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 AN 
 
 INAUGURAL DISSERTATION 
 
 ON THE 
 
 YELLOW FEVER. 
 
 SUBMITTED TO THE PUBLIC EXAMINATION OF THE 
 
 JFACU^TY OF PHYSIC 
 
 TENDER THE AUTHORITTSc^^F^THE TRUSTEES OF COLUMBIA COLLEGE, 
 IN THE STATE OF NEW-YORK, 
 
 The Right Rev. BENJAMIN MOORE, D.D. President j 
 
 FOR THE DEGREE OF 
 
 DOCTOR OF PHYSIC, 
 
 On the 8th Day of November, 1803. 
 
 BY JAMES R. MANLEY, M. A, 
 
 citizen of the State of N,ew-York. 
 
 NE W-rORK\ 
 
 Printed by T. S;!* J. Swords, Printers to the Faculty of Physio 
 of Columbia College. 
 
 1803. 
 

 
 
 .r^ "^ 
 
fO 'THE 
 
 Medical Students of Coliwibla College. 
 
 In compliance with an ordinance of this College, I now 
 present to the Public, as an Inaugural Dissertation, a few 
 remarks upon a disease till lately but little known in this 
 country; the nature of which we have unfortunately been 
 experimentally taught at the expense of the lives of many 
 of our most valuable citizens. 
 
 The subject of this paper is one which has afforded 
 matter of considerable speculation to all classes of the com- 
 munity, but particularly to Physicians, who, at the present 
 day, greatly differ, both as it respects the origin and the 
 Jireatment of Yellow Fever. 
 
 I may, by many peisons, (whom I must conceive less 
 candid than the gentlemen to whom this is addressed) be 
 deemed guilty of detraction on the one hand, and arrogance 
 on the other, in attempting to differ, in the one case, from 
 high authorities, and, in the other instance, in even daring 
 to hazard the publication of a single idea not sanctioned by 
 popular opinion. A blind acquiescence in the opinions of 
 men of acknowledged ability, is an evil which has ever been 
 much deprecated by liberal men, and which must continue 
 
( vi ) 
 
 St) to be until a corrective be efFectually applied. This 
 servile attachment is a proininent feature in the character 
 of professional men generally ; but it is more observable 
 among medical gentlemen than among persons of any other 
 description; and it seems to arise, as a very natural conse- 
 quence, from the manner in which a medical education is 
 conducted. Young men, upon commencing the study 
 of the SCIENCE OF LIFE, think it not prudent to indulge 
 their own speculations in matters of so much consequence 
 both to their patients and themselves. In addition to this, 
 they are sometimes even taught to distrust the evidence of 
 their own senses, rather than suffer them to give birth to 
 an opinion which would militate against any favourite 
 theory. Works of experienced writers, as they are called, 
 are put into their hands : those writings are filled with that 
 kind of knowledge Vv'hich is infinitely above the compre- 
 hension of their juvenile capacities : their judgments are 
 matured only by the exercise of their understandings ; and 
 ere their judgments are sufficiently strong, or before they 
 dare assume that independency of mind which alone is the 
 necessary effect of the exercise of their own intellectual 
 faculties, they are deluded by the plausible, though incor- 
 rect, reasonings of ingenious sophists. They admire their 
 productions; they respect their superiority of talents; and 
 thus are led on, from one degree of partiality to another, 
 until, finally, ere themselves are aware, they are found to be 
 zealous advocates for systems which they do not understand, 
 and practising from principles deduced from mere hypothe- 
 ses grounded upon the assumption of false premises. 
 
 It is this over- weening respect for the opinions of great 
 men which has been the efficient cause of the comparatively 
 slow progress of medical science, and it is this which will 
 continue to retard it as long as professional pride, divested 
 
( vii ) 
 
 of liberality of sentiment, shall glory in echoing the dogmas 
 of philosophic tyrants. Waving all further remarks on the 
 ill consequences which result from servilely adopting the 
 opinions of our fathers, I shall now enter particularly on 
 my subject ; fervently wishing that the example of the Pro- 
 fessors of this College may have its due effect upon you. 
 Gentlemen, who are placed under their guardianship, in 
 enabling you to combat this error, so degrading in itself, 
 and so injurious to the cause of Medicine. 
 
 JAMES R. MANLEY. 
 
