 a dozen times. Of this I faw feveral inflances in 
 the yellow fever of 1794. The pulfe during the 
 fainting, is often tenfe and full. 
 
 9. Coldnefs of the extremities, and of the whole 
 body. This cold ftate of fever when it occurs early, 
 yields more readily to bleeding, than to the mofl 
 cordial medicines. 
 
 10. Sweats 
 
A DEFENCE OF BLOOD-LETTING. 201 
 
 10. Sweats are fuppofed to forbid blood-letting. 
 I have feen two inflances of death, from leaving a 
 paroxyfm of malignant fever to terminate itfelf by 
 fweating. Dr. Sydenham has taught a contrary 
 pratTtice in the following cafe. " While this con- 
 ftitution (fays the Doctor) prevailed, I was called 
 to Dr. Morice, who then praflifcd in London. He 
 had this fever, attended v/ith profufe fweats and nu- 
 merous petechice. By the confent of fome other 
 phyficians, our joint friends, he was blooded, and 
 rofe from his bed, his body being firil wiped dry. 
 He found immediate relief from the ufe of a cooling 
 diet and medicines, the dangerous fy mptoms foon 
 going off; and by continuing this method he reco- 
 vered in a few days.^' * In the fame fever, the 
 Dodor adds further, " For though one might ex- 
 ped great advantages in purfuing an indication 
 taken from what generally proves ferviceable (viz. 
 fweafmg)^ yet I have found by conftant experience, 
 that the patient not only finds no relief, but con- 
 trary wife, is more heated thereby ; fo that fre* 
 quently a delirium, petechise, and other very dan- 
 gerous fymptoms immediately fucceed fuch^^^/^."t 
 
 Morgagni defcribes a malignant fever which pre- 
 vailed in Italy, in which the patients died in pro- 
 fufe fweats, while their phyficians were looking for 
 
 * Wallis's edition, Vol, I, p. 210. f Vol. I. p. 208; 
 
 a criiis 
 
202 A DEFENCE OF BLOOD-LETTING. 
 
 a crifis from them. Bleeding would probably have 
 checked thefe fweats and cured the fever. 
 
 1 1 . DifTolved blood, and an abfence of an inflam- 
 matory crufl on its craflamentum. I {hall hereafter 
 place diiTolved blood at the highefl point of a fcale, 
 which is intended to mark the different degrees of 
 inflammatory diathefls in the fyflem. I have men- 
 tioned in the inquiry into the proximate caufe of 
 fever, that it is the efle61: of a tendency to a palfy, 
 induced by the violent force of impreflion upon the 
 blood-veflTels. This appearance of the blood in cer- 
 tain flates of fever, infl:ead of forbidding bleeding, 
 is the mod vehement call of the fyflem for it. Nor 
 is the abfence of a crufl on the crafl!amentum of the 
 blood, a proof of the abfence of inflammatory dia- 
 thefis, or a iignal to lay afide the lancet. On the 
 contrary, I fliall fliew hereafter, that there are feve- 
 ral appearances of the blood which indicate more 
 morbid action in the blood-veflfels than a iizy or in- 
 flammatory criifl. 
 
 12. An undue proportion of ferum to crafTamen- 
 tum in the blood. This predominance of water in 
 the blood has often checked fufflcient blood-letting. 
 But it iliould be conflantly difregarded v/liile it is 
 attended with thofe flates of pulfe (to be mxentioned 
 hereafter) which require bleeding. 
 
 13. The 
 
A DEFENCE OF BLOOD-LETTING. SOJ 
 
 13. The prefence of petechias on the ilcin. Thefe, 
 I have elfewhere faid, are the eiFe<^s of the gangre- 
 nous flate of fever. Dr. Sydenham and Dr. tie 
 Haen have taught the fafety and advantage of 
 bleeding, when thefe fpots are accompanied by 
 an aftive pulfe. A boy of Mr. John Carrol owes 
 his recovery from the fmall-pox to the lofs of 
 fifty ounces of blood, by five bleedings, at a time 
 v/hen nearly every pock on his arms and legs had 
 a purple appearance. Lewis XIV. was bled five 
 times in the fmall-pox, when he was only thirteen 
 years of age, and thereby probably faved from the 
 grave, to the great honour and emolument of the 
 fingle phyfician who urged it againfl the advice of 
 all the other phyficians of the court. Dr. Cleghorn 
 mentions a fingle cafe of the fuccefs of bleeding in 
 the petechial fmall-pox. His want of equal fuccefs 
 afterwards, in fimilar cafes, was probably occafioned 
 by his bleeding too fparingly, that is, but three or 
 four times. 
 
 Abfcefies and fore breads, which accompany or 
 fucceed fever, are no obje6lions to blood-letting, 
 provided the pulfe indicates the continuance of inflam- 
 matory diathefis. They depend frequently upon the 
 fame ilate of the fyflem, as livid effufions on the /kin. 
 
 14. The long duration of fever. Inflammatory 
 diathefis is often protracted for many weeks, in the 
 
 chronic 
 
2.04 ^"^ DEFENCE OF BLOOD-LETTING. 
 
 chronic ftate of fever. It moreover frequently Re- 
 vives after having difappeared, from an accidental 
 flimulus aiTcifting fome part of the body, particularly 
 the lungs and brain. I bled a young man of James 
 Cameron, in the autumn of 1794, four times be- 
 tween the 20th and 30th days of a chronic fever, 
 in confequence of a pain in the fide, accompanied 
 hj a tenfe pulfe, which fuddenly came on after the 
 20th day of his difeafe. His blood was fizy. His 
 pain and tenfe pulfe were fubdued by the bleeding, 
 and he recovered. I wifli this cafe to be attended 
 to by young pracl:itioners. The pulmonary con- 
 fumption is often the effed of a chronic fever, ter- 
 minating with frefh inflammatory fymptoms, by effu- 
 fions in the lungs. It may eafily be prevented, by 
 forgetting the number of the days of our patient's 
 fever, and treating the pulmonary aire(ftion as if it 
 were a recent complaint. 
 
 15. Tremors and flight convulfions in the limbs. 
 Eark, wine, laudanum, and miiik are generally pre- 
 fcribed to remove thefe fymptoms ; but to be effec- 
 tua!, the}'- ihould, in mofl cafes, be preceded by the 
 lofs of a few ounces of blood. 
 
 16, Bleeding is forbidden after the 5th or 7th 
 day in a pkurify. This prohibition was introduced 
 into medicine at a time when a fear was enter- 
 tained 
 
A DEFENCE OF BLOOD-LETTING. ' 205 
 
 talned of arrefling the progrefs of nature in prd- 
 paring and expelling morbific matter from the fyf- 
 tem. From repeated experience I can affert, that 
 bleeding is llife in every flage of pleurify in which 
 there is pain and a tenfe and opprefTed pulfe ; and 
 that it has, when ufed for the firfl time after the 
 5th and 7th days, faved many lives. 
 
 17. The lofs of a fufEcIent quantity of blood is 
 often prevented by patients being apparently worfey 
 after the firfl or fecond bleeding. This change for 
 the worfe iliews itfelf in fome one or more of the 
 following fymptoms, viz. increafe of heat, chills, 
 delirium, hemorrhages, convulfions, naufea, vomit- 
 ing, faintnefs, coma, great weaknefs, pain, a tenfe 
 after a foft pulfe, and a reduction of it in force 
 and frequency. They are all occafioned by the fyf- 
 tem rifmg fuddenly from a ftate of extremxC de- 
 prefiion, in confequence of the abflracSiion of the 
 preiTure of the blood to a ftate of vigour and ac- 
 tivity, fo great in fome inftances, as to re-produce 
 a depreflion below what exifted in the fyflem be* 
 fore a vein was opened ; or it is occafioned by a 
 tranflation of morbid a6lion from one part of the 
 body to another. 
 
 The chills which follow bleeding are the effe<5^s 
 ef a change in the fever, from an uncommon to a 
 
 common 
 
206 A DEFENCE OF BLOOD-LETTING. 
 
 common ftate of malignity. They occur chiefly in 
 thofe violent cafes of fever which come on without 
 a chiliy fit. 
 
 The haemorrhages produced by bleeding, are 
 chiefly from the nofe, hsemorrhoidal veflels, or ute- 
 rus, and of courfe are, for the mod part, fafe. 
 
 Uncommon weaknefs fucceeding blood-letting, is 
 the effect of fudden indireci: debility induced upon 
 the whole fyflem, by the caufe before mentioned, 
 or of a fudden tranflation of the excitement of the 
 mufcles into the blood-veffels, or fome other part of 
 the body. Thefe fymptoms, together with all the 
 others which have been mentioned, are fo far from 
 forbidding, that they all mofl: forcibly indicate a re- 
 petition of blood-letting. 
 
 I fiiall briefly illuftrate, by the recital of three 
 cafes, the good effe^ls of bleeding, in removing pain, 
 and the preternatural flownefs, and weaknefs of the 
 pulfe, when produced by the ufe of that remedy. 
 
 In the month of June of 1795, 1 vifited Dr. Say in 
 a malignant fever, attended with pleuritic fymptoms, 
 in confultation with Dr. Phyfick. An acute pain in 
 his head followed fix fucceiflve bleedings. After a 
 feventh bleeding he had no pain. His fever foon 
 
 afterwards 
 
A DEFENCE OF BLOOD-LETTINO. lOJ 
 
 afterwards left him. In thus perfevering in the 
 ufe of a remedy which, for feveral days, appeared to 
 do harm, we were guided wholly by the flate of his 
 pulfe, which uniformly indicated, by its force, the 
 neceflity of more bleeding. 
 
 In the autumn of 1794, I was fent for to vifit Sa- 
 muel Bradford, a young man of about 20 years of 
 age, fon of Mr. Thomas Bradford, who was ill with 
 the reigning malignant epidemic. His pulfe was at 
 80. I drew about 1 2 ounces of blood from him. Im- 
 mediately after bis arm was tied up, his pulfe fell to 
 60 flrokes in a minute. I bled him a fecond time, but 
 more plentifully than before, and thereby, in a few 
 mJnutes, brought his pulfe back again to 80 flrokes 
 in a minute. A third bleeding the next day, aided 
 by the ufual purging phyfic, cured him in a few days. 
 