AN 
 
 INAUGURAL DISSERTATION 
 
 ON 
 
 YELLOW FEVER, 
 
 x ELLOW Fever has, by a great part of the 
 medical profession, been looked upon as a con- 
 tagious disease: I shall therefore commence this 
 subject by an examination into the proof v^hich 
 supports this idea: previous to which it will be 
 necessary to define the terms infection and cojita- 
 gion, or simple and specific infection. 
 
 Simple infection I consider a certain deleterious 
 agent, operating upon the human body, through 
 the medium of our atmosphere : this deleterious 
 agent being the product of natural secretion and 
 excretion, or the product of animal and vegetable 
 decomposition, depraved by the combined actioa 
 of fortuitous causes, such as a want of cleanliness, 
 of free ventilation; an unusual degree of heat 
 and humidity, &;c. which all tend to produce ^ 
 high grade of predisposition, fitting the body for 
 the pperation of the usual occasional causes of 
 
 B 
 
 "% 
 
10 
 
 fever : and in this sense all diseases may be said 
 to be more or less infectious. 
 
 Specific infection, or contagion, I consider as a 
 morbid material, imparted to the human body 
 either by actual contact, or through the interven- 
 tion of our atmospliere : this material being the 
 morbid product of morbid secretion or excretion^ 
 producing similar disease in all places, in all 
 states of the weather, in all seasons of the year, 
 in all ages^ sexes, and constitutions. 
 
 This definition, imperfect as it may be, I am 
 disposed to think, will be found to hold true, as. 
 applied to small-pox, measles, scarlatina, and the 
 whole class of exanthematous diseases, which are 
 decidedly propagated by specific infection. 
 
 We do not find that the plague becomes con- 
 tagious before the inguinal or axillary buboes, 
 have formed, and until a morbid secretion has 
 actually taken place. And our own observations, 
 upon a disease till lately of very frequent occur- 
 rence, all tend to confirm the truth of this posi^ 
 tion, that even diseases of specific infection can- 
 not reproduce themselves until the morbid mate- 
 rial which first excited the disease shall have 
 exerted such an influence upon the system as shall 
 have caused the secretion and excretion of the 
 same active matter which was essential to its ge- 
 neration in the first instance. 
 
 We fi^^nd from actual observation, that the dis- 
 ^atses just above mentioned, though assuredly 
 
ii 
 
 Specifically infectlouSj never prove so until tht 
 morbid secretion w^hich characterises all conta- 
 gious diseases has made its appearance. 
 
 The Yellow Fever has likewise been viewed as 
 a disease exclusively imported; and, unfortunate- 
 iy^ those who have embraced this opinion have 
 also considered it as specifically infectious^ mak- 
 ing the morbid secretion and excretion, which are 
 the essential characteristics of contagioji, either 
 the yellowness of the skin, or the matter of black* 
 vomiting ; neither of which will be found true, 
 since it proves fatal in many instances when nei- 
 ther of these symptoms is present. 
 
 If Yellow Fever were a disease of specific in- 
 fection, it should certainly be possessed of one 
 symptom characteristic of itself, as all contagious 
 diseases have such symptoms. The pathogno- 
 monic symptoms of small-pox, measles, scarla- 
 tina, &c. are very evident. Now, if we were 
 disposed to favour the idea of the specific nature 
 of Yellow Fever, where should we find a symp- 
 tom which should designate it particularly? We 
 should not be able to distinguish it by the fiavidity 
 of the skin; for this is no uncommon symptom 
 in many febrile diseases, and almost invariably 
 accompanies protracted cases of common tertian 
 intermittents in this country: and the matter of 
 black-vomiting, to be made pathognomonic in 
 this disease, should always mark this form of 
 fever, and never occur in diseases of any other 
 
m 
 
 descriptiori. And further, we can by no means 
 allow either of these cardinal symptoms to ht 
 the product of any morbid change which has 
 taken place in any of the circulating fluids of the 
 system. 
 
 Again: if it were a fever of a specifically in- 
 fectious nature, it should reproduce itself in all 
 places, in all persons, and in all states of the 
 atmosphere; we should observe it extending its 
 sphere of action in the winter season as well as 
 in summer ; we should find it epidemic, when 
 once produced, in the most northern latitudes^ 
 and always generating identical disease : But 
 experience teaches us the contrary; and the same 
 causes which are adequate to its production in 
 warm southern climates, must acquire a much 
 greater degree of intensity to generate a fever of 
 the same type in this or any more northern 
 country. 
 
 Plague, when carried to Moscow, progressed 
 by immediate specific infection ; and bubonic 
 plague would become epidemic in the same man- 
 ner, whether in the torrid latitude of Gambia, or 
 in the frozen regions of Zemhla. Dare any per- 
 son risk the same assertion of Yellow Fever? 
 He certainly might with the greatest safety, 
 having once established the identity of the two 
 diseases. 
 
 That the disease under consideration may be 
 imported is very possible, nay, probable ; but it 
 
is not necessary, in order to believe this, that Vv^fe 
 should call in the aid of contagion. We can 
 easily conceive that a fever contracted in the 
 AYest-Indies, from exposure to mere vicissitude 
 of weather, independent of the auxiliary causes 
 which there always exist, shall, in a passage of 
 three or four weeks, in the confined air of a small 
 vessel, reproduce analogous disease in others * 
 iiot from the specific nature of the disease itself, 
 but from the simply infectious nature of it, in 
 common with all others, when favoured by the 
 concurrence of external causes. Again : the 
 diseases so produced shall, in the confined apart- 
 ments of sailors' booths, in low, exposed and 
 naturally unhealthy situations of a city, become 
 auxiliary, though not strictly exciting causes of 
 similar diseases; which again shall differ in pro- 
 portion to the intensity of the causes which co- 
 operate with the first simple infection.* The 
 experience of every year would seem to confirm 
 the truth of this opinion: and if we should ob- 
 serve that autumnal fevers difiFer as the causes 
 which produce them are more or less powerful ; 
 and if we should further observe, as we all must 
 
 * The propriety and usefulness of quarantine establishments, in all 
 sea-port towns, not only with a view to guard against diseases strictly- 
 contagious, but also to prevent the introduction of disease in the above 
 manner, fully appears from the foregoing paragraph ; and surely qua- 
 rantine law should, from the single circumstance of its obviating possible 
 evil, meet with the sanction of all legislative bodies, in ail places where 
 reasonable apprehension ean be entertained. 
 
14 
 
 jobserve, if not blinded by pre-coneeived opinion^ 
 that Yellow Fever is a variety of autumnal fever, 
 arising from the action of concentrated causes 
 upon high degrees of predisposition; would not 
 an argument be furnished which should pointedly 
 oppose the idea of contagion? 
 
 If it w^ere contagious, how^ should w^e account 
 for the different appearances which it assumes in 
 different states of the weather^ and upon different 
 constitutions? And it certainly is a fact well au- 
 thenticated, that the mildest intermittents of our 
 country do degenerate into this form of disease, in 
 such situations as are favourable to the propaga- 
 tion of it. In what way can we reconcile these 
 -things with the specific nature of the disease in 
 question? 
 
 It has appeared in the interior of our country, 
 some hundreds of miles from any sea-port town, 
 in places totally inaccessible by w^ater. If it 
 were contagious, we must presume, upon the 
 truth of one or both of these circumstances, ei- 
 ther that the disease existed there from time 
 immemorial, or that, notwithstanding the inland 
 situation of the country, it has there been carried^ 
 concentrated, and condensed in materials, ca- 
 pable of retaining the specific matter of infec- 
 tion; neither of which opinions are sufficiently 
 supported to w^arrant their belief: but, on the 
 contrary, where it has so appeared, it has always 
 been found to originate from local causes, and to 
 
15 
 
 progress or abate, both as respects the number 
 of its victims and the violence of its symptoms^ 
 m proportion as the causes first producing it ex- 
 isted in a greater or less degree. 
 
 Having said thus much in endeavouring to dis- 
 prove the contagious nature, as also the foreign 
 origin of Yellow Fever, I shall conclude this 
 part of my Essay ; fervently wishing, if it be 
 possible, that those gentlemen who still advocate 
 the doctrine of contagion and importation, would 
 divest themselves of pre-conceived opinions, un- 
 biassed by favourite writings, discriminate be^ 
 tween speculative and experimental reasoning, 
 and candidly examine the validity of the evidence 
 which supports either opinion. It is much to 
 be regretted that medical writers have suffered 
 their trifling party differences to thwart their 
 judgments in a matter of so much consequence 
 to the public as the subject now before us: for 
 it would appear that the opposition made to a 
 doctrine so satisfactory^ and so very adequate to 
 the explanation of the disease, is to be attributed 
 to a want of that conciliating spirit which should 
 always characterize professional writings. 
 