 In the month of March 1795, Dr. Phyfick re- 
 queued me to vifit, with him, Mrs. Fries, the wife of 
 Mr. John Fries, in a malignant fever. He had bled 
 her four times. After the fourth bleeding, her pulfe 
 fuddenly fell, fo as fcarce to be perceptible. I found 
 her hands and feet cold, and her countenance 
 ghaftly, as a perfon's in the lafl moments of life. In 
 this alarming fituation, I fuggefled nothing to Dr. 
 Phyfick but to follow his judgment, for I knew that 
 he was mailer of that law of the animal economy 
 
 which 
 
208 A DEFENCE OF BLOOD-LETTING. 
 
 which refolved all her fymptoms into an oppreffed 
 ftate of the f) item. The Dodor decided in a mo- 
 ment in favour of more bleeding;. During the flow- 
 ing of the blood, the puife rofe. At the end of 
 three, ten, and feventeen hours it fell, and rofe 
 again by three fucceffive bleedings, in all of which fiie 
 loft about thirty ounces o^fizy blood. So great was 
 the vigour acquired by the pulfe, a few days after 
 the paroxyfms of depreiTion, which have been de- 
 fcribed, were relieved. ^ that it required feven more 
 bleedings to fubdue it. I wiili the hiilory of thefe 
 two cafes to be carefully attended to by the reader. 
 I have been thus minute in the detail of them, chiefly 
 becaufe I heard of feveral praftitioners who, I am 
 perfuaded, have lofl patients Ly attempting to raife 
 a pulfe that had been deprelTed by bleeding, in a 
 malignant fever, by means of cordial medicines, in- 
 ftead of the repeated ufe of the lancet. The prac- 
 tice is ftriftly rational j for in proportion as the 
 blood-veflfels are weakened by preflure, the quantity 
 of blood to be moved fliould be proportioned to the 
 diminution of their ilrength. 
 
 It is remarkable that this deprefl^ed ftate of the 
 pulfe, whether induced by a paroxyfm of fever, or 
 by blood-letting, is fometimes attended with a flrong 
 pulfation of the arteries in the bowels and head. 
 
 A I have 
 
A DEFENCE OF BLOOD-JLETTING. 20^ 
 
 ' I ha^^e mentioned among the apparent bad efFecls 
 of bleeding, that it fometnncs changes a foft into a 
 tcnfe pulfe. Of this I faw a remarkable inllancc 
 in Captain John Barry in the autumn of 1795. 
 After the lofs of 130 ounces of blood in a malig- 
 nant yellow fever, his pulfe became fo foft as to in- 
 dicate no more bleeding. In this fituanon he re- 
 mained for three days, but without rnendino^ as 
 rapidly as I expeftcd from the fcate of his pulfe. 
 On the 4th day he had an hreniorrhage from his 
 bowels, from which he lofh above a pint of blood. 
 His pulfe now fuddenly became tenfc, and continued 
 fo for two or three days. I afcribed this change in 
 his pulfe to the vefTels of the bowels, which had 
 been oppreiTed by congeflion, being fo much re- 
 lieved by the hcemorrhage, as to refume an in- 
 flammatory a£l:ion. It is thus we fee the blood-vef- 
 fels, in a common phlegmon, travel back again from 
 a tendency to mortification, to the red colour and 
 pain of commion inflammation. 
 
 From a review of the commotions excited in the 
 fyllem by bleeding, a reafon may be given Vvhy the 
 phyfitians who do not bleed in the depreffed Hate 
 of the pulfe, have {o few pa.tients in what they call 
 malignant fevers, compared with thofe who ufe a 
 contrary practice. The difeafe, in fuch cafes, being 
 locked up, is not permitted to unfold its true cha- 
 
 o radler ; 
 
210 A DEFENCE OF BLOOt)-LETTING. 
 
 ra£ler ; and hence patients are faid to die of apo- 
 plexy, lethargy, colera, dyfentery, or nervous fe- 
 ver, who, under a different treatment, would have 
 exhibited all the marks of an ordinary malignant 
 fever. 
 
 In obviating the objections to blood-letting from 
 its apparent evils, I have faid nothing of the appa- 
 rent bad effefts of other remedies. A naufea is 
 often rendered worfe by an emetic, and pains in the 
 bowels are increafed by a purge. But thefe reme- 
 dies notwithflanding maintain, and juilly too, a high 
 character among phyficians. 
 
 1 8. Bleeding has been accufed of bringing on a 
 nervous, or the chronic fl:ate of fever. The ufe of 
 this remedy, in a degree fo moderate as to obviate 
 the putrid or gangrenous flate of fever only, may 
 induce the chronic Hate of fever ; for it is the 
 -cffe6l, in this cafe, of the remains of inflammatory 
 diathefis in the blood-velTels ; but when blood is 
 •drawn proportioned to the morbid action in the (jf- 
 tem, it is impoffible for a chronic fever to be pro- 
 duced by it. Even the excefiive ufe of blood-let- 
 ting, however injurious it may be in other refpe6ls, 
 cannot produce a chronic fever, for it dellroys mor- 
 bid a£lion altogether in the blood-veffels. 
 
 19. Bleed- 
 
A "DEFENCE OF BLOOD-LETTING* CI I 
 
 ig. Bleeding has been charged with being 3 
 weakening remedy. I grant that it is fo, and in 
 this its merit chiefly confifts. The morbid action of 
 the blood- vefTels mud be fubdued in part, in an in- 
 flammatory fever, before tonic remedies can be 
 given with fafety or advantage. Now this is ufualiy 
 attempted by depleting medicines, to be mentioned 
 hereafter, or it is left to time and nature, all of 
 w^hich are frequently either deficient or exceifive in 
 their operations ; whereas bleeding, by fuddenly re- 
 ducing the morbid a^lion of the blood-velTels to a 
 willied-for-point of debility, faves a great and un- 
 necelTary wafte of excitability, and thus prepares 
 the body for the exhibition of fuch cordial remedies 
 as are proper to remove the debility which predif- 
 pofed to the fever. 
 
 20. It has been fald that bleeding renders the 
 habitual ufe of it neceffary to health and life. This 
 objection to blood-letting is founded upon an igno- 
 rance of the difference between the healthy and mor^ 
 bid aftion of the blood-veffels. Where blood is 
 drawn in health, fuch a relaxation is induced in the 
 blood- vefTels, as to favour the formation of ple- 
 thora, which may require habitual bleeding to re- 
 move it ; but where blood is drawn only in the in- 
 flammatory ftate of fever, the blood-vefTels are re- 
 duced froiii a morbid decree of flren^th to that 
 
 ^ a which 
 
212 A DEFENCE OF BLOOD-LETTING. 
 
 which is natural ; in which ftatc no predifpofition 
 to plethora is created, and no foundation laid for pe-^ 
 riodical blood-letting, 
 
 21. It has been faid that bleeding, more efpc- 
 cially where it is copious, predifpofes to elFufions of 
 lerum in the lungs, chefl, bowels, limbs, and brain. In 
 replying to this objedion to bleeding, in my public 
 leclures, I h?tve addreiTed by pupils in the following 
 language : '' Aik the poor patients who come pant- 
 ing to the door of our hofpital, with fwelled legs and 
 hard bellies, every fall, whether they have been too 
 copioufly bled, and they v/ill all tell you, that no 
 kncet has come near their arms. Aik the parents 
 who flill mourn the lofs of children who iiave died 
 in our city of the internal dropfy of the brain, whe- 
 ther they were deflroyed by exceiTive blood-letting ? 
 If the remembrance of the acute fufferings which 
 accom.panied their ficknefs and death will permit 
 thefe parents to fpeak, they will tell you, that every 
 medicine, except bleeding, had been tried to no 
 purpofe in their children's diforders. Go to thofe 
 families m which I have praclifed for many years, 
 sind inquire, whether there is a living or a dead 
 inllance of dropfy having followed, in any one of 
 them, the ufe of my lancet ? Let the undertakers 
 and grave-diggers bear witnefs againfl me, if I have 
 <sy€r, in the courfs q{ xny practice, conveyed the 
 
 body^ 
 
A DEFENCE OF BLOOD-LETTING. 213 
 
 Lody of a fingle dropfical patient into their hands, 
 by exceiTive blood-letting ?" No. Dropfies, like 
 abfcefles and gangrenous eruptions upon the flxin, 
 arife, in moil cafes, from the wafit of fufficient 
 bleeding in inflammatory difeafes. Debility, when 
 of a direct kind, whether induced by art or nature, 
 fcldom difpofcs to efTufion. Who ever heard of 
 dropfy fucceeding famine ? And how rarely do we 
 fee it accompany the extreme dire6l debility of old 
 age ? 
 
 " If ever bleeding kills," fays Botallus, either 
 dire£i:iy or indire<5lly, through the inllrumentality of 
 other difeafes, " it is not from its excefs, but be^ 
 caufe it is not drawn in a fufficient quantity, or at 
 a proper time." * And again, fays this excellent 
 writer, " One hundred thoufand men periili from 
 the want of blood-letting, or from its being ufed 
 out of time, to one who periflies from too much 
 bleeding, prefcribed by a phyfician.' 
 
 j> 4- 
 
 It is remarkable, that the dread of producing a 
 dropfy by bleeding, is confined chiefly to its ufc in 
 malignant fevers ; for the men who urge this objec- 
 tion to it, do not hefitate to draw four or five quarts 
 •f blood in the cure of pleurify, and of a flrangu- 
 
 * Cap. viil. } 4. •]• Cap. xxwl. § 4. 
 
 o 3 la ted 
 
214 A DEFENCE OF BLOOD-LETTING. 
 
 lated hernia. The habitual aflbciation of the lancet 
 with the former of thofe diforders, has often caufed 
 me to rejoice when I have heard a patient complain 
 of a pain in his fide in a malignant fever. It infured 
 to me his confent to the frequent ufe of the lancet, 
 and it protected me, when it was ufed unfuccefs- 
 fully, from the clamours of the public, for few peo- 
 ple cenfure copious bleeding in a pleurify, 
 
 22. Evacuating remedies of another kind have 
 been faid to be more fafe, and equally effedual, in 
 reducing the inflammatory ftate of fever. I fliall 
 recapitulate each of thofe evacuating remedies, and 
 then draw a comparative view of their effeds with 
 blood-letting. They are, 
 
 I. Vomits. 
 
 II. Purges. 
 
 III. Sweats. 
 
 IV. Salivation- And, 
 
 V. Bliflers. 
 
 I. Vomits have often been eirecl:ual in curing 
 fevers of a mild character. They difcharge olTen^ 
 
 five 
 
A DEFENCE OF BLOOD-LETTING. 215 
 
 "five and flimulating matters from the flomach ; they 
 leiTen the fuhiefs of the blood- velTels, by deter- 
 mining the ferum of the blood through the pores ; 
 and they equalize the excitement of the fyflem, by 
 inviting its exceilive degrees from the blood-velTels 
 to the llomach and mufcles. But they are, 
 
 1 . Uncertain in their operation, from the torpor 
 induced by the fever upon the flomach. 
 
 2. They are unfafe in many conditions of the 
 fyflem, as in pregnancy and a difpofition to apoplexy 
 and ruptures. Life has fometimes been deflroyed 
 by their inducing cramp, hemorrhage, and infiam- 
 mation in the flomach. 
 
 3. They are not fubje6l to the controul of a phy- 
 fician, often operating more or lefs than was intended 
 by him, or indicated by the difeafe. 
 
 4. They are often ineffectual in mild, and always 
 fo in fevers of great inflammatory aClion. 
 
 11. Purges are ufeful in difcharging acrid faeces 
 and bile from the bowels in fevers. They a6l more* 
 over by creating an artificial weak part, and thus 
 invite morbid excitement from the blood-veffels to 
 the bowels. They likewife leiTen the quantity of 
 
 «» 4. blood. 
 
21^ A DEFENCE OF ELOOD-LETTING. 
 
 blood by preventing fixfii acceffions of chyle, being 
 added to it ; but like vomits they iire, 
 
 1 . Uncertain in their operation ; and from the 
 f^me caufe. Many ounces of falts and caHor oil, and 
 whole drachms of calomel and jalap, have often been 
 given, without efFe^t, to rem.ove the coflivenefs which 
 is conne£l:ed with the malignant flate of fever. 
 
 2. They are not fubje£l: to the direction of a 
 phyfician, with refpe^i: to the time of their opera- 
 tion, or the quantity or quality of matter they arc 
 intended to difcharee from the bowels. 
 
 3. They are unfafe in the advanced flage of 
 fevers. Dr. Phyfick informed me that three patients 
 died in tbe water clofet under the operation of purges 
 in St. George's hofpital during his attendance upon 
 it. I have feen death in feveral inflances fucceed a 
 plentiful fpontaneous ilool in debilitated habits. 
 
 III. Sweating was introduced into practice at a 
 time when morbific mxatter was fuppofed to be the 
 proximate caufe of fever. It acls, not by expelling 
 any thing excluilvely morbid from the blood, but 
 by abflradling a portion of its fluid parts, and thus 
 reducing the aftion of the blood-veifels. This mode 
 of curing fever is ilill fafliionable in genteel life. It 
 
 excites 
 
A DEFENCE OF BLOOD-LETTING. 2l*J 
 
 €xcites no fear, and olTends no fenfc. The fwcating 
 remedies have been numerous, and fafliion has 
 reigned as much among them, as in other things. 
 Alexipharmic waters, and powders, and all the 
 train oi Ibdorific medicines, have lately yielded to 
 the different preparations of antimony, particularly 
 to James's powder. I object to them all, 
 
 1 . Becaufe they are uncertain ; large and re- 
 peated dofes of them being often given to no purpofe. 
 
 2. Becaufe they are flov/, and difagreeable, 
 where they fucceed in curing fever. 
 
 3. Becaufe, like vomits and purges, they are not 
 imder the dire£^ion of a phyfician, with refped to 
 the quantity of fluid difcharged by them, 
 
 4. Becaufe they are fometimes, even when moH 
 profufe, ineffectual in the cure of fever. 
 
 5. The preparations of antimony lately employed 
 for the purpofe of exciting fweats, are by no means 
 fafe. They fometimes convulfe the (yflem by a 
 violent puking. Even the boafled James's powder 
 has done great mifchief. Dr. Goldfmith and Mr. 
 Howard, it \z faid were deftroycd by it. 
 
 IV. Mcr- 
 
2lt A DEFENCE OF BLOOD-LETTING. 
 
 IV. Mercury, the Sampfon of the Materia Medica, 
 after havmg fubdued the venereal difeafe, the 
 tetanus, and many other formidable diforders, has 
 lately added to its triumphs and reputation, by over- 
 coming the inflammatory and malignant ilate of 
 fe^/er. I fliall coniine myfelf in this place to its de- 
 pleting operation when it afts by exciting a faliva- 
 tion. From half a pound to two pounds of fluid, 
 are difcharged by it in a day. The depletion in 
 this way is gradual, whereby fainting is prevented. 
 By exciting and inflaming the glands of the mouth 
 and throat, excitement and inflamm.ation are ab- 
 i!ra£l:ed from more vital parts. In morbid con- 
 geilion and excitement in the brain, a falivation is 
 of eminent fervice, from the proximity of the dif- 
 charge to the part aifecled. But I object to it as 
 an exclufive evacuant in the cure of fever. 
 
 1. Becaufe it is fometimies impoflible by the 
 largeil dofes of mercury, to excite it, when the 
 exigencies of the fyflem render it moil necefl^ary. 
 
 2. Becaufe it is not fo quick in its operation, as 
 to be proportioned to the rapid progrefs of the 
 malii^nant fl:ate of fever. 
 
 3. Becaufe it is at all times a difagreeable, and 
 frequently a painful remedy, more efpecially where 
 the teeth are decayed. 
 
 i.. Becaufe 
 
A DEFENCE OF BLOOD-LET TINC. 219 
 
 4. Becaufe it cannot be proportioned in its dura- 
 tion, or in the quantity of fluid difcharged by it, to 
 the violence, or changes in the fever. 
 
 Dr. Chifholm relied, for the cure of the Boullam 
 fever at Grenada, chiefly upon this evacuation. I 
 have mentioned the ratio of fuccefs which attended 
 it. 
 
 V. Blisters are ufeful in depleting from thofe 
 parts which are the feats of topical inflammation. 
 The relief obtained by them in this way, more than 
 balances their flimulus upon the whole fyflem. I 
 need hardly fay, that their effects in reducing the 
 morbid and exceflive a£lion of the blood -veflels are 
 very feeble. To depend upon them in cafes of 
 great inflammatory a61:ion, is as unwife, as it would 
 be to attempt to bale the water from a leaky and 
 fmking fliip by the hollow of the hand, inflead of 
 difcharging it by two or three pumps. 
 
 Abflemious diet has fometimes been prcfcribed 
 as a remedy for fever. It acls direclly by the ab- 
 ftra^lion of the flimulus of food from the flomach, 
 and indire^ly by leflfening the quantity of blood. It 
 can bear no proportion in its efle6ls, to the rapidity, 
 and violence of an inflammatory fever. In chronic 
 fever fuch as occurs in the pulmonary confumption, 
 
 it- 
 
520 A DEFENCE OF BLOOD-LETTIKG. 
 
 it has often been tried to no purpofe. Long before 
 it reduces the pulfe, it often induces fuch a relaxation 
 of the tone of the flomach and bowels as to accelerate 
 death. To depend upon it therefore in the cure 
 of inflammatory fever whether acute or chronic, is 
 like truding to the rays of the fun to exhale the 
 water of an overflowing tide, inftead of draining it 
 off immediately by digging a hole in the ground. 
 
 Bleeding has great advantages over every mode 
 bf depleting that has been mentioned. 
 
 1. It abftracts one of the exciting caufes, viz. the 
 ftimulus of the blood from the feat of fever. I have 
 ibrmerly illullrated this advantage of blood-letting 
 by comparing it to the abilra£lion of a grain of fand 
 from the eye to cure an opthalmja. The other 
 depleting remedies are as indirecl: and circuitous in 
 their operation in curing fever, as vomits and 
 purges would be to remove an inflammation in the 
 eye, wliile the grain of fand continued to irritate it. 
 
 2. Blood-letting is quick in its opera.tion, and may 
 be accommodated to the rapidity of fever, when it 
 manifefts itfeif in apoplexy, palfy, and fyncope. 
 
 3. It is under the command of a phyfician. He 
 may bleed ivhen and ivhere he pleafes, and may 
 
 f^iit 
 
A, DEFENCE OF BLOOD-LETTING. 221, 
 
 fiiit the quantity of blood he draws, exaflly to the 
 condition of his patient's fyllem. 
 
 4. It may be performed v/ith the leafl: attendance 
 of nurfes or friends. This is of great importance 
 to the poor at all times, and to the rich during the. 
 prevalence of contagious and mortal epidemics. 
 
 5. It diflurbs the fydem much lefs than any of 
 the other modes of depleting, and therefore is befl: 
 accommodated to that flate of the fyilem, in which 
 patients are in danger of fainting or dying upoa 
 being moved. 
 
 6. It is a more delicate depleting remedy than 
 mod of thofe which have been mentioned, particu- 
 larly vomits, purges, and a falivation. 
 
 7. There is no immediate danger to life from \i% 
 ufe. Patients have fometimes died under the opera- 
 tion of vomits and purges, but I never faw nor 
 heard an inilance of a patient's dying in a fainty fit,, 
 broucrht on by bleedinq-. 
 
 8. It is lefs weakening, when ufcd to the extent 
 that is neceilary to cure, than the fame degrees of 
 vomiting, purging, and fweating. 
 
 9. Con- 
 
222 A DEFENCE OF BLOOD-LETTING. 
 
 9. Convalefcence is more rapid and more perfecl 
 after bleeding, than after the fuccefsful ufe of any of 
 the other evacuating remedies. 
 
 By making ufe of blood-letting in fevers, we are 
 not precluded from the benefits of the other evacua- 
 ting remedies. Some of them are rendered more 
 certain and more effe^lual by it, and there are cafes 
 of fever, in which the combined or fucceifive appKca- 
 of them all, is barely fufficient to fave life. 
 
 To rely upon anv one evacuating remedy, to the 
 exclufion of the oihers, is like trufting to a p?vir of 
 oars in a fca voyage, inilead of fpreading every fail 
 of a ill) p. 
 