 The disease which is the subject of this Essay 
 i'3 thus marked in its invasion, progress and ter- 
 mination: — It is ushered in by a great degree of 
 languor, listlessness, want of recollection, and 
 disinclination to all kinds of active exertion; to 
 which soon succeeds the febrile shivering, which 
 
^ 16 
 
 again having continued an indefinite period of 
 time, is followed by an intense degree of heat — i 
 quickened and laborious respiration^ — pulse, for 
 the most part, frequent, full, hard and throb- 
 bing—skin dry — tongue whitish and moist, hav- 
 ing an appearance peculiar to diseases of mem- 
 branous inflammation— bowels generally costive, 
 great oppression at the precordia, attended also 
 with acute pains of the head, back and loins, 
 with a suffusion of the whole countenance, but 
 particularly of the eyes. In this state of the dis- 
 ease the patient is restless, sleeps little, and 
 awakes vv^ithout being refreshed; the thirst also, 
 from the first invasion of the disease, being ex^ 
 cessive. These symptoms, if not relieved, only 
 prove to be the precursors of another set of 
 symptoms infinitely more dangerous, and to 
 which the assistance of the physician can afford 
 very little relief. The pulses sink; they become 
 weak, very frequent, and often intermittent. The 
 state of the tongue is infinitely more alarming, 
 having changed from a whitish colour to one al- 
 most approaching to black. The redness of the 
 countenance generally, and eyes in particular, 
 is now followed by a yellow colour. The whole 
 body often takes on the same appearance. The 
 vomiting, which at first was by no means very 
 alarming, now becomes incessant, and the mat* 
 ter ejected, which, in the first instance, was the 
 natural contents of the stomach, appears now to 
 
It 
 
 be the effect of a morbid change having taken 
 place in that organ. Hemorrhages from the 
 nose and mouth are not unfrequent. The pa- 
 tient is by turns sensible and delirious. Sub- 
 sultus tendinum, and coldness of the extremities, 
 now succeed, when the patient may be said to 
 be struggling with death, which unfortunately 
 soon follows. 
 
 These are the symptoms of the disease, as it 
 commences and proceeds on to a fatal termina- 
 tion in the greater number of cases ; though it 
 can scarcely be said that any of the symptoms 
 which here mark the latter stage of the disease 
 are constant and invariable. The symjptoms of 
 vomiting and delirium are very generally vica^ 
 rious ; and the flavidity of the whole body is by 
 no means so constant an attendant upon the dis- 
 ease as the yellowness of the eye. Indeed, the 
 symptoms which generally distinguish it greatly 
 differ in degree, and this difference is commonly 
 found proportionate to the intensity of the con;?- 
 bined causes. 
 
 CAUSES, 
 
 I COME now to consider the causes which 
 have been found adequate to the production of 
 this disease, at different times, for years past, 
 both in this country and in the West-Indies» 
 
 C 
 
18 
 
 If we take a candid survey of the works of 
 those gentlcQien who have written professedly 
 on the diseases of warm cHmates, we shall find 
 demonstrative proof of its local origin wherever 
 it made its appearance. If we look into the dif- 
 ferent medical publications in this country, the 
 result of our researches will be the same. Phy- 
 sicians of eminence, in many parts of America, 
 have instituted inquiries on this subject, and the 
 result of those inquiries has been what we might 
 have expected from reasoning a priori on the 
 nature of the disease. 
 
 It is remarked by those physicians who have 
 treated on this subject, that when it does appear, 
 it always succeeds great moisture, in that season 
 of the year in which the sun exerts its greatest 
 influence; and although many of them contend 
 for the specific nature of the disease, we observe 
 in all their writings this remarkable coincidence 
 laid down; a proof that the one is necessary, and 
 the other indispensibly requisite in the production 
 of that vitiated state of the atmosphere to which 
 Yellow Fever, as it has appeared in the sea-ports 
 of the United States and in the West-Indies, is to 
 be wholly attributed. To this it may be objected, 
 that in the autumnal season of the years 1791, 
 1793, 1795, and 1797, rain did not fall in greater 
 quantity than is usual in warm weather ; not- 
 withstanding which this disease appeared among 
 us. But it is to be recollected, that the slips. 
 