 I fufpecl the difputes about the eligibility of the 
 different remedies which have been mentioned, have 
 arifen from an ignorance that they all belong to one 
 clafs, and that they differ only in their force and 
 m.anner of operation. Thus the phyficians of the 
 iail: century afcribed different virtues to falts of dif- 
 ferent namesp which the chemiffs of the prefent day 
 have taught us are exa6tly the fame, and differ only 
 in the manner of their being prepared. 
 
 Having replied to the principal ob]e£l:ions to blood- 
 letting, and dated its comparative advantages over 
 \ other 
 
Jk DEFENCH OF BLOOD-LETTING. 223 
 
 Other modes ofaepletion, I proceed next to mention 
 the circumitances which fliould regulate the ufc of it. 
 Thefe are, 
 
 I. The ftate of the pulse. 
 
 The following ftates of the pulfe indicate the nc*- 
 ceiTity of bleeding. 
 
 1. A full, frequent, and tenfe pulfe, fuch as oc- 
 curs in the pulmonary, rheumatic, gouty, phrenitic, 
 and maniacal flates of fever. 
 
 2. A full, frequent, and jerking pulfe, without 
 tenfion, fuch as frequently occurs in the vertiginous, 
 ^paralytic, apopleftic, and hydropic ftates of fever. 
 
 3. A fmall, fi'equent, but tenfe pulfe, fuch as oc- 
 'Curs in the chronic, pulmonary, and rheumatic fiates 
 of fever. 
 
 4. A tenfe and qukk pulfe, without much preter- 
 •natural frequency. This Hate of the pulfe is com- 
 mon in the yellow fever. 
 
 5. A flow but tenfe pulfe, fuch as occurs in the 
 apopleflic, hydrocephalic, and malignant flates of 
 fever, in which its (Irokes are from 60, to 9, in a 
 minute. 
 
 6. An 
 
224 ^ DEFENCE OF BLOOD-LETTING. 
 
 6. An uncommonly frequent pulfe, without much 
 tenfion, beating from 120 to 170 or r8o flrokes in 
 a minute. This ftate of the pulfe occurs likewifc m 
 the malignant flates of fever. 
 
 7. A foft pulfe, without much frequency or ful- 
 nefs. I have met with this ftate of the pulfe in af- 
 fections of the brain, and in that fl:ate of pulmo- 
 nary fever wliich is known by the name of pneu- 
 monia notha. It fometimes, I have remarkedj be- 
 comes tenfe after bleeding. 
 
 8. An intermitting pulfe. 
 
 9. A depreifed pulfe. 
 
 10. An im.perceptible pulfe. The flow, inter- 
 mitting, depreifed, and imperceptible flates of the 
 pulfe, are fuppofed exclufively to indicate congeftion 
 in the brain. But they are all, I believe, occa- 
 fioned likewife by great excefs of ftimulus a£l:ing 
 upon the heart and arteries. A pulfe more tenfe in 
 one arm than in the other, I have generally found 
 to attend a morbid ft ate of the brain. Much yet 
 remains to be known of the figns of a difeafe in th^ 
 brain, by the fcates of the pulfe ; hence Mr. Hun- 
 ter has jullly rem^arked, that " In infiam.mation of 
 the brain, the pulfe varies more than in infiamma- 
 
 2 tions 
 
A DEFENCE OF BLOOD-LETTING. ^2^ 
 
 tions of any other part ; and perhaps we are led to 
 judge of inflammation there, more from otbcr fymp- 
 toms than the pulfe." * 
 
 The flow, uncommonly frequent, intermitting, 
 and imperceptible ftates of the pulfe which require 
 bleeding, may be difl:inguiflied from the fame fl:ates 
 of the pulfe, which arife from direct debility or an 
 exhaufl:ed fl:ate of the fyfl:em, and that forbid bleed- 
 ing by the following marks. 
 
 1. They occur in the beginning of a fever. 
 
 2. They occur in the paroxyfms of fevers which 
 have remiflions and exacerbations. 
 
 3. They fometimes occur after blood-letting, 
 from caufes formerly mentioned. 
 
 4. They fometimes occur, and continue during 
 the whole courfe of an inflammation of the fl:omach 
 and bowels. And, 
 
 5. They occur in relapfes, after the criCs of a 
 fever. 
 
 The other fl:ates of the pulfe indicate bleeding in 
 every fl:age of fever, and in every condition of the 
 
 * Chap. ill. 9. 
 
 p fyftem. 
 
^iS A DEFENCE OF BLOOD-LETTINQ^ 
 
 iyjftem. I have taken notice, in another place, of 
 the circumftances which render it proper in the ad- 
 vanced ftage of chronic fever. 
 
 If all the ftates of pulfe which have been enume* 
 rated, indicate bleeding, it mufl be an affe£Hng 
 Gonfideration to refle<fi:^ how many lives have been 
 lofl by phyfieians limiting the lafe of the lancet only 
 to the tenfe or full pulfe ! 
 
 I wifli it comported with the propofed limits of 
 this efTay to illuftrate and eftablifli, by the recital of 
 cafes, the truth of thefe remarks upon the indica- 
 tions of bleeding from the pulfe. It is the trueft 
 index of the flate of the fyflem, and when it is per- 
 fectly underflood, it never deceives. Its frequency,, 
 (unconne£]:ed with its other Hates), being under the 
 influence of diet, motion, and the pailions of the 
 mind, is of the leafl confequence. In counting the 
 number of its ftrokes, we are apt to be diverted 
 from attending to its irregularity and force ; and in 
 thefe, it fliould always be remembered, fever chiefly 
 confiils. The knowledge acquired by attending ta 
 thefe fl:ates of the pulfe is fo definite and ufeful^ 
 and the circumftances which feduce from a due at- 
 tention to them are fo erroneous in their indications', 
 that I have fometimes wiflied the Chinefe cufl:om of 
 prefcribing, from feeling the pulfe only, without 
 
 feeing 
 
A DEFENCE OF BLOOD-LETTING. fi^y 
 
 feeing or converfing with the patient, were impofed 
 upon all phyficians. 
 
 To render the knowledge of the indications of 
 blood-letting from the ftate of the pulfe as definite 
 and correct as poflible, I fliall add, for the benefit 
 of young practitioners, the following dire(flions for 
 feeling it. 
 
 1. Let the arm be placed in a fituation in which 
 all the mufcles which move it fhall be completely 
 relaxed ; and let it, at the fame time, be free fron^ 
 the prefiTure of the body upon it. 
 
 2. Feel the pulfe in all obfcure or difficult cafes, 
 in both arms. 
 
 3. Apply all the fingers of one hand, when prac* 
 ticable, to the pulfe. For this purpofe it will be 
 mofl convenient to feel the pulfe of the right hand 
 with your left, and of the left hand with your right* 
 
 4. Do not decide upon blood-letting in difficult 
 cafes, until you have felt the pulfe for fome time. 
 The Chinefe phyficians never prefcribe until they 
 have counted 49 flrokes. 
 
 5. Feel the pulfe at the intervals of four or five 
 minutes, when you fufpeft that its force has been 
 
 p 2 varied 
 
228 A DEFENCE OF BLOOD-LETTINd. 
 
 varied by any circumflance not connected with the 
 difeafe, fuch as emotions of the mind, exercife, eat- 
 ing, drinking, and the hke. 
 
 6. Feel the pulfations of the arteries in the tem- 
 ples and in the neck, when the pulfe is deprefTed or 
 imperceptible in the wrifls. 
 
 7. Requefl filence in a fick room, and clofe 
 your eyes in feeling a pulfe in difficult cafes. By 
 fo doing, you will concentrate the fenfations of your 
 ears and eyes, in your fingers. 
 
 In judging of the ftates of the pulfe which have 
 been enumerated, it will be neceffary always to re- 
 member the natural difference in its frequency and 
 force in old people and children ; alfo in the morn- 
 ing arid evening, and in the fleeping and waking 
 ftates of the fyflem. 
 
 But to return. 
 
 11. Regard fliouid be had to the charafter of the 
 reigning epidemic, in deciding upon blood-letting. 
 If the prevailing fever be of a highly inflammatory 
 nature, bleeding may be ufed with more fafety in 
 cafes where the indications of it from the pulfe arc 
 ibmewhat doubtful. The character of a previous 
 epidemic flaould likewife dire^l the ufe of the lancet* 
 
 The 
 
A DEFENCE OF BLOOD-LETTING. 229 
 
 The peftilential fever which followed the plague in 
 London in 1665, Dr. Sydenham fays, yielded only 
 to blood-letting. It is equally neceffary in all the 
 febrile difeafes which fucceed malignant fevers. 
 
 III. The conflitution of a patient, and more efpe- 
 cially his habits with refpe£l: to blood-letting, fliould 
 be taken into conlideration, in prefcribing it. If he 
 be plethoric, and accuflomed to bleeding in former 
 indifpolitions, it will be more neceifary than in op*- 
 polite ilates and habits of the fyflem. 
 
 IV. Regard fliould be had to the country or place 
 from which perfons affe^led with fevers have lately 
 arrived, in prefcribing the lofs of blood. Fevers 
 in America are more inflammatory than fevers in 
 perfons of equal rank in Great Britain. From a 
 want of attention to this circumftance, I faw a com- 
 mon pleurify end in an abfcefs in the lungs, in a 
 fea-captain in the city of London, in the year 1769, 
 who was attended by a phyflcian of the firil repu^ 
 tation in England. He was bled but once. His 
 cure was afterwards trufted to fudorific draughts^ 
 His pulfe and his American confliitution indicated 
 the lofs of 50 or 60 ounces of blood. 
 
 V. After blood-letting has been performed, the 
 appearances of the blood fliould be attended to^, 
 
 P3 m 
 
^3« A DEFEKCE O? BLOOD-LETTING. 
 
 in order to judge of the propriety of repeating it, 
 I fliall briefly defcribe thefe appearances, and ar- 
 range them in the order in which they ind.icatc 
 the diiFerent degrees of inflammatory diathefis, be-^ 
 ginning with the higheft. 
 
 I. Diffolved blood. It occurs in the malignant 
 ftates of fever. I have feen it feveral times in 
 the pleurify, and have once heard of it in a cafe of 
 gout. I have afcribed this decompofition of the 
 blood to fuch a violent degree of flimulus upon 
 the blood- velTels, as to difpofe them to a paralytic 
 flate. It is generally confidered as a fignal to lay 
 afide the lancet. If it occur in the firft ftage of 
 a fever, it indicates a very oppolite pra^lice. By 
 repeated bleedings, the veffels recover their natu- 
 ral adlion, and the blood becomes reduced to its 
 original texture. Of this I have had frequent ex- 
 perience fince the year 1793. It required three 
 fuccefTive bleedings to reftore the blood from a 
 diffolved to a coag[ulable ftate in Mr. Benton. It 
 afterwards became very fizy. If this diffolved blood 
 appear towards the clofe of a malignant fever, no 
 other benefit than the protra6lion of life for a day 
 or two, or an eafy death, can be expelled from 
 repeating the bleeding, even though it be indicated 
 by a tenfe pulfe ; for the vifcera are generally fo 
 -much choaked by the continuance of violent a<5lion 
 
 in 
 
a t)SF£N€E OF-^IrOOD-LETTINO. i^l 
 
 In the biood-veffels, that they are feldom abk to 
 difcharge the blood which diflends them, into the 
 cavity in the vefTels which is created by the ab- 
 ftra<^ion of blood from a vein. There is fome 
 variety in the appearance of this flate of the blood, 
 \vhich indicates more or lefs violent preffure upon 
 the blood-veiTels. It threatens mofl danger to life 
 when it refembles molaifes in its confidence. The 
 danger is lefs when the part which is difTolved 
 occupies the bottom of the bowl, and when its 
 furface is covered with a fizy pellicle or coat. 
 
 Does not the reftoration of the blood from its dif- 
 organized flate, by means of bleeding, fuggefl aa 
 4dea of a fmiilar change being pradicable in the fo- 
 iids, when they are diforganized by difeafe ? And 
 are we not led hereby to an animating view of the 
 /extent and power of medicine ? 
 
 2. Blood of a fcarlet colour, without any fepara- 
 tion into craiTamentum or ferum, indicates a fecond 
 "degree of inflammatory action. It occurs Kkewife 
 in the malignant flate of fever. 
 
 3. Blood in which part of the craiTamentum is 
 dilTolved in the ferum., forming a refemblance to 
 what is called the lotura carnium, or the wafliings 
 -vif Befli in water. 
 
 p 4 4. Craf- 
 
332 A DEFENCE OF BLOOD-LETTlNG* 
 
 4. CrafTamentum finking to the bottom of a bowl 
 in yellow ferum. 
 
 5. Craflamentum floating in ferum which is at 
 firfl turbid, but which afterwards becomes yellow 
 and tranfparent by depofiting certain red and fiery 
 particles of the blood in the bottom of the bowl. 
 
 6. Sizy blood, or blood covered with a bufFy 
 coat. The more the craflamentum appears in the 
 form of a cup, the more inflammatory action is faid 
 to be indicated by it. This appearance of the blood 
 occurs in all the common fliates of inflammatory 
 fever. It occurs too in the mild fl:ate of malignant 
 fevers, and in the clofe of fuch of them as have 
 been violent. It is not always connected with the 
 common inflammatory fl:ate of the pulfe, for I have 
 obferved it occaflonally in mofl: of the different fliates 
 of the pulfe which have been defcribed. The ap- 
 pearance of this bufly coat on the blood in the yel- 
 low fever, is always favourable. It fliews the dif- 
 eafe to be tending from an uncommon, to a common 
 degree of inflammatory diathefls. 
 
 It would feem, from thefe fadls, as if the power 
 of coagulation in the blood was lefl^ened in an exa£l: 
 ratio to the increafe of fliimulus upon the blood- 
 veflels, and that it was increafed in proportion to 
 
 the 
 
A DEFENCE OF BLOOD-LETTlKG. 233 
 
 the diminution of that ftimuhis, to that degree of 
 action which conflitutes what I have called common 
 inflammatory a£lion. 
 
 Here as upon a former occafion we may fay with 
 concern, if bleeding be indicated by all the appear- 
 ances of the blood which have been enumerated, 
 how many lives have been lofl by phyficians limiting 
 the ufe of the lancet to thofe cafes only, where the 
 blood difcovered an inflammatory crufl ! 
 
 Thefe remarks upon the relative figns of inflam- 
 matory action in the blood- veflels, fliould be admit- 
 ted with a recollection that they are all liable to be 
 varied by a moderate, or violent exacerbation of 
 fever, by the fize of the llream of blood, and by the 
 heat, coldnefs, and form of the cup into which the 
 blood flows. This occafional uncertainty in the in- 
 dications of the fl:ate of fever by the blood, fliouId 
 lead us back to the pulse. When time, and more 
 attention to this index of the fl;ate of the fyfl:em in 
 fevers, fliall have brought to light all the knowledge 
 that the pulfe is capable of imparting, the ap- 
 pearances of the blood in fevers, will be regarded 
 as little as the appearances of the urine. 
 
 ' VI. Blood-letting fliould always be copious where 
 there is danger from congeftion or inflammation, 
 
 in 
 
234 A DEFENCE OF BLOOD-LETTING, 
 
 iQ vital parts. This danger is indicated moft com-j 
 monly by pain ; but there may be congeflion in the 
 liver, bowels, and even in the head, without pain. 
 In thefe cafes, the ftate of the pulfe fliould alv/ays 
 govern the ufe of the lancet. 
 
 VIL What quantity of blood may be taken, with 
 fafety, from a patient in an inflammatory fever ? To 
 anfwer this queflion it v/ill be neceflary to remark, 
 I. That in a perfon of an ordinary fize, there are 
 fuppofed to be contained between 25 and 28 pounds 
 of blood, and 2. That much more blood may be 
 taken v/hen the blood- veflels are in a ftate of morbid 
 excitement and excitability, than at any other time. 
 One of the ufes of the blood is to flimulate the 
 blood-veflels, and thereby to aiTifl in originating, 
 and preferving animal Hfe, In a healthy ftate of 
 the vefTels, the whole mafs of the blood is neceiTary 
 for this purpofe ; but in their flate of morbid ex- 
 citability, a much lefs quantity of blood than what 
 h natural, (perhaps in fome cafes four or five 
 pounds) are fiifficient to keep up an equal and 
 vigorous circulation. Thus very fmall portions of 
 light, and found, are fufficient to excite vifion and 
 hearing in an inflamed, and highly excitable flate 
 of the eyes and ears. Thus too, a fmgle glafs of 
 wine v/ill often produce delirium in a fever in a 
 man, v/ho, when iiiJiealth, is in the habit of drinking 
 
 a bottle 
 
A DEFENCE OF BLOOD-LETTING. 235 
 
 a bottle every day without having his pulfe quick- 
 ened by it. 
 
 An ignorance of the quantity of blood which has 
 been drawn by defign, or lofl by accident, has con- 
 tributed very much to encourage prejudices againfl 
 blood-letting. Mr. Cline drew 320 ounces of blood 
 in 20 days from a patient in St. Thomas's hofpital, 
 who laboured under a contufion of the head. But 
 this quantity is fmall compared with the quantity 
 lofl by a number of perfons whofe cafes are recorded 
 by Dr. Haller.* I fliall mention a few of them. 
 One perfon lofl 9 pounds of blood, a fecond 12, 
 a third 18, and a fourth 22, from the nofe at 
 one time. A fifth lofl 12 pounds by vomiting 
 in one night, and a fixth 22 from the lungs. A 
 gentleman at Angola loft between 3 and 4 pounds 
 daily from his nofe. To cure it he was bled 97 
 times in one year. A young woman was bled 1020 
 times in 19 years, to cure her of plethora which 
 difpofed her to hyfleria. Another young woman lofl 
 125 ounces of blood by a natural haemorrhage every 
 month. To cure it, flie was bled every day, and 
 ^very other day for 14 months. In none ofthefe 
 inflances, was death the confequence of thefe great 
 evacuations of blood. On the contrary, all the per- 
 
 "^ Elementa Phyfiolog'ge, vol. iv. p. 45. 
 
 fons 
 
fej^ A DEFENCE OF BLOOD-LETTING. 
 
 fens alluded to, recovered. Many fimllar inflances 
 of the fafety, and even benefit of profnfe difcharges 
 of blood by nature and art, might be mentioned 
 from other authors. I ihall infert only one more, 
 which ihall be taken from Dr. Sydenham's account 
 of the cure of the plague. " Among the other 
 calamities of the civil war which afflifled this nation, 
 the plague alfo raged in feveral places, and was 
 brought by accident from another place to Dunftar 
 Callle in Somerfetfliire, where fome of the foldiers 
 dying fuddenly, with an eruption of fpots, it like- 
 wife feized feveral others. It happened at that time 
 that a furgeon who had travelled much in foreign 
 parts, was in the fervice there, and applied to the 
 governor for leave to alTifl his fellow foldiers who 
 were affli^led with this dreadful difeafe in the beft 
 manner he was able ; which being granted, he took 
 fo large a quantity of blood from ev<ery one at the 
 beginning of the difeafe, and before any fwelling 
 was perceived, that they were ready to faint, and 
 drop dov/n, for he bled them all ftanding, and in 
 the open air and had no veiTel to meafure the blood, 
 wiiich falling on the ground, the quantity each per- 
 •ionlofl, could not of courfe be known. The opera- 
 tion being over, he ordered them to He in their 
 tents ; iind though he gave no kind of remedy after 
 bleeding, yet of the numbers that were thus treated, 
 )iot a iii>gle perfon died. I had this relation from 
 
 colonel 
 
A DEFENCE OF BLOOD-LETTING. 
 
 '^-n 
 
 €olonel Francis Windham a gentleman, of great 
 honor, and veracity, and at this time governor of 
 theCaflle."* 
 
 Again. An ignorance of the rapid manner in 
 which blood is regenerated when loll or drawn, has 
 helped to keep up prejudices againfl blood-letting. 
 A perfon (Dr. Haller fays) lofl live pounds of blood 
 daily from the h^emorrhoidal veffels for 62 days^ 
 and another ']^ pounds of blood in 10 days. The 
 lofs each day was fupplied by frefli quantities of 
 ahment. 
 
 Thefe fafts I hope, will be- fufEcient to e{labli& 
 the fafety and advantages of plentiful blood-letting 
 in cafes of violent fever ; alfo to fhew the fallacy 
 and danger of that practice which attempts the cure 
 of fuch cafes of fever, by what is called moderate 
 bleeding. There are, it has been faid, no half 
 truths in goveiTiment. It is equally true, that there 
 are no half truths in medicine. This half-way prac- 
 tice of moderate bleeding, has kept up the mortality 
 of peftilential fevers in all ages, and in all coun- 
 tries. 
 