1^ 
 
 wharves, and low and filthy situations of many 
 parts of our city, furnished every thing essential 
 to the production of this pestilential effluvium; 
 and it was to the locality of the cause alone that 
 we are to impute the comparatively small number 
 of its victims in those seasons.* 
 
 It would be needless for me to multiply autho- 
 rities in support of the endemial origin of this 
 disease. Dr. Rush, in his treatise on the Yellow 
 Fever, as it appeared in Philadelphia, in the year 
 1793, has placed this matter in a very clear point 
 of view, as respects that place ; and our own 
 observations in the year 1798, in this city, per- 
 fectly coincide with those laid down by writers 
 on the causes of fevers in warm climates: and if 
 analogical reasoning may be admitted, we can no 
 longer doubt its indigenous origin. The banks 
 of the Ganges, the Indus, and the Nile, are all 
 visited with analogous diseases, when the waters 
 which inundated their respective countries have 
 begun to subside, and their muddy shores are 
 exposed to the direct rays of a scorching sun : 
 and the fatality of disease in the islands of Suma- 
 tra and Java is justly attributed to the same cause. 
 In addition to this, the writings of Lind, Jack- 
 son, Mosely, and others, might be adduced to 
 
 * Vide an Essay, inserted in the Medical Repository, vol. i. p. 315. by 
 Valentine Seaman, M, D. entitled, Jn Inquiry into the Cause and Preva- 
 lence of the Tellonx) Fever in New-Tork, in 1795. See also a Report made 
 by a Committee of the Medical Society of this State, in January, 1799. 
 
20 
 
 prove the absolute power of vegetable and animal 
 decomposition to produce the most violent and 
 dangerous febrile diseases. 
 
 Whether the vitiated atmosphere, thus gene^ 
 rated by the action of the sun upon animal and 
 vegetable materials capable of decomposition, 
 be merely the predisponent or the exciting cause 
 of this disease, I judge not necessary to answer; 
 though I should suppose that this will differ ac- 
 cording to the situation of the patient previous to 
 the invasion of disease. Any agent, capable of 
 inducing a great degree of debility, may become a 
 predisponent cause: accordingly, excessive heat, 
 fatigue consequent upon m.ental or bodily exer^ 
 tion, fear, grief, intemperance in eating, frequent 
 intoxication, the application of cold, and the 
 subduction of accustomed stimuli, are all laid 
 down by authors as predisponent causes of the 
 disease, though, at the same time, no person can 
 doubt the capability of any one of these causes 
 to excite the disease, when operating upon pre* 
 disposition already formed. From continued ac- 
 tion the predisponent may become the exciting 
 cause. Thus a vitiated atmosphere, independent 
 of any other cause capable of being detected by 
 our senses, may become, and I have no doubt 
 does become, efficient to the production of 
 Yellow Fever. 
 
21 
 
 TREATMENT. 
 
 FROM the consideration of the symptoms of 
 this disease, in all its different stages, the first 
 indication which would present itself would be 
 to moderate the excessive excitement of the sys- 
 tem. 
 
 II. To obviate the occasional causes of fever. 
 
 III. To prevent or remove the danger of the 
 system falling into a state of great debility. 
 
 The first indication would be answered by, 
 
 1. Blood-letting. 
 
 2. Mild cathartic medicines. 
 
 3. Cool air—cool water, externally applied, 
 and internally exhibited with acids. 
 
 4. A temporary suspension of the exercise of 
 the senses. 
 
 5. Blisters, applied to those parts most liable 
 to be injured by the increased action of the ar- 
 terial system. 
 
 I am well aware that the propriety of blood- 
 letting in this disease has been much questioned; 
 but I am very much inclined to think that the 
 prejudice against this point of practice has arisen 
 from the two general and promiscuous use of 
 the lancet. 
 
 Those gentlemen who so strenuously oppose 
 blood-letting, are, notwithstanding, great advo- 
 cates for the old sudorific plan of treatment. Now 
 
122 
 
 tills sudorific plan, with them, is intended to an- 
 swer the double purpose of eliminating from the 
 system 'the morbid material which generates the 
 disease; while, at the same time, it serves to 
 moderate the action of the sanguineous system. 
 If so, the event of both methods would be pre- 
 cisely the same: but as respects the operation 
 of the remedies, in my view there would be an 
 essential difference. In the one case the excita- 
 bility of the system will be alm.ost exhausted 
 by the administration of medicines to force a 
 perspiration^ which can by no means prove cri- 
 tical, since the means used defeat the very end 
 for which they are intended: whereas, in the 
 other case, we observe that, when venesection 
 has been premised, perspiration is almost the im- 
 mediate consequence of the application of tepid 
 bathing, or even cool air; and this perspiration 
 will be found to be infinitely more beneficial to 
 the patient than that induced by stimulating me- 
 dicines and vinous drinks, since it is not followed 
 by any considerable exhaustion of strength, it 
 being the immediate eflfect of the subduction of 
 heat ; v/hile, in the other instance, it is altogether 
 caused by excessive stimulation, w^hich vv^e wish 
 as much as possible to avoid. 
 