 I have combated this pradiice elfewhere, t and 
 have alTerted, upon the authority of Dr. Syden- 
 
 * Vol. I. p. 131. f Account of the Yellow Fever, in 1793. 
 
 ham. 
 
238 A DEFENCE O^ BLOOD-jLETTlNG. 
 
 ham, that it is much better not to bleed at all, than 
 to draw blood difproportioned in quantity to the 
 violence of the fever. If the flate of the pulfe be 
 our guide, the continuance of its inflammatory aflion, 
 after the lofs of even an 100 ounces of blood, in- 
 dicates the neceffity of more bleeding, as much as 
 it did the firfk time a vein was opened. In the 
 ufe of this remedy it may be truly faid, as in many- 
 of the enterprizes of life, that nothing is done, while 
 any thing remains to be done. Bleeding fhould be 
 repeated while the fymptoms which at firfl indicated 
 it continue, fliould it be until four-fifths of the blood 
 contained in the body are drawn away. In this 
 manner we aft in the ufe of other remedies. Who 
 ever leaves off giving purges in a colic, attended 
 with coftivenefs, before the bowels are opened? or 
 who lays afide mercury as a ufelefs medicine, becaufe 
 a few dofes of it do not cure the venereal difeafe ? 
 
 I fliall only add under this head, that I have 
 always obferved the cure of a malignant fever to be 
 moft complete, and the convalefcence to be mofl 
 rapid, when the bleeding has been continued until 
 a paknefs is induced in the face, and until the patient 
 is able to fit up without being fainty. After thefe 
 circumftances occur, a moderate degree of force in 
 the pulfe will gradually wear itfelf away without 
 doing any harm, 
 
 VIII. In 
 
^ DEFENCE 'OF BLOOD-LETTING-. 239 
 
 ,- VIII. In drawing blood, the quantity fliould bq 
 large or fmall at a time, according to the flate of 
 the fyftem. In cafes where the pulfe ^£ts with force 
 and freedom, from lo to 20 ounces of blood may 
 be taken at once ; but in cafes of great indire^l de- 
 bihty, where the pulfe is deprelTed, it will be bet- 
 ter to take away but a few ounces at a time, and to 
 repeat it three or four times a-day. By this means^ 
 the blcod-veifels more gradually recover their vigour, 
 and the apparent bad elFe^ls of bleeding are thereby 
 prevented. Perhaps the fame advantages might be 
 derived in many other cafes from the gradual ab- 
 Itraftion of ftimuli, that are derived from the gra- 
 dual increafe of their force and number, in their ap- 
 plication to the body. In an inflammatory fever, the 
 charadler of which is not accurately known, it is 
 fafefl: to begin with moderate bleeding, and to in- 
 creafe it in quantity, according as the violence and 
 duration of the difeafe ihall make it neceffary. Iii 
 fevers and other difeafes which run their courfes in a 
 few days or hours, and which threaten immediate 
 diifolution, there can be no limits fixed to the quan^ 
 tity of blood which may be drawn at once, or in a 
 fliort time. Botallus drew 3,4, and 5 pints in a 
 day in fuch cafes. Dr. Phyfick drew 90 ounces by 
 weight from Dr. Dewee?, in a fudden attack of the 
 apoplectic (late of fever ^^ at one bleeding, and there- 
 
240 A DEFENCE OF BLOOD-LETTING. 
 
 by reftored him fo fpeedily to health, that he was 
 able to attend to his bufmefs in three days afterwards- 
 In chronic flates of fever, of an inflammatory type, 
 fmall and frequent bleedings are to be preferred to 
 large ones. We ufe mercury, antimony, and diet 
 drinks as alteratives in many difeafes with advan- 
 tage. We do not expert to cure certain difeafes of 
 debility by two or three immerfions in a cold bath. 
 We perfifl with patience in prefcribing all the above 
 remedies for months and years, before we expe£l to 
 reap the full benefits of them. Why fhould not 
 blood-letting be ufed in the fame way, and have the 
 lame chance of doing good. I have long ago adopted 
 this alterative mode of ufing it, and I can now look 
 around me, and with pleafure behold a number of 
 perfons of both fexes who owe their lives to it. In 
 many cafes I have prefcribed it once in two or three 
 months for feveral years ; and in fome I have ad- 
 vifed it every two weeks, for feveral months. 
 
 There is a ilate of fever in which an excefs in the 
 a^lion of the blood-veifels is barely perceptible, but 
 which often threatens immediate danger to life, by 
 a determination of blood to a vital part. In this 
 cafe, I have frequently feen the fcale turn in favour 
 of life, by the lofs of but four or ^yc ounces of 
 blood. The preffure of this, and even of a much 
 4 lefs 
 
A DEFENCE OF BLOOD-LETTING. ^^t 
 
 lefs quantity of blood in the clofe of a fever, I be- 
 lieve as effedtually deflroys life, as the excefs of 
 feveral pounds does in its beginnings 
 
 In cafes where bleeding does not cure, it may be 
 ufed with advaiitage as d. palliative remedy. Many 
 difeafes induce death in a full and highly excited 
 flate of the fyflem. Here opium does harm, while 
 bleeding aiFords certain relief. It belongs to this 
 remedy, in fuch cafes, to eafe pain, to prevent con- 
 vulfions, to compofe the mind, to protract the ufe of 
 reafon, to induce fleep, and thus to fmooth the paf« 
 fage out of life. 
 
 IX. Bleeding from an artery, commonly called 
 arteriotomy, would probably have many advantages 
 over venefe^lion, could it be performed at all times 
 with eafe and fafety. Blood difcharged by hemor- 
 rhages affords more relief in fevers than an equal 
 quantity drawn from a vein, chiefly becaufe it is 
 poured forth in the former cafe from a ruptured 
 artery. I mentioned formerly, that Dr. Mitchell had 
 found blood drawn from an artery to be what is 
 called denfe, at a time when that v/hich was drawn 
 from a vein in the fame perfons, was diifolved. 
 This fa(5l may poflibly admit of fome application. In 
 the clofe of malignant fevers, where bleeding ha-s 
 been omitted in the beginning of the diforder, blood 
 
 c^ drawn 
 
343 A DEFENCE OF BLOOD-LETTING, 
 
 drawn from a vein is generally fo diffolved, as to be 
 t)eyond the reach of repeated bleedings to reftore it 
 to its natural texture. In this cafe, arteriotomy 
 might probably be performed with advantage. The 
 arteries, which retain their capacity of life longer 
 than the veins, by being relieved from the imme- 
 diate preffure of blood upon them, might be en- 
 abled fo to a£l upon the torpid veins, as to reftore 
 their natural a^ion, and thereby to arreft departing 
 life* Arteriotomy might further be ufed with ad- 
 vantage in children, in whom it is difficult, and 
 fometimes impra£licable to open a vein. 
 
 X. Much has been faid about the proper place 
 from whence blood ftiould be drawn. Bleeding in 
 the foot was much ufed formerly, in order to e^c- 
 cite a revulfion from the head and breaft ; but our 
 prefent ideas of the circulation of the blood have 
 taught us, that it may be drawn from the arm with 
 equal advantage in nearly all cafes. To bleeding in 
 the foot there are the following objeftions : i. The 
 difficulty of placing a patient in a fituation favour- 
 able to it. .2. The greater danger pf wounding a 
 tendon in the foot than in the arm. And, 3. The 
 impoffibility of examining the blood after it is 
 drawn ; for in this mode of bleeding, the blQpd 
 generally flow$ into a bafon or pail of water. 
 
 Under 
 
A DEFENCE OF BLOOD-JLETTING. 243 
 
 Under this head I fliall decide upon the method 
 of drawing blood by means of cups, in the inflam^ 
 matory flate of fever. Where an Inflammatory fever 
 arlfes from local affection, or from contufion in the 
 head or breaft, or from a morbid excitement in 
 thofe, above other parts of the arterial fyftem, they 
 may be ufeful ; but where local affection is a fymp- 
 tom of general and equable fever only, it can fel- 
 dom be neceifary, except where bleeding from the 
 arm has been omitted, or ufed too fparingly in the 
 beginning of a fever ; by which means fuch fixed 
 congeflion often takes place, as will not yield to ge- 
 neral bleeding. 
 
 XL Much has been faid likewife about the pro- 
 per time for bleeding in fevers. It may be ufed 
 at all times, when indicated by the pulfe and other 
 circumflances, in continual fevers ; but it fliould 
 be ufed chiefly in the paroxyfms of fuch as Inter- 
 mit. I have conceived this practice to be of fo much 
 confequence, that when I expert a return of the 
 fever in the night, I requeft one of my pupils to 
 fit up with my patients all night, in order to meet 
 the paroxyfm, if neceflary, with the lancet. But 
 I derive another advantage from fixing a centlnel 
 over a patient in a malignant fever. When a 
 paroxyfm goes off in the night, it often leaves the 
 fyflem in a flate of fuch extreme debility as to 
 
 <12 endanger 
 
^44 A DEFENCE OF BLOOD-lETTIN^. 
 
 endanger life. In this cafe, from 5 to lo drops 
 of laudanum, exhibited by a perfon who is a judge 
 of the pulfe, obviate this alarming debility, and 
 often induce eafy and refrefliing ileep. By treat- 
 ing the human body like a corded inftrument, in 
 thus occafionally relaxing or bracing the fyflem, 
 according to the excefs or deficiency of flim.ulus 
 in thofe hours in which death mod frequently oc- 
 curs, I think I have been the means of faving 
 feveral valuable lives, 
 
 I regret that the limits I have fixed to this 
 defence of blood-letting will not admit of my ap- 
 plying the principles which I have delivered, to 
 all the inflammatory flates of fever. I have ftiewn, 
 in a former publication, the advantages of bleed- 
 ing in the hydropic ilate of fever. In a future 
 effay, I hope to eflabhfh its efficacy in the gouty 
 and maniacal flates of fever. I have faid that 
 madnefs is the efFeft of a chronic inflammation in 
 the brain. Its remedy, of courfe, fhould be fre- 
 quent and copious blood-letting. Phyfical and mo- 
 ral evil are fubjeft to fimilar laws. The mad- 
 fhirt, and all the common means of coercion are 
 as improper fubflitutes for bleeding in madnefs, 
 as the whipping-pofl and pillory are for foli- 
 tary confinement and labour, in the cure of vice. 
 The pulfe fhould govern the ufe of the lancet in 
 
 this. 
 
A DEFENCE OF BLOOD-LETTING. 245 
 
 this, as well as in all the ordinary dates of fever. 
 It is the dial-plate of the fyflem. But in the mif- 
 placed ftates of fever, the pulfe, like folly in old 
 age, often points at a different mark from nature. 
 In all fuch cafes, we muft conform our practice 
 to that which has been fuccefsful in the reigning 
 epidemic. A fmgle bleeding, when indicated by 
 this circumftance, often converts a fever from a 
 fuffocated or latent, to a fenfible flate, and thus 
 renders it a more fimpie and manageable difeafe. 
 
 It is worthy of confideration here, how far lo- 
 cal difeafes, which have been produced by fevers, 
 might be cured by re-exciting the fever. Sir 
 William Jones fays the phyficians in Perfia always 
 begin the cure of the leprofy by blood-letting. * 
 PoiTibly this remedy diiFufes the difeafe through 
 the blood-velTels, and thereby expofes it to be 
 more eafily a^led upon by other remedies. 
 
 I intended to have enlarged upon the good ef- 
 fects of bleeding in feveral difeafes which are not 
 accompanied with fever, but having trefpaifed too 
 long upon the reader's patience, by the minute- 
 nefs of my details upon this fubje£i:, I fliall take 
 notice at prefent of its efficacy in but the five 
 following morbid flates of the fyilem. 
 
 * Afiatic EfTays. 
 
 <L3 I. During 
 
34^ A DEFENCE OF BLOOD-LETTING* 
 
 r. During the period in which the menfes ceafe 
 to flow, there is always a morbid fulnefs and excite- 
 ment in the blood-veflels ; hence the head achs, 
 coughs, droplies, haemorrhages, glandular obftruc- 
 tions, and cancers, which occur in that ftage of life. 
 They may all be prevented by frequent and mode- 
 rate blood-letting. 
 
 2. Pain is probably not conne^ed neceffarily with 
 child-bearing. Many of the other evils inflifled 
 upon the human race, in confequence of the difobe- 
 dience of our firil parents, have been lelTened or 
 eradicated by the ingenuity of man. The pain of 
 child-bearing travellers tell us, is much leffened 
 among the Turkifli women, by their taking fweet 
 oil f which a6i:s as a purge) during their pregnancy. 
 DiYtS: debility, whether induced by failing or long 
 and flow difeafes, tends alike to mitigate the pains of 
 labour. Thefe fa6ls have led me to inquire, whe- 
 ther blood-letting does not produce the fame eife61:. 
 I have often obferved labours to be ftiort and com- 
 paratively cafy, which have fucceeded a fever that 
 has been cured by bleeding. Upon my mentioning 
 this fafi: to Dr. Dewecs, he informed me that he 
 had often bled when parturition was flow, and that 
 he had always found that he thereby both fliortened 
 and lefl!ened the pains of labour. 
 
 3. I have 
 
A DEFENCE OF BLOOD-LETTING. 247 
 
 3. I have faid that there is but one remote caufc 
 €f fever. Of courfe there can be no effential dif- 
 ference between the ftimulus of the faHva of a rabid 
 animal, and the flimulus of contagion or miafmata, 
 in inducing morbid actions in the fyflem. The heat, 
 thirft, quick and tenfe pulfe, and local efFufions which 
 occur in the hydrophobia, indicate it to be a fpaf- 
 modic ftate of fever. As there is but one remote,* 
 and one proximate caufe of fever, fo there is but one 
 method of curing it, and that is by reducing morbid 
 a^lion when it is exceffive by depletion, and after- 
 wards removing debihty by tonic remedies. I can 
 fee no reafon why the hydrophobia fhould not yield 
 to thefe obvious, and univerfal principles in medi* 
 cine. From its great force, it is probable it will 
 require the moil copious bleeding, and afterwards 
 the mofl powerful tonics to cure it of any diforder 
 in the world. 
 
 4. In diflocations of bones which refifl both ikil! 
 afid force, it has been fuggefted that bleeding, un* 
 
 * The exciting caufe of fever, which may be confidered as 
 forming an exception to this fimple view of its remote caufe, 
 is nothing but a reinforcement of the remote caufe, when it 
 is too feeble to excite fever. It generally a<5ls as a ftimulus, 
 and when it a«5ls by abftradling a natural ftimulus from the 
 body, it throws fuch a balance of force into the fcale of the 
 remote caufe, as to enable it to induce feVer, 
 
 CL4 ti! 
 
348 A DEFENCE OF BLOOD-LETTING, 
 
 til fainting is induced, would produce fuch a re* 
 laxation in the mufcles as to favour their reduction. 
 This principle was happily applied in the winter of 
 1795, by Dr. Phyfick in the Pennfylyania hofpital, 
 in a cafe of a diflocated humerus of two months 
 continuance. The Doctor bled this patient until 
 he fainted, and then reduced his flioulder in lefs 
 tlian a minute, with a very fmall exertion of force, 
 
 5. I have elfewhere fpoken in favour of blood-let- 
 ting in fome of the difeafes of old age.* The palfy, 
 apoplexy, cough, and colic, fo common among old 
 ppople, might, I believe be prevented in many in- 
 flances by the occafional, but moderate ufe of thi§ 
 remedy, 
 
 Thus have I finiflied my defence of blood-letting 
 as a remedy foi certain difeafes. Let not the reader 
 fuppofe that I am unduly attached to it. I have 
 little reafon to be fo, for the dread of my ufmg it 
 Ix}. every difeafe, and the falfe reports of my uiing 
 it in equal degrees in difeafes of oppofite characters, 
 have deprived me probably of many thoufand pounds 
 in the courfe of my life. But my predile6i:ion for 
 the lancet above all other depleting remedies, has 
 aSecled my happinefs, much more than my interefl^ 
 
 * Medical Inquhles, and Obfervations, Vol. II. 
 
 It 
 
A DEFENCE OF BLOOD-LETTING. 249 
 
 It has made the duties of my profeflion (which would 
 otherwife be pleafant) extremely painful to me. 
 Often have I been forced to fubmit my judgment to 
 the fears and prejudices of my patients, and thereby 
 to confume days and weeks in curing a difeafe, 
 which might have been cured in fome inflances by 
 the lofs of a few ounces of blood, in a day or an 
 hour. Often, when the appearance of danger has 
 made the prefcription of blood-letting neceiTary to 
 fave life, have I read difaffe^lion to it in dejected 
 looks, or tears, and fometimes heard it in the 
 fcreams of a whole family. And often have I been 
 reproached for killing people by bleeding, who 
 h3.ve died, only becaufe they fubmit ted to the re- 
 medy when it was too late, or becaufe it was too 
 fparingly adminiHered to do them fervice. Nor have 
 the teflimonies of whole families and neighbourhoods 
 who have been cured of malignant fevers by bleed- 
 ing, balanced the difcredit of the lofs of the few 
 p3.tients in whom it was thus improperly ufed ; for 
 the recoveries in thofe cafes have been confidered 
 as remarkable, only becaufe the patients furvived 
 the frequent ufe of the lancett 
 
 It was In confequence of the violence that blood- 
 letting offered to the feelings of his patients, and to 
 the practice of cotemporary phyficians, that Dr. 
 
 Sydenham 
 
25© A DEFENCE OF BLOOD-LEttmC. 
 
 Sydenham was forced to adopt fweatlng ag ft fub« 
 ftitute for bleeding in the plague, and to ufe it very 
 fparingly in the rheumatifm. I have reafon to la- 
 ment his having accommodated this favourite re- 
 medy to ignorance or fear in a fingle difeafe. Had 
 he perfifled in the ufe of it, he would indeed hav^ 
 ^^ blefled mankind, and refeued me.'* 
 
 We are fometimes told by the terrorifls in medi- 
 cine, that the Indians cure their inflammatory fevers' 
 without bleeding. To relieve myfelf from the dif- 
 trefs and obloquy to which my ufe of this remedy 
 cxpofed me, I have carefully fought for, and ex- 
 amined their remedies for inflammatory fever with 
 a flncere defire to adopt them ; but my inquiries 
 have fatisiied me, that they are not only wholly 
 difproportioncd to the habits of civilized life, but 
 that they are far lefs fuccefsful than blood-letting 
 even among themfelves. With the fame wilh to 
 avoid a painful conflict with the fears and prejudices 
 of my patients, I have preferibed all the remedies 
 which are (et down under the firfl: head of the fyl- 
 labus, as fubflitutes for bleeding, but I aiH forry 
 to add, without efle61:. However ufeful they may 
 b€ as auxiliaries to blood-letting, they are all feeble 
 without it, when ufed to cure a fever of violent in- 
 fiammatorv a^£i:ioR. 
 
 In 
 
A DEFENCE OF Bi^OOD-LETTINO. 251 
 
 In contemplating the prejudices againfl blood-let- 
 ting which prevail fo generally in our country, I 
 have been led to afcribe them to a caufe v^^holly 
 political. Wg are defcended chiefly from Great 
 Britain, and have been for many years under the 
 influence of Englifli habits upon all fubjec^s. Some 
 of thefe habits, as far as they relate to government, 
 have been partly changed ; but in drefs, arts, manu- 
 factures, manners, and fcience, we are ftill governed 
 by our early aflbciations. Britain and France have 
 been for many centuries hereditary enemies. The 
 hoftility of the former to the latter nation, extends 
 to every thing that belongs to their chara£i:er. It 
 difcovers itfelf, in an eminent degree, in diet and 
 medicine. Do the French love foups ? the Englifli 
 prefer folid flefli. Do the French love their meats 
 well cooked ? the Englifli prefer their meats but 
 half roafl:ed. Do the French flp coffee after dinner? 
 the Englifli fpend their afternoons in drinking Port 
 and Madeira wines. Do the French phyficians pre* 
 fcribe purges and glyflcrs to cleanfe the bowels ? 
 the Englifli phyficians prefcribe vomits for the fame 
 purpofe. Above all, do the French phyficians ad- 
 vife bleeding in fevers ? the Englifli phyficians forbid 
 it, in mofl: fevers, and fubflitute fweating in the 
 room of it. Here then we difcover the fource of 
 the prejudices and errors of our countrymen, upon 
 the fubjedl of blood-letting. They are of Britifli 
 
 origin. 
 