 But the greatest objection alleged against this 
 practice is, that it induces a degree of debility very 
 dangerous to the patient, and very difficult to re- 
 move, A question might here be asked which 
 
23 
 
 experience only must answer — which of the 
 afore-mentioned remedies induces the greatest 
 deo-ree of exhaustion? And here, as in all other 
 m.edical disputations, the comparative merits of 
 each mode of treatment should be settled by the 
 comparative success of each practice. 
 
 The occurrence of hemorrhage in this disease 
 is not very unusual; nay, it is a common circum- 
 stance. If these hemorrhages are active in some 
 patients, no person can doubt the propriety of 
 venesection in such particular cases; and if pas- 
 sive, they must occur from indirect debiHty, 
 which is the effect of excessive excitement. If 
 we obviate this excessive excitement, we of ne- 
 cessity prevent this dangerous state of indirect 
 debility; and in doing this we do nothing more 
 than anticipate an evacuation which, in all pro- 
 bability, will take place: and were this the only 
 good effect arising from its use, it would cer- 
 tainly be more safe to hazard the subduction of a 
 definite quantity of blood, than to risk the event 
 of passive hemorrhage; m^ore especially since, by 
 this means, we accelerate a recovery which else 
 would be tedious, painful and protracted : we fit 
 the system for the after operation of other reme- 
 dies, and relieve ourselves from all fears of con- 
 gestion or effusion in parts essential to life. 
 
 It has been ascertained, from the dissections 
 of persons who have died of this disease, that, 
 in very many instances, some of the viscera were 
 
24. ^ 
 
 congested, and effusion had taken place in others 5 
 as also that the membranes immediately investing 
 those organs had taken on an inflammatory ap- 
 pearance. Surely such circumstances justify the 
 propriety of blood-letting, and call loudly for 
 the exercise of the lancet as an essential point of 
 practice. 
 
 In thus speaking of blood-letting, I would not 
 be understood as approving it in all cases of 
 this disease. I only wish to recommend its more 
 general use, and to check, if possible, that torrent 
 of obloquy which has been so illiberally poured 
 upon those physicians who have given into this 
 practice. 
 
 In evacuating the first passages it will be pro- 
 per always to have in view the state of the sto- 
 mach, whether it be sufficiently retentive to ad- 
 mit of the exhibition of stimulant medicines: if 
 it be not, we should by no means hazard the ad- 
 ministration of a remedy which would tend to 
 invert its action— the inverted action of this or 
 gan being one of the most formidable symp- 
 toms with which we have to contend: notwith- 
 standing which caution, it would be proper, in 
 the first stage of the disease, before the stomach 
 is materially affected, to exhibit, in addition to 
 the neutral salts usually prescribed, calomel in 
 proper doses, which will then answer the dou- 
 ble intention of evacuating the stomach and in» 
 testines at the same time that it would relieve 
 
25 
 
 the disease by inducing a new irritation, and, 
 by increasing the action of the absorbent system, 
 free the patient from the dangerous consequences 
 of congestion or effusion in any vital organ. If 
 the second intention of this medicine cannot be 
 answered in this way, it may be used in the 
 manner recommended by Mr. Clare, and also 
 externally applied with great advantage. The 
 propriety of mercurial medicines in this disease, 
 and the great safety with which they may be 
 administered in its most desperate forms, will 
 appear from the practice of Dr. Chisholm in the 
 fevers of Grenada, and also from the accounts 
 given of it by the most eminent physicians irj 
 this country.* 
 
 In addition to the mercurial medicine already 
 named, it would be proper to exhibit such sa.- 
 line remedies as would relieve the stomach at the 
 same time that they proved mildly eccoprotic^ 
 and co-operated with the bath in producing per- 
 spiration; and the medicine best calculated for 
 this purpose will be found to be the citrate of 
 pot-ash, given in its forming state (the efferves- 
 cing draught of Reverius) ; the carbonic acid air, 
 extricated during the formation of this salt in the 
 
 * Vide Rush's Inquiries, vol. iii. — Brown's Account of this Fever as? 
 it appeared ii^i Boston, 1798 — and Stuart's Inaugural Dissertation : from 
 all which writings it would appear, that when calomel had exerted its 
 influence upon the glaiidular system, so as to have induced a sensible 
 ptyajism, the recovery of the patient was almost insured. 
 
 D 
 
26 
 
 stomach, being very grateful to the patient, and 
 very effectual in checking the disposition to vo- 
 
 miting. 
 
 The use of mild enemata, throughout the whole 
 course of this disease, after the first evacuations; 
 have been premised, is a point of practice very 
 piuch and very properly insisted on. The supe- 
 rior advantages of keeping the bowels pervious 
 by this method, rather than by the exhibition of 
 cathartic medicines, when the stomach is so re- 
 markably irritable and irretentive, will appear tq 
 every person who is the least conversant with 
 the disease under consideration. 
 
 As a third mean of moderating the inordinate 
 action of the arterial system, we know none bet- 
 ter calculated than the admission of cool air to 
 the surface of the patient, the exhibition of cool 
 subacid drinks, together with the use of cold- 
 bathing. All authors, with great propriety, 
 agree in recommending to induce perspiration lu, 
 all febrile diseases, as a certain mean by which 
 to fi'ee the system from that extraordinary quan- 
 tity of heat which is the essence of the disease; 
 and from actual observation it has been ascer- 
 tained, that there is no method which more cer» 
 tainly produces this effect than bathing, which 
 has this decided advantage over the exhibition 
 of internal remedies (which, by the bye, are 
 generally antimonial preparations), that its tem= 
 
-27 
 
 p'erature can always be suited to the state of 
 the patient, and the manner of its application 
 may be varied as circumstances shall at any 
 time seem to require : whereas, the state of 
 the patient's stomach often renders the use of 
 internal medicines unavailing, and very frequently 
 injurious. It has been found by experiment, 
 that it may be used with success in all states of 
 fever, except at its immediate invasion, or wdien 
 the patient suffers in the cold stage of the pa- 
 roxysm: and so fully satisfied was Dr. Jackson 
 of its efficacy, that he insists very much upon its 
 use in the fevers of Jamaica; Jind, speaking par- 
 ticularly of fever as it prevailed at Savanna La 
 Mar, he has these remarkable words: " It should 
 be used with freedoni and with boldness, and it 
 is the remedy on which we must principally de- 
 pend."* Dr. Rush believed it to be a very 
 powerful remedy in fevers, from witnessing its 
 efficacy in other diseases, and found, upon ex- 
 periment, that, judiciously applied, it answered 
 his most sanguine expectations^ and that, blood- 
 letting excepted, no remedy w^as more effectual 
 in reducing the excessive excitement of the 
 system. And Dr. James Currie, of Liverpool, 
 has clearly established its safety and confirmed its 
 celebrity, by repeated experiments in all cases of 
 fever which came under his observation. I deem 
 
 * Jackson on the Fevers of Jamaica, p. 223. 
 
m 
 
 it unnecessary here to detail the particular modes 
 of applying water, or the particular temperatures 
 of baths, as applied to the different states of a 
 patient. For a more minute account of the effi^ 
 cacy of this practice, I refer my readers to the 
 invaluable works of those celebrated authors just 
 mentioned. 
 
 As a fourth m^ean to answer the first indica- 
 tion, the irritations caused by impressions made 
 upon the organs of sense are to be avoided as 
 much as in our power, and particularly those 
 which produce disagreeable sensations. The ex- 
 ercise of the mind, as proving directly stimulant 
 to the system, should be very sedulously guarded 
 against; particularly such exercise as may be pro^ 
 ductive of passion or emotion. 
 
 For the same reason that we would apply epis* 
 pasties in local inflammatory affections, we should 
 use them in the first stage of this disease, that we 
 may not only have the benefit resulting from their 
 evacuations, but that we may reap the advantages 
 which would arise from their action, as inducing 
 new and more powerful irritations in the parts 
 contiguous to those which labour under actual 
 or partial inflammation from the operation of dis- 
 ease. 
 