2^2 A DEFENCE OF BLOOD-LETTINGr 
 
 origin. They have been inculcated upon us in 
 Britifh univerfities, and in Britifli books ; and they 
 accord, as illy with our climate, and flate of fociety, 
 ss the Dutch foot floves did, with the temperate cli- 
 mate of the Cape of Good Hope.* 
 
 It Is probable the bad confequences which have 
 followed the indifcrimate, ufe of the lancet in 
 France, and fome other countries, may have con- 
 tributed in fome degree to create the prejudices 
 againfl it, which are entertained by the phyficians in 
 Great Britain. Bleeding like opium has lofl its cha- 
 
 * I have frequently been furprized in vifitlng Englif^ 
 patients, to hear them fay, when I have prefcrlbed bleeding, 
 that their phyficians in England, had charged them never to 
 he bled. This advice excluded all regard to the changes 
 which climate, diet, new employments, and age might in- 
 duce upon the fyftem. I am difpofed to believe that many 
 lives are loft, and numerous chronic difeafes created in Great 
 Britain by the negleft of bleeding in fevers. My former pupil 
 I>r. Fifher in a letter from the Univerfity of Edinburgh, 
 dated in the Winter of 1795, aflures me that he had cured 
 feveral of his fellow ftudents of fevers (contrary to general 
 prejudice) by early bleeding, in as eafy and fummary a way 
 as he had been accuftomed to fee them cured in Philadelphia, 
 by the ufe of the fame remedy. Dr. Gordon of Scotland, 
 and feveral other phyficians in Great Britain have lately re- 
 vived the lancet, and applied it with great judgment, and 
 f»5:cefs to the cure of fevers. 
 
 raster 
 
A DEFENCE OF BLOOD-LETTING. 2^^ 
 
 rafler in many cafes by being prefciibed for the na?ne 
 of a difeafe. It is flill ufed, Mr. Townfend tells us, 
 in this empirical way in Spain, where a phyfician, 
 when fent for to a patient, orders him to be bled 
 before he vifits him. The late jull theory of the 
 manner in which opium ac^s upon the body, has re- 
 trained its mifchief, and added greatly to its ufeful- 
 nefs. In like manner, may we not hope that jufl 
 theories of difeafes, and proper ideas of the m.anner 
 in which bleeding a£ls in curing them, will prevent 
 a relapfe into the evils which formerly accompanied 
 tbis remedy, and render it a great and univerfal 
 blefling to mankind ? 
 
 I have great pleafure in acknowledging, that the 
 eflablifliment and defence of blood-letting has not 
 been committed to me alone, in the city of Philadel- 
 phia. A number of our phyficians, highly refpe£t- 
 able for talents and knowledge, have adopted this 
 invaluable remedy, and have ufed it with a fuccefs 
 which has rendered their pra6i:ice reputable to them- 
 felves, and beneficial to the public. The fuperior 
 fuccefs of the friends of blood-letting in recovering- 
 patients, is acknowledged by all ranks of citizens ; 
 but they have been taught by fomc of the phyficians 
 of the city to believe, that this fuccefs does not ex- 
 tend to malignant and dangerous difeafes. For ex- 
 ample. Thefe gentlemen fay the yellow fevers 
 
 which 
 
254 ^ D£f£NC£ OF BLOOD-LETTING- 
 
 which we cure by copious blood-letting are common 
 remittents or intermittents ; and that the manias, 
 the internal dropfies of the brain, and the pulmo- 
 nary confumptions which we prevent, or cure, by 
 the fame remedy, are either tranfient derangements 
 of mind from trifling fevers, or common head achs, 
 or colds. But error and calumny in this, as in many 
 other cafes, refute themfelves. It is well known 
 that all thofe difeafes have prevailed for feveral years 
 in our city, and that moll of our phyficians have had 
 their ufual proportion of patients in them. It is 
 fcarcely poiTible that we iliould maintain our propor- 
 tion of bufmefs, and not meet with the fame num- 
 ber of cafes of thofe difeafes as our brethren. We 
 do meet with them, and we prevent their mortality, 
 in a great degree, by copious or frequent blood- 
 letting. 
 
 From the influence which this detraiElion from the 
 merit of bleeding has upon its fuceefs, we are forced 
 to lament, that the greateil poflible benefits will 
 never be derived from it, until the fame uniformity 
 of opinion and pra£i:ice obtain with refpe6l to its ufe, 
 which prevails with refpe^i: to the ufe of pure air and 
 cool drinks in fevers. 
 
 How long error, ignorance, prejudice, and in- 
 
 terefl, upon the fubje£l of blood-lettiug, fhall con- 
 
 4 tinue 
 
A DEFENCE OF BLOOD-LETTING. 2S5 
 
 tinue to render fevers one of the principal outlets of 
 human life, I know not ; but their influence cannot 
 laft always. Perhaps the bleiTmgs of fpeedy health, 
 long life, and more univerfal population, which are 
 infured in a great degree by the ufe of this re- 
 medy, may be referved by heaven for a more vir- 
 tuous and enlightened race of men, than thofe who 
 CQmpofe the prefent inhabitants of our globe. 
 
 I fliall conclude this work by a reflexion which 
 has been fuggefled by fome of the preceding pages. 
 
 The prefent is an eventful asra in human affairs. 
 Our world appears to be upon the eve of a great 
 and univerfal revolution. This revolution, I be- 
 lieve, will ultimately be in favour of human happi- 
 nefs. I do not found my belief of a change for the 
 better, in the condition of mankind, upon the pre- 
 sent ftate of things ; for every view we can take of 
 them, whether it be directed to morals, religion, or 
 government, exhibits the reverfe of fuch a change. 
 I believe in the rapid approach of a new order of 
 things, from the coincidence of prefent events with 
 the prediflions contained in the Old and New Tefta- 
 ments. Thefe predictions are now accomplifliing by 
 natural means. Events, effential to each other, have 
 lately taken place, as if by concert, in different na- 
 tions j and truths, effential to thofe events, have 
 
 hccn 
 
^^6 A DEFENCE OF BLOOD-LETTINCJ. 
 
 been difcovered or revived in different parts of the 
 world. Thus, in a former age, the difcovery of the 
 art of printing was connected with the revival of 
 letters, and a change in the moral and religious ftate 
 of Europe. Thus, too, the application of the load- 
 ftone to the purpofe of navigation, immediately pre- 
 ceded the difcovery and fettlement of America. 
 One of the predi£lions alluded to in the Old Tefta- 
 ment is, that agriculture, civilization, peace, and juft 
 government fhall be introduced into the eaflern coun- 
 tries, and of courfe, that an immenfe increafe of the 
 human fpecies fhall be effected by their influence, in 
 that part of the globe. To this delightful change 
 in the ftate of the eaflern part of the world, there 
 exifts but one natural obflacle; and that is, the 
 plague and other malignant fevers ftill continue to 
 depopulate whole cities and nations, thereby often 
 producing every fpecies of public and private mifery. 
 The extent of this mifery may eafily be conceived of, 
 by the recital of a fmgle and recent event. In the 
 year 1773 one of thofe malignant fevers deftroyed 
 275,000 people in Baflbrah, amounting to feven- 
 eighths of the inhabitants of that city. To obviate 
 the objedlion to the fulfilment of ancient prophecy, 
 from the prevalence of malignant and deftrudive 
 fevers in the eaft, it will only be neceffary to attend 
 to what has been faid by Dr. Hartley, upon the 
 propagation of Chriflianity throughout the world by 
 I natural 
 
A DEFENCE OF BLOOD-LETTING. 257 
 
 natural means. " Mankind .■ (fiiys this enlightened" 
 philofopher and Chriilian) feem to have it in their 
 power to obtain fuch quahfications in a natural way, 
 as, by being conferred upon the Apollles in a fuper- 
 naLural one, were the principal means of their fuc- 
 cefs in the firil propagation of the Gofpel. 
 
 ^' Thus, as the Apoftles had the power of heal- 
 ing miracnioufly, future miiuonaries may, in a jfliort 
 time, accomplilli themfelves with the knowledge of 
 all the chief practical rules of medicine. This art is 
 wonderfully fnnplified of late years, and is improving 
 every day in fmiplicity and efficacy. And it may 
 be hoped, that a few theoretical pofitions, well af- 
 certained, with a moderate experience, may enable 
 the young pradlitioner to proceed to a confiderable 
 variety of cafes with fafety and fuccefs." * 
 
 What Dr. Hartley preconceived with refpe(51: to 
 difeafes in general, has, we hope, been realized with 
 refped to malignant fevers. If we may judge from 
 the fuccefs which has lately attended the treatment 
 of one of them in the cities of Baltimore and Phila- 
 delphia, we may {2lMy affert, that no one of them 
 is incurable. It will not be neceffary to fend men, 
 educated in colleges, into the Afiatic countries to 
 
 '- Obfervations on Man, Propofition clxxxiii. p. 378. 
 
 cure 
 
258 A DEFENCE OF BLOOD-LETTING. 
 
 cure their peftilentlal dlfeafes. Men, and even wo- 
 men, may be employed for that purpofe, who have 
 not perverted their reafon by a fervile attachment to 
 any fyflem of medicine. It will be fiifficient for our 
 milTionaries to know, that a powerful epidemic chafes 
 away, or mixes with all other difeafes, to be ac- 
 quainted with the different ftates of the pulfe, to be 
 able to open a vein, to adminiffer a few flrong dofes 
 of purging phyfic, and to gratify the calls of nature 
 in their patients for cold water and cool air. 
 
 I enjoy, in the profpecl of thefe events, a confo- 
 lation which furpalTes, beyond calculation, all the 
 diflrefs and pain I have felt from my unfuccefsful at- 
 tempts to introduce the remedies for malignant 
 fevers into general ufe among the citizens of Phila- 
 delphia ; for the men who are to live an hundred 
 years hence, and in foreign countries, ihould be con- 
 lldered as equally fellow citizens with thofe who are 
 our coevals, and who live and die in the fame coun- 
 try with us. 
 
 THE END. 
 
^ 
 
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 ^ 
 

 '^/'Sl^ 
 
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