 From the dissections of persons who have died 
 of this disease, it has been ascertained that the 
 vessels of the stomach in some instances, those 
 
!2^ 
 
 of tlie hrain in others, and those of the liver iil 
 many, have been distended with blood, and have 
 put on the appearance of parts having undergone 
 inflammation. In such cases the application of 
 blisters to those particular parts Vv^ould have been 
 adviseable : and from the tendency which this 
 disease shows to spend its force upon one or other 
 of these organs, by inflammation and its conse- 
 quences, it would, in my opinion, not only be 
 adviseable, but really judicious and successful 
 practice, to apply blisters in the early stages of 
 ail cases of this disease^ before the hrain, stomach 
 or liver become materially affected; at the same 
 time carrying the application to the point of ul- 
 ceration, that they may serve as extensive issues. 
 But in the more advanced stages of this fever^ 
 likewise, the application of cantharides, with a 
 view to stimulate the patient, and render his sys- 
 tem more alive to the operation of other reme- 
 dies, should not only be admitted, but insisted 
 on as an essential part of the cure; and for this 
 purpose it is not requisite that it should vesicate 
 the part to which it is applied: we only wish to 
 avail ourselves of its stimulus, and its action as a 
 rubefacient fully answers our purpose. 
 
 The treatment which shall answer the second 
 general indication, viz. the avoiding the occa- 
 sional causes of fever, may be laid down in a 
 very few words. For this purpose the patient 
 
should be immediately removed from such situa- 
 tions as are favourable to the generation of dis- 
 ease. The apartment in which he is lodged 
 should be as spacious, cleanly and well ventilated 
 as possible. If this be impracticable, the utmost 
 possible care should be taken to correct the at- 
 mosphere in which the patient is immersed^ 
 and to cool it by artificial means. The chamber 
 of the patient should be in some measure co- 
 vered with powdered quick-lime. _ The bed and 
 body linen of the patient should be frequently 
 changed. The secretions and excretions should 
 be kept in equllibrio, lest by their retention, in 
 the one case, they should create disagreeable ir- 
 ritations, or by their profuse evacuations, on the 
 other hand, they should induce a dangerous de- 
 bility. The excrementitious matters of the pa- 
 tient should be rapidly and carefully removed from 
 his room. The state of his stomach and bowels 
 should be strictly attended to, and plentiful dilu- 
 tion persisted in ; being careful that nothing be 
 taken into the stomach as food that cannot be 
 easily assimilated by its digestive powers. To 
 these may be added the injurious application of 
 cold, as a point concerning which we should be 
 very solicitous. By attending to these circum- 
 stances we shall, in a great measure, obviate the 
 occasional causes of fever. 
 
 After having answered the two first indica- 
 
31 
 
 tions, procured a solution of the fever, and 
 guarded the patient from the danger of a relapse, 
 as far as that relapse shall depend upon the ap- 
 plication of usual causes, I come now to the 
 last general indication' — to prevent or remove 
 the danger of the system falling into a state of 
 great debiJity. The operation of medicines, in 
 addition to the action of disease, must certainly 
 have greatly exhausted the natural vigour of the 
 patient. To prevent this exhaustion of strength 
 being over-proportionate to the state of previous 
 febrile excitement, requires judicious treatment 
 in the first stage of the disease, and therefore 
 would more properly be referred to the first in- 
 dication. The removal of this state of debility 
 is that which more particularly appertains to 
 this last proposed part of the cure; upon which 
 it is the more unnecessary to dwell, since it is 
 that part of the treatment of all fevers which is, 
 above all others, best understood. I shall only 
 pbserve, that the exhibition of tonic medicines 
 to patients convalescent from this disease, I be- 
 lieve, is not so generally necessary as has been 
 usually supposed; the recovery of persons having 
 once commenced, being in this, as in most other 
 acute diseases, remarkably rapid. The admi- 
 nistration of bark, wine, steel, blisters, cold-bath- 
 ing, &c. though they maybe admitted, in many 
 pases, as being productive of benefit to patients. 
 
32 
 
 may, generally speaking, be dispensed with, with- 
 out incurring any hazard; and the restoration of 
 the patient's strength may be safely trusted to 
 the exhibition of a nourishing diet of easy di-* 
 gestion, consisting chiefly of farinaceous food, ; 
 
 together w^ith the use of milk (which is ex- | 
 
 tremely grateful to most patients at this period), | 
 
 moderate exercise in the open air, and the regi- 
 men usually observed by patients convalescent 
 WiH febrile disease. 
 
 i 
 
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